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Master Blanket Purchase Order ADCS16-119258

Header Information
Purchase Order Number: ADCS16-119258 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: $339.97
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~27.zip Signed HITECH HIPPA Form Signed Offer and Acceptance Jewish Family and Childrens Svcs_Award Letter Certificate of Insurance JFCS Extension.docx JFCS COI Exp 10312017.pdf JFCS Licenses.pdf Contract Amendment 2~26.zip Contract Amendment 3~62.zip
Vendor Attachments: Attachment 01 ADCS Qualified Contractor Application Attachment 02 List of References Attachment 03 Licensure Certification Attestation Offer and Acceptance Sole Proprietor Waiver Independent Contractor Agreement Designation of Confidential Trade Secret and Proprietary Information HITECH Business Associate Agreement Arizona Substitute W-9 Attachment 04 Professional License
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000005566 - JEWISH FAMILY & CHILDRENS SERVICE INC
Alexis Smith-Schallenberger
4747 N. 7th St., Suite 100
Phoenix, AZ 85014-3654
US
Email: alexis.smithschallenberger@jfcsaz.org
Phone: (602)452-4637
FAX: (602)253-7065
Alt. Reference: Z0001
Payment Terms: Shipping Method:
Shipping Terms: Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to carole.berwald@jfcsaz.org at 01/05/2016 01:40:28 PM
Change Order 1 Emailed to carole.berwald@jfcsaz.org at 01/05/2016 04:03:47 PM 01/11/2016 01:45:51 PM
Change Order 2 Emailed to cynthia.mackey@jfcsaz.org at 12/08/2016 02:24:57 PM 12/08/2016 03:10:48 PM
Change Order 3 Emailed to alexis.smithschallenberger@jfcsaz.org at 12/13/2017 11:25:16 AM 12/15/2017 07:15:23 AM
Change Order 4 Emailed to alexis.smithschallenberger@jfcsaz.org at 10/03/2018 08:09:37 AM 10/03/2018 08:34:57 AM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
9000005566
PZ9000005566 JEWISH FAMILY & CHILDRENS SERVICE 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 $0.00 $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 #:  000035763-R1 / 5
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $139.63 HR - Hour 0.00 $0.00 $0.00 $139.63
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 #:  000035763-R1 / 7
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $123.60 HR - Hour 0.00 $0.00 $0.00 $123.60
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 #:  000035763-R1 / 9
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $38.37 EA - Each 0.00 $0.00 $0.00 $38.37
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 10.0, Item # 4:   One (1) Group Counseling Session - Rural 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 10 Quote # / Quote Item #:  000035763-R1 / 10
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $38.37 EA - Each 0.00 $0.00 $0.00 $38.37
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
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