1-Project Budget and Funding Sources Worksheet.docx
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- Solicitation number
- ALTSD CO - Planning & Design - Draft - Similar 2
- Issued by
- New Mexico
About this file
This is a Project Budget and Funding Sources Worksheet issued by the New Mexico Aging and Long Term Services Department for senior center capital outlay funding applications. The worksheet serves as a standardized template for applicants requesting capital outlay funds for planning and design projects, which may include needs assessments, feasibility analyses, surveys, engineering services, architectural design, cost estimating, regulatory reviews, permitting support, and construction documents. Applicants must complete one worksheet per project and align all budget amounts with project scope and supporting documentation. The form requires identification of the senior center facility name, fiscal agent, application type, and project title, along with the ICIP project title, priority level, and fiscal year designation.
The budget section requires itemization of capital outlay requests and other funding sources with corresponding quote or estimate references, culminating in a total project budget figure. The funding sources section allows applicants to identify and track the status of capital outlay requests, local government funds, tribal funds, state funds, federal funds, grant or donor funds, and other sources, with each listed as either secured or pending. Applicants must confirm whether total funding equals the total project budget and must identify any remaining funding gaps with expected sources and availability dates. The worksheet also requires certification of budget accuracy and alignment with supporting quotes, estimates, and project scope by an authorized representative, including signature and date. This budget worksheet is a required component of the Capital Outlay 2028 Application for Planning and Design funding.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-Certification Letter.docx | DOCX document | |
| 2-Scope of Work and Deliverables Schedule Worksheet.docx | DOCX document |
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Text version
Project Budget and Funding Sources Worksheet Use for all application types. Complete one worksheet per project. Amounts must align with project scope and supporting documentation.
Project Information
| Field |
| Applicant response |
Senior Center Facility Name
Fiscal Agent
Application Type
Project Title
ICIP Project Title / Priority / Fiscal Year
| Amount Requested |
| $ |
| Total Project Cost |
| $ |
Project Manager / Contact
Project Budget
| No. |
| Budget Category / Line Item |
| Description |
| Amount |
| Capital Outlay Request |
| Other Funding |
| Quote/Estimate Ref. |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
Total Project Budget
| $ |
| $ |
| $ |
Funding Sources
| Funding Source |
| Amount |
| Status |
| Date Available |
| Restrictions / Notes |
| Capital Outlay requested |
| $ |
| Requested |
| Local government / fiscal-agent funds |
| $ |
| Secured / Pending |
| Tribal funds |
| $ |
| Secured / Pending |
| State funds |
| $ |
| Secured / Pending |
| Federal funds |
| $ |
| Secured / Pending |
| Grant / donor / other funds |
| $ |
| Secured / Pending |
| Other: |
| $ |
| Secured / Pending |
| Total Funding Sources |
| $ |
Budget Completion and Advance-Funding Confirmation Does the total funding equal the total project budget? Yes / No If no, identify remaining funding gap, expected source, and date available:
Identify costs not included and how they will be funded:
Identify the fiscal-agent fund, reserve, appropriation, or other source used to pay allowable costs before reimbursement:
Budget Certification I certify that this budget is complete and accurate to the best of my knowledge; aligns with quotes, estimates, and scope; identifies all known sources; and includes costs necessary to complete the project or identifies any remaining gap.
Authorized Representative Name: ______________________________________________________________________ Title: ______________________________________________________________________ Signature: ______________________________________________________________________ Date: ______________________________________________________________________
Final Consolidated Senior Center Capital Outlay Application Question Sets | Page 1
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