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Master Blanket Purchase Order ADCS16-119255

Header Information
Purchase Order Number: ADCS16-119255 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: $210.00
Master Blanket/Contract End Date (Maximum): 12/31/2020 04:03:00 PM
Project No.:
Special Purchase Types:
PIJ NUMBER:
Commodity Reference Id:
PO External Doc Type: None
Agency Attachments: Central Registry Form DCS-1183A Exhibit 1 Limited English Proficiency Policy Exhibit A J.K. Principles Exhibit B Progress Report CSO-1139A Exhibit C DCS Unit Consult Log and Verification of Client Services-Clinical-Cnslg Exhibit D DCS Counseling Consultation Services Invoice Exhibit E ADJC Verification of Juvenile Services-Clinical-Counseling Exhibit G DCS Significant Incident Report CSO-1151A Exhibit I Quarterly Data Report Exhibit M ADJC Program Evaluation Counseling_Consultation Services RFP rev 10-21-15 Exhibit F ADJC Service Providers Unusual-Significant Incident Report Protocol rev 10-23-15 Exhibit H Clinical Family Assessment rev 10-23-15 01 Pre-solicitation Documents.zip 02 Solicitation Documents.zip Determination for MultiAgency Contracts for Psychiatric_Psychological_Counseling Services~15.pdf Signed HITECH HIPPA Form Signed Offer and Acceptance Human Resource Training_Award Letter HRT Extension.docx HRT COI Exp 4012017.pdf HRT Facility License Exp 6302017.pdf HRT Staff Licenses.pdf Contract Amendment 2~32.zip Contract Amendment 3~74.zip
Vendor Attachments: BAFO Attachment 02 List of References~1.docx BAFO Attachment 03 Licensure-Certification Attestation.pdf BAFO Attachment 04 OTC Dept of Health Services License.pdf BAFO Attachment 04 Copy of Professional License Aubrey Hinton license.pdf BAFO Attachment 04 Copy of Professional License Rachel Vaughan license.pdf BAFO Attachment 04 Copy of Professional License Amna Gilmore license.pdf BAFO Attachment 04 Copy of Professional License -Cynthia Moran license.pdf BAFO Attachment 04 Copy of Professional License Holli Gonzalez license.pdf BAFO Attachment 04 Copy of Professional License Katie Lyon license.pdf BAFO Attachment 04 Copy of Professional License Krystal Paquette license.pdf BAFO Attachment 04 Copy of Professional License Michelle Lunka license.pdf BAFO Attachment 04Copy of Professional License Heather Fernandez-Schallau license.pdf BAFO Attachment 01 ADCS Qualified Contractor Application~2.doc BAFO Business Associate Agreement.pdf BAFO Sole Proprietor Waiver.pdf BAFO Independent Contractor Agreement.pdf BAFO Designation of Confidential Trade Secret and Proprietary Information.pdf BAFO Offer and Acceptance.pdf
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000003698 - HUMAN RESOURCE TRAINING INC
Cecilia D Jones
1951 W Camelback Rd
Suite 450
Phoenix, AZ 85015
US
Email: contracts@hrtaz.com
Phone: (602)433-1344
FAX: (602)249-1570
Alt. Reference: Z0002
Payment Terms: Net 30 Shipping Method:
Shipping Terms: Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to contracts@hrtaz.com at 12/29/2015 01:06:02 PM 01/05/2016 11:09:46 PM
Change Order 1 Emailed to contracts@hrtaz.com at 12/08/2016 02:15:55 PM 12/08/2016 02:17:17 PM
Change Order 2 Emailed to contracts@hrtaz.com at 12/15/2017 04:07:48 PM 12/18/2017 01:10:20 PM
Change Order 3 Emailed to contracts@hrtaz.com at 10/11/2018 02:13:09 PM 10/17/2018 04:46:36 PM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
9000003698
PZ9000003698 HUMAN RESOURCE TRAINING 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 $15,715.00 $0.00
Item Information   
Print Sequence # 5.0, Item # 1:   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 #:  000035520-R1 / 5
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $80.00 HR - Hour 0.00 $0.00 $0.00 $80.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 7.0, Item # 2:   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 #:  000035520-R1 / 7
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $130.00 HR - Hour 0.00 $0.00 $0.00 $130.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
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