BLANK_EXHIBIT_B_FINANCIAL_PROPOSAL_FORM_RFA_COE_3-3-25locked_1_.xlsx

XLSX spreadsheet 34 KB Posted Apr 11, 2025

Attached to: RFA - Excellence in Infant and Early Childhood Mental Health
Solicitation number: BPM050654
Issued by: Maryland

About this file

Written by GovTribe AI · Apr 12, 2025

This is a Financial Proposal Form from the Maryland Department of Health Behavioral Health Administration, specifically for the Center of Excellence in Infant and Early Childhood Mental Health Program (COE). The document covers a five-year service period from July 1, 2025 to June 30, 2030, and provides a detailed template for potential vendors to complete their financial proposals. The form requires comprehensive financial information, including personnel costs, salaries, fringe benefits, travel expenses, supplies, subcontracts, procurement contracts, and other direct costs.

The financial template is structured to capture total direct costs, modified direct costs, and indirect costs, with a placeholder for an indirect cost rate percentage. Vendors are instructed to complete the form precisely, with a warning that failure to adhere to the instructions may result in proposal rejection. The document also mandates that a separate Budget Narrative in Word format must accompany the Financial Proposal Form. The form includes signature lines for company details, location of services, contact information, and federal identification number, emphasizing the formal and comprehensive nature of the financial submission process.

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RFA_-_Center_of_Excellence_in_Infant_and_Early_Childhood_Mental_Health_Program_4.11.25.pdf	PDF	Apr 11, 2025

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Sheet1

Exhibit B - Financial Proposal Form

The Financial Proposal shall contain all price information in the format specified on these pages. Complete the Financial Proposal Form only as provided in the Financial Proposal Form format. Do not amend, alter or leave blank any items on the Financial Proposal Form. If option years are included, Offerors must submit costs for each option year. Failure to adhere to any of these instructions may result in the financial proposal being determined non- responsive and rejected by the Department.

Please Note: Budget Narrative (to be completed in Word) must accompany each Financial Proposal Form.

Sydnee Distance: Sydnee Distance:

Please be sure to submit the Budget Narrative (in Word) as well.

Maryland Department of Health Behavioral Health Administration

Center of Excellence in Infant and Early Childhood Mental Health Program

(COE)

Sydnee Distance: Sydnee Distance:

Please insert the Project Name.

July 1, 2025-June 30, 2030
Service Description					FY26			Total Price
Salaries
Personnel
Name		Title	% Effort	Annual Salary each period
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
COST:					$ - 0	$ - 0	$ - 0	$ - 0
Fringe Benefits			% Effort	Fringe Benefit Rates
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
COST:					$ - 0	$ - 0	$ - 0	$ - 0
Travel
								$ - 0
								$ - 0
COST:					$ - 0	$ - 0	$ - 0	$ - 0
Supplies
								$ - 0
COST:					$ - 0	$ - 0	$ - 0	$ - 0
Subcontracts
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
COST:					$ - 0	$ - 0	$ - 0	$ - 0
Procurement Contracts
								$ - 0
								$ - 0
								$ - 0
								$ - 0
COST:					$ - 0	$ - 0	$ - 0	$ - 0
Other Direct Costs
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
								$ - 0
COST:					$ - 0	$ - 0	$ - 0	$ - 0
TOTAL COST
TOTAL DIRECT COSTS					$ - 0	$ - 0	$ - 0	$ - 0
TOTAL MODIFIED DIRECT COSTS						$ - 0	$ - 0	$ - 0
TOTAL INDIRECT COSTS - IDC	10

Aaron Jenkins: Aaron Jenkins:

Please select the indirect cost percentage.from the drop down	%		$ - 0	$ - 0	$ - 0
		TOTAL COSTS - DIRECT + INDIRECT			$ - 0	$ - 0	$ - 0

Signature

Printed Name & Title

Company Name

Company Address

Location(s) from which services will be performed (City, State)

Telephone

Fax

FEIN

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