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Master Blanket Purchase Order ADCS16-119251

Header Information
Purchase Order Number: ADCS16-119251 Release Number: 0 Short Description: Counseling & Consultation Services
Status: 3PS - Sent Purchaser: Delilah Gonzalez Receipt Method: Quantity
Fiscal Year: 2016 PO Type: Blanket Minor Status:
Organization: Arizona Department of Child Safety
Department: OP - Office of Procurement Location: OP - Contracts Type Code:
Alternate ID: Entered Date: 12/24/2015 09:22:07 AM Control Code:
Days ARO: 0 Retainage %: 0.00% Discount %: 0.00%
Print Dest Detail: If Different
Catalog ID: Release Type: Direct Release Pcard Enabled: No
Contact Instructions: Delilah Gonzalez at 602-255-2887 or Delilah.Gonzalez@azdcs.gov Tax Rate: Actual Cost: $625.00
Master Blanket/Contract End Date (Maximum): 12/31/2020 11:59:59 PM
Project No.:
Special Purchase Types:
PIJ NUMBER:
Commodity Reference Id:
PO External Doc Type:
Agency Attachments: 01 Pre-solicitation Documents.zip 02 Solicitation Documents.zip Determination for MultiAgency Contracts for Psychiatric_Psychological_Counseling Services Counseling_Consultation Services RFP rev 10-21-15 Counseling RFP Exhibits and Forms~5.zip Signed HITECH HIPPA Form Signed Offer and Acceptance A New Leaf Award Letter New Leaf License.pdf New Leaf COI.pdf A New Leaf Amendment.docx A New Leaf COI Exp 4012017.pdf A New Leaf Staff Licenses.pdf New Leaf Facility Licenses Exp 6302017.pdf Contract Amendment 2~37.zip Contract Amendment 3~54.zip
Vendor Attachments: Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Attachment 04 Professional License Offer and Acceptance~2.pdf Attachment 01 ADCS Qualified Contractor Application~1.pdf Attachment 02 List of References~2.pdf Attachment 03 Licensure.Certification Attestation~1.pdf Designation of Confidential Trade Secret Proprietary Information~1.pdf HITECH Business Associate Agreement~1.pdf Independent Contractor Agreement~1.pdf Sole Proprietor Waiver~1.pdf
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000001976 - A NEW LEAF INC
Beth Noble
868 E. University Dr.
Mesa, AZ 85203
US
Email: bnoble@turnanewleaf.org
Phone: (480)969-4024
FAX: (480)969-0039
Alt. Reference: Z0001
Payment Terms: Net 30 Shipping Method:
Shipping Terms: N/A Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to bnoble@turnanewleaf.org at 12/30/2015 02:23:11 PM 01/04/2016 11:45:32 AM
Change Order 1 Emailed to bnoble@turnanewleaf.org at 08/29/2016 09:27:07 AM 08/29/2016 10:16:44 AM
Change Order 2 Emailed to bnoble@turnanewleaf.org at 12/08/2016 02:09:03 PM 12/08/2016 02:48:55 PM
Change Order 3 Emailed to bnoble@turnanewleaf.org at 12/21/2017 09:44:56 AM 12/19/2017 12:52:11 PM
Change Order 4 Emailed to bnoble@turnanewleaf.org at 09/20/2018 11:39:38 PM 09/20/2018 03:14:40 PM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
9000001976
PZ9000001976 A NEW LEAF INC Email Active
Master Blanket/Contract Controls
Master Blanket/Contract Begin Date: 01/01/2016 Master Blanket/Contract End Date: 12/31/2019
Cooperative Purchasing Allowed: Yes
Organization Department Dollar Limit Dollars Spent to Date Minimum Order Amount
ADCS - Arizona Department of Child Safety AGY - Agency Umbrella Master Control $0.00 $0.00 $0.00
ADES - Arizona Department of Economic Security AGY - Agency Umbrella Master Control $0.00 $0.00 $0.00
ADJC - Arizona Department of Juvenile Corrections AGY - Agency Umbrella Master Control $0.00 $212.50 $0.00
Item Information   
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Print Sequence # 1.0, Item # 1:   One (1) Hour Consultation - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 1 Quote # / Quote Item #:  000035456-R1 / 1
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $90.00 HR - Hour 0.00 $0.00 $0.00 $90.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 3.0, Item # 2:   One (1) Hour Unit Consultation - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 3 Quote # / Quote Item #:  000035456-R1 / 3
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $90.00 HR - Hour 0.00 $0.00 $0.00 $90.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 5.0, Item # 3:   One (1) Therapy Hour of Individual and/or Family Counseling: Office Setting - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 5 Quote # / Quote Item #:  000035456-R1 / 5
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $85.00 HR - Hour 0.00 $0.00 $0.00 $85.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 7.0, Item # 4:   One (1) Therapy Hour of Individual and/or Family Counseling: Home Based - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 7 Quote # / Quote Item #:  000035456-R1 / 7
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $120.00 HR - Hour 0.00 $0.00 $0.00 $120.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 9.0, Item # 5:   One (1) Group Counseling Session - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 9 Quote # / Quote Item #:  000035456-R1 / 9
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $40.00 EA - Each 0.00 $0.00 $0.00 $40.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
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