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Master Blanket Purchase Order ADCS16-119256

Header Information
Purchase Order Number: ADCS16-119256 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: $299.00
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~33.zip Signed HITECH HIPPA Form Signed Offer and Acceptance SW Human Development_Award Letter Contract Amendment 1 Contractor COI_6-1-17 ADHS License_exp. 1-31-17 Contract Amendment 2 Contract Amendment 3~73.zip
Vendor Attachments: Attachment 04 - Copy of Professional License Sole Proprietor Waiver Independent Contractor Agreement Arizona Substitute W9 Designation of Confidential, Trade Secret and Proprietary Information Attachment 03 - Licensure-Certification Attestation Attachment 04 - Independent Clinical License S. Schunk Attachment 04 - Independent Clinical License G. Kelly Attachment 04 - Independent Clinical License K. Resseguie HITECH Business Associate Agreement Offer and Acceptance Form Attachment 01 - ADCS Qualified Contractor Application Attachment 02 - List of References
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000005101 - SOUTHWEST HUMAN DEVELOPMENT
Margaret Robles
2850 N. 24th Street
Phoenix, AZ 85008
US
Email: swhdprocure@swhd.org
Phone: (602)266-5976
FAX: (602)468-3405
Alt. Reference: Z0001
Payment Terms: Shipping Method:
Shipping Terms: Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to swhdprocure@swhd.org at 01/07/2016 07:02:56 AM 01/07/2016 08:28:03 AM
Change Order 1 Emailed to swhdprocure@swhd.org at 12/23/2016 03:36:15 PM 01/03/2017 08:16:00 AM
Change Order 2 Emailed to swhdprocure@swhd.org at 12/21/2017 11:17:32 AM 12/21/2017 02:46:40 PM
Change Order 3 Emailed to swhdprocure@swhd.org at 10/04/2018 02:07:08 PM 10/04/2018 02:25:20 PM
Change Order 4 Emailed to swhdprocure@swhd.org at 10/11/2018 02:16:42 PM 10/31/2018 03:33:40 PM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
9000005101
PZ9000005101 SOUTHWEST HUMAN DEVELOPMENT 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 $0.00 $0.00
Item Information   
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 #:  000035713-R1 / 1
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $124.00 HR - Hour 0.00 $0.00 $0.00 $124.00
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 #:  000035713-R1 / 3
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $115.00 HR - Hour 0.00 $0.00 $0.00 $115.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 9.0, Item # 3:   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 #:  000035713-R1 / 9
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $60.00 EA - Each 0.00 $0.00 $0.00 $60.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
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