Exhibit_02_Budget_Form.pdf

268 KB Posted

Attached to
OSDH School Nurse Pilot Project
Solicitation number
EV00000980
Issued by
Oklahoma

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This is a Contract Budget Form issued by the Oklahoma State Department of Health (OSDH) for use by contractors responding to the OSDH School Nurse Pilot Project. The form serves as the standardized budget submission document that contractors must complete and submit as part of their proposal to provide school nurse services addressing physical health, mental health, wellbeing, and social services for students and families in Oklahoma public schools. The form requires contractors to identify themselves, provide contact information, and specify a total fixed cost for the proposed services.

The budget form is organized into standard line item categories including Personnel/Salaries, Fringe Benefits, Travel/Training, Supplies, Contractual, Administrative Costs/Indirect Costs (IDC), and Other costs. For each category, contractors must provide detailed narratives breaking down specific positions, staff names, annual salaries, number of months of employment, and percentage of time allocated to the project. The form accommodates both OSDH funding amounts and local match funding, with designated fields for identifying local match funding sources. Contractors must calculate category totals and arrive at total program costs, with signature lines for authorization by the contractor's representative. The form structure indicates that OSDH may require local cost-sharing contributions, making it essential for bidders to clearly identify and document all funding sources supporting their proposed budget.

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Other files

File Type Posted
OMES_Form_CP004.pdf PDF
OMES_Form_CP076.pdf PDF
Bidder_Instructions.pdf PDF
Attachment_B_General_Terms.docx DOCX document
Exhibit_01_Requirements.pdf PDF
Attachment_C_AgencyTerms_PLACEHOLDER.pdf PDF
Exhibit_03_Third_Party_Information.pdf PDF
Attachment_A_Agency_Purpose.pdf PDF

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OKLAHOMA STATE DEPARTMENT OF HEALTH

CONTRACT BUDGET FORM

Contractor: _______________________________________________ Date: __________________

Contractor Contact:_______________________________________ Phone: _____________________

Contractor Address: ___________________________________________________________________

TOTAL FIXED COST: $_________________

Summary Budget Request:

Budget Line Item OSDH Amount Match (if applicable) TOTAL

Personnel/Salaries Fringe Benefits Travel/Training Supplies Contractual Admin Costs/IDC Other

Total ** Local Match Funding source(s): ________________________________________________

Narrative/Detail Budget Request:

Personnel/Salaries Position Staff Annual No. % Title Name Salary Months Time STATE MATCH ( if applicable) TOTAL

Category Total

OKLAHOMA STATE DEPARTMENT OF HEALTH

CONTRACT BUDGET FORM

Contractor Name: ______________________________________________ Date: _______________

Narrative/Detail Budget Request (Continued):

Fringe Benefits STATE MATCH (if applicable) TOTAL

Category Totals Travel-PerDiem/Training STATE MATCH (if applicable) TOTAL

Supplies STATE MATCH (if applicable) TOTAL

Contractual STATE MATCH (if applicable) TOTAL

Admin Costs/IDC STATE MATCH (if applicable) TOTAL

Other STATE MATCH (if applicable) TOTAL

STATE MATCH (if applicable) TOTAL

TOTAL PROGRAM COSTS

Contractor’s Signature: ____________________________________________ Date: ______________

Printed Name: ___________________________________ Title: ____________________________

Budget Line Item
Personnel/Salaries
Position Staff Annual No. %
STATE
Category Total
Fringe Benefits
STATE
Category Totals
Travel-PerDiem/Training
STATE
Category Totals
Supplies
STATE
Category Totals
Contractual
STATE
Category Totals
Admin Costs/IDC
STATE
Category Totals
Other
STATE
Category Totals
STATE
TOTAL PROGRAM COSTS
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