State of Alabama Jefferson Co. Wraparound RFP# 2007-837-01
Department of Human Resources appendix E: fixed rate budget
appendix E: fixed rate budget
Agency: Address: Project Title: Jefferson County Wraparound Program
Budget Period: December 01, 2007 to September 30, 2009
The parties hereto agree that the contract reimbursement shall not exceed the cost/rate set out below.
SERVICES DAILY RATE ELIGIBLE UNITS TOTAL
PER FOR THE CONTRACT COST PER
UNIT PERIOD SERVICES
jefferson county
Wraparound
Program ______X 365 Days ______
______X ______
______X ______
______X ______
______X ______
______X ______
______X ______
The County Department will make payment for the actual number of eligible units of service provided during a calendar month.
Reimbursement is at a fixed rate.
Total expenditures under this contract shall not exceed the Grand Total set out above.
Budget Recap of Expenses
I. Personnel:
A. Salaries ______
B. Fringe Benefits: ______
II. Subcontracted Services:
A. Consultants: ______
B. Audit Service: ______
C. Other (Identify) ______
III. Travel:
A. Mileage (Show rate of Reimbursement) ______
B. Per Diem (Show Rate of Reimbursement) ______
IV. Space:
A. Telephone ______
B. Rent (include copy of lease) ______
C. Use Allowance (No More than 2% of
Acquisition Cost/Year) ______
D. Rental Rate System ______
E. Utilities ______
F. Maintenance of Building/Grounds ______
G. Minor Repairs to Building ______
V. Supplies:
A. Office ______
B. Household ______
C. Recreational ______
D. Educational ______
E. Medical ______
F. Personal Care ______
VI. Equipment:
A. Rental (include rental agreement) ______
B. Repair ______
C. Depreciation ______
VII. Other:
A. Insurance ______
B. Vehicle Operation ______
C. Taxes ______
D. Food in Excess of USDA ______
E. Other Allowable Costs, ______
Specify General Categories: ______
VIII. Total Program Cost: ______
IX. Program Income: Please report all income from all sources available to your program. (Detail Sources)
______
X. Client Date:
A. Potential Units of Service (Multiply
License Capacity by Days in Year.) ______
B. DHR Eligible Units of Service ______
C. Ineligible Units of Service ______
XI. Rate of Information:
A. Proposed for FY08: ______Families served at $______Fixed Slots Cost Rate for
$______Total Allocation