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Master Blanket Purchase Order ADCS16-119271

Header Information
Purchase Order Number: ADCS16-119271 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: $830.00
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~19.zip Signed HITECH HIPPA Form Signed Offer and Acceptance Desert Edge Mentoring_Award Letter DC16-119271 DESERT EDGE COI 2-27-2016.pdf Amendment 1 Counselor Licenses and Diplomas.zip DHS_LicenseRenewal Insurance Documentation Desert Edge Mentoring - Amendment 2.docx Desert Edge Mentoring - Professional License Renewal.pdf Desert Edge Mentoring COI (GL) exp. 2-27-17.pdf Desert Edge Mentoring COI (WC) exp. 1-05-17.pdf Contract Amendment 3~41.zip Contract Amendment 4~22.zip
Vendor Attachments: Offer and Acceptance Form Attachment 01 ADCS Qualified Contractor Application Attachment 02 List of References Attachment 03 Licensure/Certification Attestation Attachment 04 Professional License Sole Proprietor Waiver Independent Contractor Agreement Designation of Confidential, Trade Secret & Proprietary Information HITECH Business Associate Agreement
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000018723 - Desert Edge Mentoring Services
Dennis Gregory
1950 W. Heatherbrae Dr.
Suite 10
Phoenix, AZ 85015
US
Email: desert_edge_mentoring@hotmail.com
Phone: (602)237-2485
FAX: (602)274-6531
Alt. Reference: Z0003
Payment Terms: Shipping Method:
Shipping Terms: Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to desert_edge_mentoring@hotmail.com at 01/04/2016 02:02:17 PM
Change Order 1 Emailed to desert_edge_mentoring@hotmail.com at 02/23/2016 10:55:12 AM 03/01/2016 06:58:25 PM
Change Order 2 Emailed to desert_edge_mentoring@hotmail.com at 07/15/2016 04:21:16 PM 12/08/2016 01:34:59 PM
Change Order 3 Emailed to desert_edge_mentoring@hotmail.com at 12/27/2016 07:33:16 AM 12/14/2017 01:34:18 PM
Change Order 4 Emailed to desert_edge_mentoring@hotmail.com at 12/15/2017 09:38:32 AM 12/15/2017 09:51:08 AM
Change Order 5 Emailed to desert_edge_mentoring@hotmail.com at 09/20/2018 11:26:15 PM 10/05/2018 11:41:35 AM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
9000018723
PZ9000018723 Desert Edge Mentoring Services 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   
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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 #:  000035543-R1 / 1
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $120.00 HR - Hour 0.00 $0.00 $0.00 $120.00
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 #:  000035543-R1 / 3
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 # 5.0, Item # 3:   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 #:  000035543-R1 / 5
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $120.00 HR - Hour 0.00 $0.00 $0.00 $120.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 7.0, Item # 4:   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 #:  000035543-R1 / 7
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $135.00 HR - Hour 0.00 $0.00 $0.00 $135.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 9.0, Item # 5:   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 #:  000035543-R1 / 9
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $80.00 EA - Each 0.00 $0.00 $0.00 $80.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
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