attachment-6-rfp-2027-dbh-01-servi-app-g-rev1--1-.xlsx

XLSX spreadsheet 39 KB Posted

Attached to
Service to Science
Solicitation number
RFP-2027-DBH-01-SERVI
Issued by
Grafton County, New Hampshire

About this file

This is a cost sheet template and budget narrative form issued by the New Hampshire Department of Health and Human Services, Division for Behavioral Health, for RFP-2027-DBH-01-SERVI, a competitive procurement for consultation, technical assistance, and evaluation support services for substance misuse prevention programs. The solicitation requires vendors to submit detailed budget proposals across two state fiscal years: SFY 27 (upon Governor and Executive Council approval through June 30, 2027) and SFY 28 (July 1, 2027 through June 30, 2028). The cost sheet accommodates line-item budget entries for salary and wages, fringe benefits, consultants, equipment, supplies (educational, laboratory, pharmacy, medical, and office), travel, software, marketing/communications, education and training, other specified costs, and subrecipient contracts. Vendors must provide budget narratives explaining the direct relationship of each cost line to meeting solicitation objectives. A separate salary and wages breakdown section requires detailed position-level information including position titles, current staff assignments, projected hourly rates, full-time equivalent hours per week, and allocation percentages across programs and sites. Letters of Intent and vendor questions were due March 9, 2026, with solicitation responses due April 3, 2026 at 12:00 PM Eastern Time.

The total anticipated contract funding is $500,000, divided equally between the two fiscal years at $250,000 each. Indirect cost rates are permitted on direct costs excluding equipment and are capped at 15 percent or the vendor's Negotiated Indirect Cost Rate Agreement (NICRA), whichever is lower; for subrecipient contracts, indirect rates apply only to the first $50,000 of each subaward. All costs must be entered in whole dollars with no cents, and vendors must maintain consistency between direct and indirect cost treatment per 2 CFR 200 requirements. The RFP evaluation allocates 300 of 1,000 total points to cost proposals, evaluated using a formula based on lowest proposed cost. No set-aside designations or incumbent vendor restrictions are identified. Successful contractors must register with the New Hampshire Department of State, Department of Administrative Services, and Department of Justice Charitable Trust Unit if applicable, and maintain commercial general liability insurance of at least $1,000,000 per occurrence and $2,000,000 aggregate, with the contract term extending through June 30, 2028 and potentially renewable for up to two additional years.

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Instructions

Cost Sheet Instructions
Contractor Name:Enter the Contractor's name, which must match the P-37.
Budget Request for:Enter the name of the project/program title.
Indirect Cost Rate (if applicable)The Contractor's indirect cost rate as a percentage will auto populate. See 2 CRF 200.414 Indirect (F&A) Costs for more information.

Line Item Instructions All costs should be entered in whole dollars with no cents.

Next to each cost, enter a description in the Budget Narrative column that explains the specific line item costs included and their direct relationship to meeting the objectives of this solicitation.

1. Salary & Wages Enter total salary and wage costs for personnel allocated to this agreement for the specified budget period.

2. Fringe Benefits Enter total fringe benefits costs for personnel allocated to this agreement for the specified budget period.

3. Consultants Enter total costs for individuals (who are not employees of the Contractor) to provide consultant services, including, but not limited to, professional expertise, training, and/or education.

4. Equipment
Enter total Equipment costs. Equipment is defined as tangible, non-expendable personal property (including exempt property) that has a useful life of more than one year AND an acquisition cost of $10,000 or more per unit. Note all equipment costs must be excluded when calculating indirect costs.
5.(a) Supplies - EducationalEnter total Educational Supplies costs.
5.(b) Supplies - LaboratoryEnter total Laboratory Supplies costs.
5.(c) Supplies - PharmacyEnter total Pharmacy Supplies costs.
5.(d) Supplies - MedicalEnter total Medical Supplies costs.
5.(e) Supplies OfficeEnter total Office Supplies costs.

6. Travel Enter Travel costs, including expenses for transportation necessary to complete the required services.

7. Software Enter Software costs.

8. (a) Other - Marketing/CommunicationsEnter Other - Marketing/Communications costs.
8. (b) Other - Education and TrainingEnter Other - Education and Training costs.
8. (c) Other - OtherEnter Other - Other costs in the available rows below.
Other (please specify)Using as many rows as needed, specify the type of Other costs (e.g. Postage) in Column A and enter the costs for the specified budget period.
9. Subrecipient Contracts
Enter total costs for Subrecipient Contracts. Note if a contractor is identified as a Subrecipient in accordance with 2 CFR § 200.331, the indirect cost rate may only be applied to the first $50,000 of each subrecipient contract (i.e. subaward) per Appendix IV to 2 CFR 200.
Total Direct CostsUnless the formula needs to be modified, Total Direct Costs will automatically total in this line.
Total Indirect CostsEnter the total indirect costs (if applicable) based on the indirect cost rate percentage. Any one cost must be treated consistently as either a direct or indirect cost and cannot be charged as both. Note the indirect cost rate cannot be applied to Equipment costs. The indirect cost rate may only be applied to the first $50,000 of each subrecipient contract (i.e. subaward).

TOTAL TOTAL Costs will automatically total in this line.

Cost Sheet New Hampshire Department of Health and Human Services

Contractor Name:Enter Vendor Name
Budget Request for:RFP-2027-DBH-01-SERVI
Indirect Cost Rate (if applicable)ERROR:#DIV/0!

Line Item Budget - State Fiscal Year 27 (Upon G&C approval-6/30/27) Budget - State Fiscal Year 28 (07/01/27 - 06/30/28) Budget Total - All SFYs Budget Narrative Explain specific line item costs included and their direct relationship to meeting the objectives of this solicitation.

1. Salary & Wages$0$0$0
2. Fringe Benefits$0$0$0
3. Consultants$0$0$0
4. Equipment
Indirect cost rate cannot be applied to equipment costs per 2 CFR 200.1 and Appendix IV to 2 CFR 200.$0$0$0
5.(a) Supplies - Educational$0$0$0
5.(b) Supplies - Lab$0$0$0
5.(c) Supplies - Pharmacy$0$0$0
5.(d) Supplies - Medical$0$0$0
5.(e) Supplies Office$0$0$0
6. Travel$0$0$0
7. Software$0$0$0
8. (a) Other - Marketing/ Communications$0$0$0
8. (b) Other - Education and Training$0$0$0
8. (c) Other - Other (specify below)$0$0$0
Other (please specify)$0$0$0
Other (please specify)$0$0$0
Other (please specify)$0$0$0
Other (please specify)$0$0$0
9. Subrecipient Contracts$0$0$0
Total Direct Costs$0$0$0
Total Indirect Costs$0$0$0

TOTAL $0 $0 $0

Appendix G - Cost Sheet

Salary & Wages Breakdown

Salary & Wages Breakdown

New Hampshire Department of Health and Human Services

Proposal Agency Name:
Program:
Budget Period:
ABCDEFGH
Position TitleCurrent Individual in PositionProjected Hrly Rate as of 1st Day of Budget PeriodHours per Week dedicated to this program - FTEAmnt Funded by this program for Budget PeriodTotal Salary for Budget Period% of Salary Funded by this programSite*
Example:
Program CoordinatorExample Staff$21.0020$21,840$43,68050%
Administrative Salaries
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
Total Admin. Salaries$0$0ERROR:#DIV/0!
Direct Service Salaries
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
Total Direct Salaries$0$0ERROR:#DIV/0!
Total Salaries by Program$0.00$0.00ERROR:#DIV/0!
*Please list which site(s) each staff member works at, if your agency has multiple sites.

Budget to Print New Hampshire Department of Health and Human Services

Contractor Name:Enter Vendor Name
Budget Request for:RFP-2027-DBH-01-SERVI
Budget PeriodERROR:#REF!
Indirect Cost Rate (if applicable)ERROR:#DIV/0!
Line ItemProgram Cost - Funded by DHHS
1. Salary & Wages$0
2. Fringe Benefits$0
3. Consultants$0
4. Equipment
Indirect cost rate cannot be applied to equipment costs per 2 CFR 200.1 and Appendix IV to 2 CFR 200.$0
5.(a) Supplies - Educational$0
5.(b) Supplies - Lab$0
5.(c) Supplies - Pharmacy$0
5.(d) Supplies - Medical$0
5.(e) Supplies Office$0
6. Travel$0
7. Software$0
8. (a) Other - Marketing/ Communications$0
8. (b) Other - Education and Training$0
8. (c) Other - Other (specify below)$0
Other (please specify)$0
Other (please specify)$0
Other (please specify)$0
Other (please specify)$0
9. Subrecipient Contracts$0
Total Direct Costs$0

Total Indirect Costs $0

TOTAL $0

&"Arial,Regular"Exhibit C-X Budget

&"Arial,Regular"Project ID # &"Arial,Regular"Contractor Initial: __________

Date: ___________

File details come from the government source that posted it. Updated .