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Master Blanket Purchase Order ADCS16-119268

Header Information
Purchase Order Number: ADCS16-119268 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: $1,601.00
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~10.zip Signed HITECH HIPPA Form Signed Offer and Acceptance CPES_Award Letters Determination_Mistake_Discovered_After Award_CPES Community Provider of Enrichment Services COI Exp 112017.pdf Contract Amendment 1 ADCS Qualified Contractor Application rev 12-21-16 ADHS LIcenses_Exp. 4-30-17 CPES Listing of Employees Subcontractors ContractorCOI_Exp. 1-1-17 Contract Amendment 2 Contract Amendment 3~77.zip
Vendor Attachments: Signed Offer and Acceptance Form.pdf Attachment 01 ADCS Qualified Contractor Application .pdf Attachment 02 List of References~1.pdf Attachment 03 Licensure-Certification Attestation~1.pdf Attachment 04 Copy of Professional License~1.pdf SOLE PROPRIETOR WAIVER~1.pdf INDEPENDENT CONTRACTOR AGREEMENT~1.pdf HITECH Business Associate Agreement~1.pdf Designation of Confidential Trade Secret and Proprietary Information~1.pdf
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000012204 - COMMUNITY PROVIDER ENRICHMENT SERVICES INC
William Allaire
4825 N. Sabino Canyon Rd.
Tucson, AZ 85750
US
Email: MLGreenhow@cpes.com
Phone: (520)884-7954
FAX: (520)884-0383
Alt. Reference: Z0401
Payment Terms: Shipping Method:
Shipping Terms: Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to MLGreenhow@cpes.com at 12/31/2015 10:02:34 AM
Change Order 1 Emailed to MLGreenhow@cpes.com at 01/08/2016 10:19:05 AM
Change Order 2 Emailed to MLGreenhow@cpes.com at 01/08/2016 10:19:06 AM 01/11/2016 11:16:13 AM
Change Order 3 Emailed to MLGreenhow@cpes.com at 08/04/2016 11:54:12 AM 10/27/2016 04:54:06 PM
Change Order 4 Emailed to MLGreenhow@cpes.com at 12/23/2016 02:07:14 PM 12/28/2016 08:53:27 AM
Change Order 5 Emailed to MLGreenhow@cpes.com at 12/27/2017 10:02:14 AM 12/28/2017 02:18:24 PM
Change Order 6 Emailed to MLGreenhow@cpes.com at 10/11/2018 03:06:10 PM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
9000012204
PZ9000012204 COMMUNITY PROVIDER ENRICHMENT SERVICES 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   
1-5 of 12
1 2  3 
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 #:  000035473-R1 / 1
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $125.00 HR - Hour 0.00 $0.00 $0.00 $125.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 2.0, Item # 7:   One (1) Hour Consultation - Rural 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
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:
 
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 #:  000035473-R1 / 3
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $100.00 HR - Hour 0.00 $0.00 $0.00 $100.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 4.0, Item # 3:   One (1) Hour Unit Consultation - Rural 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 4 Quote # / Quote Item #:  000035473-R1 / 4
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $110.00 EA - Each 0.00 $0.00 $0.00 $110.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 5.0, Item # 4:   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 #:  000035473-R1 / 5
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:
 
1-5 of 12
1 2  3 
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