Master Blanket Purchase Order ADCS16-119259

Header Information
Purchase Order Number: ADCS16-119259 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: $75.00
Master Blanket/Contract End Date (Maximum): 12/31/2020 11:59:59 PM
Project No.:
Special Purchase Types:
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~16.zip Signed HITECH HIPPA Form Signed Offer and Acceptance Joseph Frank Gaunt_Award Letter Joseph Gaunt COI Exp 12012016.pdf Gaunt Amendment.docx Joseph Gaunt License.pdf Joseph Gaunt COI Exp 5012017.pdf Joseph Gaunt Sole Proprietor Waiver.pdf Contract Amendment 2~20.zip Contract Amendment 3~53.zip
Vendor Attachments: Signed Offer and Acceptance Form~1.pdf Attachment 02 List of References~1.pdf Attachment 03 Licensure Certification Attestation~1.pdf Attachment 04 Professional License~1.pdf Sole Proprietor Waiver~1.pdf Independent Contractor Agreement~1.pdf Designation of Confidential Trade Secret and Proprietary Infomation~1.pdf HITECH Business Associate Agreement~1.pdf Attachment 01 ADCS Qualified Contractor Application~2.pdf
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000005854 - JOSEPH FRANK GAUNT
Joseph Gaunt
1300 S Watson Rd
Ste 114-217
Buckeye, AZ 85326
Email: Lgaunt2@gmail.com
Phone: (602)684-6527
FAX: (623)878-9673
Alt. Reference: Z0003
Payment Terms: Net 30 Shipping Method:
Shipping Terms: N/A Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to Lgaunt2@gmail.com at 01/04/2016 12:01:50 PM 01/05/2016 01:39:19 PM
Change Order 1 Emailed to Lgaunt2@gmail.com at 08/08/2016 08:12:13 AM 08/08/2016 09:05:38 AM
Change Order 2 Emailed to Lgaunt2@gmail.com at 12/19/2016 11:46:47 AM
Change Order 3 Emailed to Lgaunt2@gmail.com at 12/19/2016 11:49:16 AM 12/06/2017 08:53:55 AM
Change Order 4 Emailed to Lgaunt2@gmail.com at 12/12/2017 02:02:58 PM
Change Order 5 Emailed to Lgaunt2@gmail.com at 09/20/2018 11:17:43 PM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
PZ9000005854 JOSEPH FRANK GAUNT 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 #:  000035817-R1 / 5
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $75.00 HR - Hour 0.00 $0.00 $0.00 $75.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
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