Attachment_2-_Budget_Forms__12-24__-_RFP_Only.xlsx
XLSX spreadsheet 91 KB Posted
- Attached to
- EXT HSA | RFP 1269 Senior Accompaniment Services
- Solicitation number
- SFGOV-0000012203
- Issued by
- San Francisco County, San Francisco City, California
About this file
This is a budget form template for the City and County of San Francisco Human Services Agency (SFHSA) associated with RFP #1269 for Senior Accompaniment Services. The form establishes budget parameters for a four-year contract term spanning July 1, 2026, through June 30, 2030, with annual fiscal year breakdowns. The RFP seeks proposals from nonprofit organizations to provide accompaniment services to older adults and adults with disabilities who require community accompaniment due to safety concerns. A pre-proposal conference was scheduled for November 5, 2026, at 11 a.m. via Microsoft Teams.
The budget template is designed as a blank form for vendors to complete and includes sections for salaries and benefits, operating-direct expenses, indirect costs calculated at a 15 percent rate, consultant and subcontractor costs (with those exceeding $50,000 listed separately), direct client pass-through expenses, and capital expenditures. The form accommodates fringe benefit rates and requires vendors to detail position titles, full-time equivalent (FTE) allocations, funding percentages, and adjusted FTE calculations across all four fiscal years. All line items currently display zero values, indicating this is a template awaiting completion by prospective bidders. The budget structure allows for comprehensive cost allocation across personnel, operational expenses, subcontracting arrangements, and capital needs over the full contract period.
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Text version
Budget Summary Appendix B, Page 1
| HUMAN SERVICES AGENCY BUDGET SUMMARY | |||||
| BY PROGRAM | |||||
| Grantee/Contractor: Vendor Name | Full Term: | 7/1/26 - 6/30/30 | |||
| Program: Program Name | Effective Date: | ||||
| New Modification Revision (Check One) | Modification # | ||||
| 7/1/26- 6/30/27 | 7/1/27 - 6/30/28 | 7/1/28 - 6/30/29 | 7/1/29 - 6/30/30 | 7/1/26 - 6/30/30 | |
| Expenses | Original | Original | Original | Original | Total |
| Salaries & Benefits | $0 | $0 | $0 | $0 | $0 |
| Operating-Direct | $0 | $0 | $0 | $0 | $0 |
| Subtotal | $0 | $0 | $0 | $0 | $0 |
| Indirect Percentage (%) | 15% | 15% | 15% | 15% | 15% |
| Indirect Costs (Line 16 X Line 15) | $0 | $0 | $0 | $0 | $0 |
| Consultant/Subcontractor ($50,000+) | $0 | $0 | $0 | $0 | $0 |
| Direct Client Pass-Through | $0 | $0 | $0 | $0 | $0 |
| Capital Expenses | $0 | $0 | $0 | $0 | $0 |
| Total Expenses | $0 | $0 | $0 | $0 | $0 |
| HSA / DAS Revenues | |||||
| Funding | $0 | ||||
| $0 | |||||
| $0 | |||||
| CODB Eligible 1 | $0 | ||||
| CODB Eligible 2 | $0 | ||||
| CODB Eligible 3 | $0 | ||||
| CODB FY 1 |
Patrick Garcia: Note:
| Zero for brand new programs | $0 | |||||
| CODB FY 2 | $0 | |||||
| CODB FY 3 | $0 | |||||
| CODB FY 4 | $0 | |||||
| OTO | $0 | |||||
| Addback | $0 | |||||
| $0 | ||||||
| $0 | ||||||
| $0 | ||||||
| $0 | ||||||
| Total HSA / DAS Revenues | $0 | $0 | $0 | $0 | $0 | |
| Grantee/Contractor Revenues | ||||||
| $0 | ||||||
| $0 | ||||||
| $0 | ||||||
| $0 | ||||||
| Total Grantee/Contractor Revenues | $0 | $0 | $0 | $0 | $0 | |
| Total Revenues | $0 | $0 | $0 | $0 | $0 | |
| Prepared by and Date: | ||||||
| Telephone No. & Email: | HSA Budget Form (3/24) |
(Vendor Name) Appendix B &P (Program), (FY Length) (F$P), (Commission Month)
Salary & Benefits
| Grantee/Contractor: Vendor Name | Appendix B, Page 2 |
| Program: Program Name |
Salaries & Benefits Detail
| Agency Totals | HSA Program | 7/1/26- 6/30/27 | Agency Totals | HSA Program | 7/1/27 - 6/30/28 | Agency Totals | HSA Program | 7/1/28 - 6/30/29 | Agency Totals | HSA Program | 7/1/29 - 6/30/30 | 7/1/26 - 6/30/30 | |
| POSITION TITLE | Annual Full Time Salary for FTE |
Kim: Annual Full Time Salary for FTE:
Please report in this column the total annual compensation for this classification for a Full Time Employee Total FTE Kim: Total FTE:
Percentage of time employee works on this specific program % FTE funded by HSA (Max 100%) Kim: % FTE funded by HSA
Percentage of employee's time in this program that is paid by HSA.
Adjusted FTE Kim: Adjusted FTE
Total FTE x % FTE funded by HSA Original Annual Full Time Salary for FTE Kim: Annual Full Time Salary for FTE:
Please report in this column the total annual compensation for this classification for a Full Time Employee Total FTE Kim: Total FTE:
Percentage of time employee works on this specific program % FTE funded by HSA (Max 100%) Kim: % FTE funded by HSA
Percentage of employee's time in this program that is paid by HSA.
Adjusted FTE Kim: Adjusted FTE
Total FTE x % FTE funded by HSA Original Annual Full Time Salary for FTE Kim: Annual Full Time Salary for FTE:
Please report in this column the total annual compensation for this classification for a Full Time Employee Total FTE Kim: Total FTE:
Percentage of time employee works on this specific program % FTE funded by HSA (Max 100%) Kim: % FTE funded by HSA
Percentage of employee's time in this program that is paid by HSA.
Adjusted FTE Kim: Adjusted FTE
Total FTE x % FTE funded by HSA Original Annual Full Time Salary for FTE Kim: Annual Full Time Salary for FTE:
Please report in this column the total annual compensation for this classification for a Full Time Employee Total FTE Kim: Total FTE:
Percentage of time employee works on this specific program % FTE funded by HSA (Max 100%) Kim: % FTE funded by HSA
Percentage of employee's time in this program that is paid by HSA.
Adjusted FTE Kim: Adjusted FTE
| Total FTE x % FTE funded by HSA | Original | Total | ||||||||||||||||||||
| Employee A (example) | 1.00 | 100% | 1.00 | $0 | 1.00 | 100% | 1.00 | $0 | 1.00 | 100% | 1.00 | $0 | 1.00 | 100% | 1.00 | $0 | $0 | |||||
| Employee B (example) | 0.50 | 80% | 0.40 | $0 | 0.50 | 80% | 0.40 | $0 | 0.50 | 80% | 0.40 | $0 | 0.50 | 80% | 0.40 | $0 | $0 | |||||
| Employee C (example) | 0.50 | 100% | 0.50 | $0 | 0.50 | 100% | 0.50 | $0 | 0.50 | 100% | 0.50 | $0 | 0.50 | 100% | 0.50 | $0 | $0 | |||||
| - 0 | $0 | - 0 | $0 | - 0 | $0 | - 0 | $0 | $0 | ||||||||||||||
| - 0 | $0 | - 0 | $0 | - 0 | $0 | - 0 | $0 | $0 | ||||||||||||||
| - 0 | $0 | - 0 | $0 | - 0 | $0 | - 0 | $0 | $0 | ||||||||||||||
| - 0 | $0 | - 0 | $0 | - 0 | $0 | - 0 | $0 | $0 | ||||||||||||||
| - 0 | $0 | - 0 | $0 | - 0 | $0 | - 0 | $0 | $0 | ||||||||||||||
| - 0 | $0 | - 0 | $0 | - 0 | $0 | - 0 | $0 | $0 | ||||||||||||||
| - 0 | $0 | - 0 | $0 | - 0 | $0 | - 0 | $0 | $0 | ||||||||||||||
| TOTALS | $0 | 2.00 | 2.80 | 1.90 | $0 | $0 | 2.00 | 280% | 1.90 | $0 | $0 | 2.00 | 280% | 1.90 | $0 | $0 | 2.00 | 280% | 1.90 | $0 | $0 |
| FRINGE BENEFIT RATE | 25% | 25% | 25% | 25% | |||||
| EMPLOYEE FRINGE BENEFITS | $0 | $0 | $0 | $0 | $0 |
| TOTAL SALARIES & BENEFITS | $0 | $0 | $0 | $0 | $0 |
| HSA Budget Form (3/24) |
(Vendor Name) Appendix B &P (Program), (FY Length)
Operating-Direct
| Grantee/Contractor: Vendor Name | Appendix B, Page 3 |
| Program: Program Name |
Operating Expenses Detail
| 7/1/26- 6/30/27 | 7/1/27 - 6/30/28 | 7/1/28 - 6/30/29 | 7/1/29 - 6/30/30 | 7/1/26 - 6/30/30 | |
| Original | Original | Original | Original | Total | |
| Expenditure Category | |||||
| Rental of Property | $0 | ||||
| Utilities(Elec, Water, Gas, Phone, Garbage) | $0 | ||||
| Office Supplies, Postage | $0 | ||||
| Building Maintenance Supplies and Repair | $0 | ||||
| Printing and Reproduction | $0 | ||||
| Insurance | $0 | ||||
| Staff Training | $0 | ||||
| Staff Travel-(Local & Out of Town) | $0 | ||||
| Rental of Equipment | $0 | ||||
| Consulting/Professional Services | |||||
| Consultant A (first $50k; anything over on next tab) | $0 | ||||
| Subcontractor A (first $50k; anything over on next tab) | $0 | ||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| Other | |||||
| Other A | $0 | ||||
| Other B | $0 | ||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 |
| Total Operating Expense | $0 | $0 | $0 | $0 | $0 |
| HSA Budget Form (3/24) |
Appendix B &P (Program), (FY Length)
Subcontractors-Pass Thru
| Grantee/Contractor: Vendor Name | Appendix B, Page 4 |
| Program: Program Name |
Subcontractors-Pass Thru
| 7/1/26- 6/30/27 | 7/1/27 - 6/30/28 | 7/1/28 - 6/30/29 | 7/1/29 - 6/30/30 | 7/1/26 - 6/30/30 | |
| Original | Original | Original | Original | Total | |
| Subcontractor | |||||
| Consultant A (only amount above $50k) | $0 | ||||
| Subcontractor A (only amount above $50k) | $0 | ||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 |
Total Subcontractor $0 $0 $0 $0 $0
| Direct Client Pass-Through | |
| Direct Client Pass-Through A | $0 |
| Direct Client Pass-Through B | $0 |
| $0 | |
| $0 | |
| $0 | |
| $0 | |
| $0 | |
| $0 | |
| $0 | |
| $0 |
| Total Direct Client Pass-Through | $0 | $0 | $0 | $0 | $0 |
| HSA Budget Form (3/24) |
Appendix B &P (Program), (FY Length)
Capital Expenses
| Grantee/Contractor: Vendor Name | Appendix B, Page 5 |
| Program: Program Name |
Capital Expenses Detail
| 7/1/26- 6/30/27 | 7/1/27 - 6/30/28 | 7/1/28 - 6/30/29 | 7/1/29 - 6/30/30 | 7/1/26 - 6/30/30 | |
| Original | Original | Original | Original | Total | |
| Equipment (any single item $10k+) | |||||
| Equipment A | $0 | ||||
| Equipment B | $0 | ||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| Remodeling | |||||
| Remodeling A | $0 | ||||
| Remodeling B | $0 | ||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 | |||||
| $0 |
| Total Capital Expenditure | |||||||
| (Equipment and Remodeling Cost) | $0 | $0 | $0 | $0 | $0 | ||
| HSA Budget Form (3/24) |
Appendix B &P (Program), (FY Length)
Justifications
File details come from the government source that posted it. Updated .