3-Fiscal Forms HHH Appendicies 2-6.xlsx

XLSX spreadsheet 106 KB Posted Apr 28, 2026

Attached to: Continuing Sobriety Voucher Pilot Program
Solicitation number: RFP-2026-765-HHH-FS
Issued by: Bernalillo County, Albuquerque City, New Mexico

About this file

Written by GovTribe AI · May 13, 2026

This file consists of standardized fiscal forms and detailed instructions for budget development submitted by the City of Albuquerque Department of Health, Housing & Homelessness in support of the Continuing Sobriety Voucher Pilot Program. The forms are designed to capture comprehensive budgetary information for a two-year pilot program that will provide Level-3 recovery housing placement and supportive services to up to twenty-five (25) individuals annually who are exiting substance use treatment programs. The Excel-based forms include an Expense Summary Form (Appendix #2), Revenue Summary Form (Appendix #3), Personnel Budget Detail Form (Appendix #4), Operating Costs Budget Detail Form (Appendix #5), and Projected Drawdown Schedule (Appendix #6). All forms utilize embedded formulas to automatically populate data across tabs to ensure accuracy and consistency.

The fiscal forms require detailed justification of all budgeted expenses across multiple categories including personnel costs (salaries, wages, payroll taxes, and employee benefits), operating costs (contractual services, supplies, occupancy, equipment, travel, direct assistance to beneficiaries, and other allowable expenses), and indirect costs. Revenue sources must be itemized by funding source type including federal grants and pass-through funds, Medicaid reimbursements, state and local government revenues, and other contributions. The operating costs section mandates specific detail for each line item with allocation methodologies, and distinguishes between direct program contractual services and administrative contractual services. Organizations must project quarterly drawdown schedules and provide explanations if any quarter exceeds 25 percent of total requested funds. If services are provided on a unit rate basis, applicants must identify the per-unit reimbursement rate, specify the unit of measure (unduplicated client, hour, etc.), and provide rate justification demonstrating how costs align with proposed program activities and outcomes.

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File	Type	Posted
2-CSV Pilot Plan Attachment B.docx	DOCX document	Apr 28, 2026
4-RFP BOILERPLATE Scope FINAL 4.27.26.pdf	PDF	Apr 28, 2026
1-R-218Enacted (1).pdf	PDF	Apr 28, 2026

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TIPS

How to use the Excel forms with formulas

1 Start with APP #5: Operating expenses entered in APP#5 will automatically populate APP #2. The Agency Name and Project Title will populate the corresponding fields on other tabs.”

2 Complete APP #4 next. Personnel expenses will populate APP #2

3 When adding rows, make sure all formulas—especially sums and subtotals—remain correct and unaffected.

4 Detailed instructions on each form can be found on tabs.

APP#2

City of Albuquerque

Department of Health, Housing & Homelessness

APPENDIX #2: Expense Summary Form

1. Agency Name:

2. Project Title:

Expenditure Category	Program Total	City Funding Requested	Percent Requested
Personnel Costs
Salaries & Wages	$ - 0	$ - 0
Payroll Taxes and Employee Benefits	$ - 0	$ - 0
Total Personnel Costs	$ - 0	$ - 0

Operating Costs - Direct
Contractual Services-Direct/Program	$ - 0	$ - 0
Contractual Services-Administrative	$ - 0	$ - 0
Audit Costs	$ - 0	$ - 0
Consumable Supplies	$ - 0	$ - 0
Telephone	$ - 0	$ - 0
Postage and Shipping	$ - 0	$ - 0
Occupancy
a. Rent	$ - 0	$ - 0
b. Utilities	$ - 0	$ - 0
c. Other	$ - 0	$ - 0
Equipment Lease/Purchase	$ - 0	$ - 0
Equipment Maintenance	$ - 0	$ - 0
Printing & Publications	$ - 0	$ - 0
Travel
a. Local Travel	$ - 0	$ - 0
b. Out of Town Travel	$ - 0	$ - 0
Conferences, Meetings, Etc.	$ - 0	$ - 0
Direct Assistance to Beneficiaries-General	$ - 0	$ - 0
Direct Assistance to Beneficiaries-Housing	$ - 0	$ - 0
Membership Dues	$ - 0	$ - 0
Equipment, Land, Buildings	$ - 0	$ - 0
Insurance	$ - 0	$ - 0
Fuel and Vehicle Maintenance	$ - 0	$ - 0
Total Operating Costs	$ - 0	$ - 0

Total Direct Costs (Personnel & Operating) $ - 0 $ - 0

Indirect Costs ( ____%; attach Rate Letter)

TOTAL PROGRAM EXPENSES $ - 0 $ - 0

q As applicable, attach Indirect Cost Rate Letter

APP#3

City of Albuquerque

Department of Health, Housing & Homelessness

APPENDIX #3: Revenue Summary Form

1. Agency Name:

2. Project Title:

Revenue Sources	Agency Total	% of Agency Budget	Program Total	% of Program Budget
Government Revenues
Revenues from Federal Government*

(On separate lines, list each Federal Agency providing fees/funding and amount of funding) *This must include federal pass-through funding.

Grants from Federal Government Agencies:

Medicaid Reimbursements:

Other Federal Revenues:

Subtotal Federal Agencies	$ - 0	$ - 0
Revenues from State Government

(On separate lines, list each State Agency providing fees/funding and amount of funding) Grants from State Government Agencies:

Other State Government Revenues:

Subtotal State Agencies $ - 0 $ - 0

Revenues from County Government:

Revenues from the City of Albuquerque (including this proposal or contract):

(On separate lines, list each City-funded project and the amount of funding)

Other Municipal Government Revenues:

Subtotal Local Government	$ - 0	$ - 0
TOTAL GOVERNMENT REVENUES FROM ALL SOURCES	$ - 0	$ - 0
Other Revenue:
Contributions
Other Revenue
Subtotal Other Revenues	$ - 0	$ - 0

TOTAL REVENUE FROM ALL SOURCES: $ - 0 $ - 0

Cross Check
$ - 0	Per App #2
$ - 0	Per Above
$ - 0	Variance should be zero

APP#4

City of Albuquerque

Department of Health, Housing & Homelessness

APPENDIX #4 - Project Budget Detail Form - Personnel

1. Agency Name:

2. Project Title:

Personnel Costs: Use this form to justify all salaries, wages, payroll taxes and fringe benefits shown on the Expense Summary Form. Add additional rows as necessary. Utilize the dropdown in Column F to indicate if line item represents more than on staff member.

	3. FTE
on Program	Position Title	Salary for the Program	City Funding Requested	Percent Requested (Amount Requested / Salary to the Program)	Represents Multiple Staff

(Use drop down)

4. Salaries & Wages		$ - 0	$ - 0
5. Payroll Taxes and Employee Benefits*
6. Total Personnel Costs		$ - 0	$ - 0
7. Enter Estimated % of Payroll Taxes & Benefits
Payroll Taxes
	FICA
	UI
	WC
	Other
Employee Benefits
	Health Insurance
	Retirement
	Other
0.00%	*Total

Cross Check	Cross Check
$ - 0	$ - 0	Per App #2
$ - 0	$ - 0	Per Above
$ - 0	$ - 0	Variance should be zero

APP#5

City of Albuquerque

Department of Health, Housing & Homelessness

APPENDIX #5 - Project Budget Detail Form - Operating Costs

1. Agency Name:

2. Project Title:

	3. Direct and Indirect Costs:
	Line Item and Basics
(Non-Personnel)	Program Total	City Funding Requested	Amount Other Sources	Percent Requested

Contractual Services-Direct/Program (Contracts that directly support program/service delivery to clients) •Vendor type/name

•Proposed amount	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Contractual Services-Administrative

(Contracts that support operations, management, or compliance) •Vendor type/name

•Proposed amount	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Audit Costs	$ - 0	$ - 0	$ - 0
	Provide total Agency Audit Costs:___________	$ - 0
		$ - 0
	Consumable Supplies	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Telecommunication Services	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Postage and Shipping	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Occupancy (Must be based on program’s share of facility use)	$ - 0	$ - 0	$ - 0
	a. Rent	$ - 0
	b. Utilities	$ - 0
	c. Other	$ - 0
	Equipment Lease	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Equipment Maintenance	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Printing & Publications	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Travel	$ - 0	$ - 0	$ - 0
	a. Local Mileage Reimbursement	$ - 0
	b. Out of Town Travel	$ - 0
	Conferences/Meetings	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Direct Assistance to Beneficiaries- General	$ - 0	$ - 0	$ - 0
	General Assistance: Costs associated with providing support to beneficiaries, including program services, supplies, and other allowable expenses. Please provide short description.	$ - 0
	Direct Assistance to Beneficiaries-Housing	$ - 0	$ - 0	$ - 0
	Housing Assistance: Costs specifically related to housing support, such as rent, housing vouchers, utilities, or application fees for beneficiaries. Please provide short description.	$ - 0
	Membership Dues	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Equipment, Land, Buildings (greater than $5,000)	$ - 0	$ - 0	$ - 0
		$ - 0
		$ - 0
	Insurance (as required by the contract)	$ - 0	$ - 0	$ - 0
	Indicate insurance cost by insurance type	$ - 0
		$ - 0
	Fuel and Vehicle Maintenance	$ - 0	$ - 0	$ - 0
	Must excludes fuel and vehicles already accounted for in the travel costs above; applies only to project-specific vehicles. Please provide short description.	$ - 0
		$ - 0
	Total Operating Costs	$ - 0	$ - 0	$ - 0

Cross Check	Cross Check
$ - 0	$ - 0	Per App #2
$ - 0	$ - 0	Per Above
$ - 0	$ - 0	Variance should be zero

APP#6

City of Albuquerque

Department of Health, Housing & Homelessness

APPENDIX #6: Budget Detail Form: Projected Drawdown Schedule

1. Agency Name:

2. Project Title:

3. Amount and percent of total requested funds on a quarterly basis:
Quarter Ending	Amount to be Requested	Percent of Total
INSERT DATES
INSERT DATES
INSERT DATES
INSERT DATES
Total	- 0
			- 0	Total per App #2
Explanation if any projected drawdowns exceed 25% of the total requested funds:			- 0	Variance should be zero

4. As applicable: Reimbursement Rate – only applicable to unit of service contracts:

Rate:	$ per unit	unit of service
$ per (hour, client, etc.)

Annual units:

5. As applicable: Rate Justification – only applicable to unit of service contracts:

APP#2 instructions INSTRUCTIONS - APPENDIX #2: Expense Summary Form

Expenditures reimbursed under Social Services agreements must be allowable as outlined in the Administrative Requirements for Social Services Contracts awarded by the City of Albuquerque, and must be reasonable and allocable.

Personnel Costs

Salaries and Wages: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #4. Manual Calculation: Enter the amounts budgeted to pay salaries and wages for regular staff of the organization employed to carry out project-related activities.

Payroll Taxes and Benefits: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #4. Manual Calculation: Enter the amounts budgeted to payroll taxes and employee benefits. Payroll taxes should include legally mandated payroll taxes for regular employees of the organization, including FICA and unemployment insurance tax. The amounts charged to the City must constitute an allocable percentage of salaries and wages.

Total Personnel Costs: A formula is embedded in the Excel worksheet to automatically enter the sums of salaries, wages, payroll taxes, and employee benefits. Manual Calculation: provide a subtotal for Personnel costs in this section.

Operating Costs

Contractual Services-Direct/Program: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to pay the costs of services provided to the project through contractual agreements with organizations and individuals who are not regular employees, with the exception of the costs for conducting annual or special audits. Contractual serviced entered here directly support program/service delivery for individuals receiving services.

Contractual Services-Administrative: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to pay the costs of services provided to the project through contractual agreements with organizations and individuals who are not regular employees, with the exception of the costs for conducting annual or special audits. Contractual serviced entered here support operations, management, or compliance.

Audit Costs: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to pay the costs of conducting annual or special audits of the organization. The amount budgeted to the City shall not exceed the proportion that the City contract revenue is of the total agency revenue budget.

Consumable Supplies: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to pay the costs of supplies and equipment utilized by the project which have a price which does not exceed $5,000 per unit.

Telecommunications: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the budgeted amount for project-related telecommunication services, including usage and installation costs for telephones, cell phones, internet, and wireless networks. All telecommunication expenses must comply with agency policy and directly support the funded program. Consider cost allocations by location and staff when determining the budget.

Postage and Shipping: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted for project postage and shipping.

Occupancy

A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Rent: Enter the amount budgeted for space lease/rental costs allocable to the project.

Utilities: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the budgeted amount for allocable project utility costs, including electricity, heating and cooling, water, sewer, and other utilities not included in rent, space charges, or telecommunications.

Other: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted for other allocable project occupancy costs including the costs of security, janitorial services, elevator services, upkeep of grounds, leasehold improvements not exceeding $5,000, and related occupancy costs not included in rent, space charges, or telecommunications.

Equipment Lease: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amounts budgeted for the purchase or lease of equipment allocable to the project.

Equipment Maintenance: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to maintain or repair existing agency equipment utilized and allocable to the project.

Printing and Publications: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the budgeted amount for the purchase or reproduction of project-related printed materials, including allocable photocopying costs.

Travel Costs

Local mileage reimbursement: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the budgeted amount for project-related travel within Bernalillo County, including mileage reimbursement and allocable operating or maintenance costs of agency-owned or hired vehicles used to transport staff or clients. Costs must follow agency policies and procedures. Do not include commuting costs to and from work.

Out-of-Town Travel: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted for the costs of project travel outside of Bernalillo County, including costs for transportation, lodging, subsistence, and related expenses incurred by employees, board members, or clients who are in travel status on official business allocable to the project.

Conferences, Meetings, etc.: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted for the costs of registration and materials for staff, board, or clients’ attendance at meetings and conferences allocable to the project or for the costs of meetings conducted by the agency in connection with that contract.

Direct Assistance to Beneficiaries-General: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the costs budgeted for the payment of participant wages and benefits, stipends, food, clothing, and other goods and services purchased directly on behalf of clients funded in this project. Allocation and distribution of these funds must be in accordance with Agency Policies and Procedures.

Direct Assistance to Beneficiaries-Housing: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the costs specifically related to housing support, such as rent, housing vouchers, utilities, or application fees paid on behalf of individuals funded in this project. Allocation and distribution of these funds must be in accordance with Agency Policies and Procedures.

Membership Dues: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to pay the costs of dues paid by the agency on behalf of staff, board members, or the agency itself to professional organization related to the purposes of the project.

Equipment, Land, Buildings: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted for the purchase of equipment, land, and for the acquisition or construction of buildings allocable to the project, the cost of which exceeds $5,000. Costs charged to Equipment, Land, Buildings, or renovation capital costs must comply with the Administrative Requirements.

Insurance: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to pay the costs of insurance, including bonding, allocable to the project.

Fuel and Vehicle Maintenance: A formula is embedded in the Excel worksheet to automatically enter the amounts from Appendix #5. Manually Calculation: Enter the amount budgeted to pay for fuel and maintenance not covered under local travel, i.e. fuel for a bus.

Total Operating Costs: A formula is embedded in the Excel worksheet to sum the total. Manual calculation: Enter the sum of all line items under operating costs.

Total Direct Costs: A formula is embedded in the Excel worksheet to sum the Total Personnel Costs and Total Operating Costs. Manual calculation: Enter the sum of Total Personnel Costs and Total Operating Costs.

Indirect Costs: Enter the amounts budgeted to pay indirect costs for the project. Costs charged to Indirect must conform to Administrative Requirements. As applicable, attach explanation of basis for each indirect cost or an approved cost rate letter from cognizant Federal agency.

Total Program Expenses: A formula is embedded in the Excel worksheet to sum the total of Direct and Indirect Costs. Manual calculation: sum the Direct and Indirect Costs.

Percent Requested: A formula is embedded in the Excel worksheet to calculate the Percent Requested. Manual Calculation: Divide City Funding Request in Column C by Project Total in Column B for each individual row. Display as a percentage with one decimal point (e.g. 33.3%).

&9 &6Rev 2.2026

APP#3 instructions INSTRUCTIONS - APPENDIX #3: Revenue Summary Form

1. In the “Revenue Sources” column, list the names of all entities providing funding.

2. For each funding source listed, enter the anticipated revenues in the corresponding columns:

• Agency Total

• Program Total

3. Insert additional lines as needed to accommodate all funding sources.

4. After adding new line items, verify that the data from the new lines are correctly included in all totals and percentages

A formula is embedded in the Excel worksheet to calculate the "% of Agency Budget" and "% of Program Budget" subtotals and totals. Manual Calculation: Divide the Subtotals in the :Agency Total" by the "Total in Total Revenue From All Sources"; Divide the Subtotals in the "Program Total" by the Total in Total Revenue From All Sources. Display as a percentage with one decimal point (e.g., 33.3%).

Definitions:

Grants from Federal Government Agencies are funds paid to the agency as a recipient or sub-recipient by a unit of Federal government other than Medicaid. This must include federal pass-through funding.

[2 CFR Section 200.300 Subrecipient and contractor determinations sets forth the considerations in determining whether payments constitute a Federal award or a payment for goods or services provided as a contractor.]

Medicaid Reimbursements are funds paid to the agency as a result of billing Medicaid for reimbursable expenses for services to eligible clients.

Other Federal Revenues are funds paid to the Agency by a unit of Federal government for goods or services provided as a contractor other than Grants or Medicaid.

Grants from State Government Agencies are funds paid to the agency as a recipient or sub-recipient by a unit of State government.

Other State Government Agencies are funds paid to the Agency by a unit of State government for goods or services provided as a contractor other than Grants.

Revenues from County Government are funds paid to the agency from a County.

Revenues from City of Albuquerque are funds paid to the agency from the City of Albuquerque. List each all funded projects (or contract), include the request in this project, on a separate line.

Total Revenues from Government Sources: Manual calculation is a subtotal of all federal, state and local funds.

Contributions: Money income donated to the agency by any non-government sources.

Other Revenue: Income to the agency from sources not falling into other categories (Charitable foundation grants, loans, etc.).

Total Revenue From all Sources: Total of money revenue from all sources including public, private and foundation sources.

&9 &6Rev. 2.2026

APP#4 instructions APPENDIX #4: Instructions for Project Budget Detail Form – Personnel

Section 1. Enter the name of the agency submitting the proposal.

Section 2. Enter the project title as shown on the Proposal Summary and Certification form.

Section 3. Detail positions' salaries to be included in Personnel Costs in the Expense Summary Form in APPENDIX #2. Add rows and use additional sheets as necessary. In column F, utilize the drop down box to indicate if the position is representative of more than one staff member. The following illustration is provided for clarification purposes only.

Sample Illustration
FTE on Project	Position Title	Salary for the Program	City Funding Requested	Percent Requested (Amount Requested / Salary to the Program)	Represents Multiple Staff

(Use drop down)

3.0	Case Manager	$80,000	$40,000	50%	Yes
This individual is dedicated full-time to this project, however their salary is covered 50% by the City and 50% by other funding sources.

0.5	Case Manager	$20,000	$15,000	75%	No
This individual works full time but splits time 50/50 between this project and unrelated projects. Their salary is covered 75% by City funds and 25% by another funding source.

0.5	Case Manager	$20,000	$20,000	100%	No
This individual works half time. They dedicate all their time to this project, and the agency seeks 100% coverage by City funds – no other funding sources.

q In the column labeled “FTE on Project” list the amount of full time staff supporting the project, regardless of funding source (e.g., if an FTE will spend half time on this City-funded project, insert .50).

q In the column labeled “Position Title” give the title of each position working on this project.

q In the column labeled “Salary for the Program” enter the salary amount dedicated to the project for each position by multiplying the % FTE by total annual salary.

q In the column labeled “Amount Requested” enter the amount of funding requested from the City for each individual position.

q In the column “Percent Requested” calculate as: Amount Requested / Salary on Project. Note: The Annual Salary dedicated to the project / % FTE should = Annual Salary for this position.

q In the column “Represents Multiple Staff ”, use the drop down menu to indicate if the position listed is representative of more than one staff member.

Section 4. Provide a sum of the columns for "Salary for the Project" and "Amount Requested" and calculate "Percent Requested" by dividing the sum of “Amount Requested” by the sum of “Annual Salary Dedicated to Project”

Section 5. Enter the total amount of payroll taxes and employee benefits for project salaries in the column labeled “Salary for the Project,” the “Amount Requested” from the City, and the percent of the total to the charged to the City.

Section 6. Enter the sum of the lines 4 and 5 in the column’s labeled “Salary for the Project,” and “Amount Requested.” Enter the percentage of the total amount requested from the City.

Section 7. Enter the percentage of salaries and wages charged to FICA, Unemployment Compensation, health insurance, retirement, and other employee benefits in Section 5.

Note: Should the FTE or percentage of time for each position change during the contract year, a Budget Amendment request will be required.

&"Times New Roman,Regular"&P

&9 &6Rev. 2.2025

APP#5 instructions INSTRUCTIONS - APPENDIX #5: Program Budget Detail Form – Operating Expenses

Section 1. Enter the name of the agency submitting the proposal.

Section 2. Enter the project title as shown on the Proposal Summary and Certification form.

Section 3. Detail each Operating Cost line item on the Expense Summary Form in APPENDIX #2. Use one line per expense included in project. Add rows and use additional sheets as necessary. The following illustration is provided for clarification purposes only.

Sample Illustration
	Project Total	Amount Requested	Amount Other Sources	Percent Requested
Contractual Services-Direct/Program
Contractor #1: 50% of Contractor 1 costs at $150 per month for 12 months	$ 900.00	$ 450.00	$ 450.00	50.00%
Contractor #2: 50% of Contractor 2 costs at $150 per month for 12 months	$ 900.00	$ 450.00	$ 450.00	50.00%

Contractual Services-Administrative
Contractor #1: 50% of Contractor 1 costs at $150 per month for 12 months	$ 900.00	$ 450.00	$ 450.00	50.00%
Contractor #2: 50% of Contractor 2 costs at $150 per month for 12 months	$ 900.00	$ 450.00	$ 450.00	50.00%

Audit Costs	$ 5,000.00	$ 2,000.00	$ 3,000.00	20.00%
Provide total Agency Audit Costs:$20,000_

Consumable Supplies
Copier paper	$ 100.00	$ 50.00	$ 50.00	50.00%
Office cleaning Supplies	$ 100.00	$ 25.00	$ 75.00	25.00%

Travel
Local Travel: 150 of miles/month * $0.58/per mile * 12 months	$ 1,044.00	$ 1,044.00	$ - 0	100.00%

Direct Assistance to Beneficiaries- General
Food, clothing, and other goods for 50 clients for a maximum of $200 per client	$ 10,000.00	$ 10,000.00	$ - 0	100.00%
Direct Assistance to Beneficiaries-Housing
Rental assistance for 50 clients at $900 per month for 12 months	$ 540,000.00	$ 400,000.00	$ 140,000.00	74.00%
Insurance (as required by the contract)
Commercial General Liability, Professional Liability, Workers Compensation, and Auto insurance.	$ 8,000.00	$ 4,000.00	$ 4,000.00	50.00%
q Describe all elements included in the line item costs and indicate the basis used for determining the costs in the first column.

q Provide the total agency audit cost in the detail as requested.

q In the column headed “Project Total” enter the agency total program costs of the line item.

q In the column headed “Amount Requested” enter the amount requested from the City.

q In the column headed “Amount Other Sources” enter the amount to be paid from other sources.

q In the column headed “Percent Requested” enter the percent of the total program expenditures requested from the City.

q Include detail for each separate item as shown in the above illustration (e.g., each contractor, each type of direct assistance to beneficiaries).

q If cost is allocated, provide the allocation plan.

APP#6 instructns

INSTRUCTIONS - APPENDIX #6: Budget Detail Form: Projected Drawdown Schedule

The applicant must estimate the amount and percent of City funding it anticipates expending during each quarter of the fiscal year and the unit rate (if applicable).

Section 1. Enter the appropriate Quarter Ending dates (e.g., September 30, December 31, March 31, June 30).

Section 2. For each of the quarterly periods indicated, enter the amount of City funding the agency projects expending in the column headed “Amount to be Requested.” For each of the quarterly periods indicated, enter the amount of City funding the agency projects expending in the column headed “Amount to be Requested.”

Section 3. In the column headed “Percent of Total,” enter the percentage of all City funds projected to be expended during the quarter.

If the applicant anticipates expending more than 25% of the total requested from the City in any one quarter, provide a brief explanation of these expenditures in the space provided.

Section 4. As applicable, if reimbursement will be based on a unit rate, identify the per unit reimbursement rate for services to be provided, the unit basis (unduplicated client, hour, etc.) and the proposed number of annual units. Rate shall include any applicable taxes and shall constitute full and complete compensation for the successful applicant’s services under this proposal.

If separate rates are required for services based on factors such as service location, service type or other factors, please provide a list of specific rates, one individual rate at a time, and explain in the Rate Justification section (5).

Section 5. As applicable, if a reimbursement will be based on a unit rate, provide a rate justification. The intent of the justification is to tie together the budget with program activities and outcomes. To accomplish this, applicants should identify the basis used in establishing the reimbursement rate in context of the proposed services. Include the rationale used in developing cost components noted on the required budget forms. Additionally, indicate how the proposed reimbursement rate is necessary and reasonable to accomplish the program proposed in the narrative.

&9 &6Rev. 2.2025

File details come from the government source that posted it. Updated May 13, 2026.