Exhibit C - Budget with Justification Form.xlsx
XLSX spreadsheet 20 KB Posted
- Attached to
- RFP-Managed Care at YSCs
- Solicitation number
- RFP IKAA 2026000150 2
- Issued by
- Pueblo County, Colorado
About this file
This is a Budget with Justification Form (Exhibit C) for the Colorado Department of Human Services, Division of Youth Services, designed for use in response to the RFP-Managed Care at YSCs contract opportunity. The form serves as a template for offerors to submit detailed budget proposals for the managed care program at Youth Services Centers (YSCs). The document is structured to capture comprehensive cost information across multiple expenditure categories, including administrative personnel services, administrative operating expenses, direct staff personal services, contractual services, supplies and operating expenses (including travel), and indirect costs or cost allocation.
The budget template requires offerors to provide line-item justifications for all proposed costs, with particular emphasis on personnel expenses that must include position titles, descriptions of work, annual gross salaries, benefits/fringe calculations, and the percentage of time allocated to the project. For non-personnel costs, offerors must explain the rationale and methodology for cost estimates. The form accommodates subcontractor costs with requirements for detailed descriptions of work scope, deliverables, and cost calculation methods. Offerors requesting indirect costs must provide copies of their negotiated indirect rate plans or cost allocation plans, with CDHS agreeing to honor state or federal negotiated rate agreements. The template allows for itemization of multiple positions and expenses across all categories, with automatic subtotals for administrative costs, direct costs, and final total budget requests. This form is designed to ensure standardized, transparent budget submissions that facilitate comparison and evaluation across competing proposals.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit A DYS Accounting Requirements.docx | DOCX document | |
| Exhibit B HIPAA BAA (Business Associate Agreement).docx | DOCX document | |
| Exhibit D Contract Template, Terms & Conditions v 4.13 Final Locked.docx.pdf | ||
| Addendum 1_Answers.docx | DOCX document | |
| Final RFP Managed Care .docx | DOCX document |
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Text version
Budget Template
| Exhibit C - Budget with Justification Form | |
| Colorado Department of Human Services |
DIVISION OF YOUTH SERVICES - BUDGET WITH JUSTIFICATION FORM
| Offeror Business Name | Program Contact Name, Title, Phone and Email |
| Budget Period | Fiscal Contact Name, Title, Phone and Email |
| Project Name |
| Expenditure Categories |
| Administrative Personal Services |
Position Title Description of Work Public Health & Environment:
Enter budget justification for the employee or position title. Justification should address the role and expected contribution of budgeted personnel.
If less than full FTE, indicate in the description the % FTE worked for your agency.
Describe how fringe is projected and what components are included (insurance, paid time off, pension, etc).
Gross or Annual Salary Deborah J. Polk: Enter the employee's annual (12 month) gross salary.
Benefits Deborah J. Polk: Enter the total amount of fringe for the employee based on their annual salary.
Percent of Time on Project Deborah J. Polk: Enter the percentage of the employee's time spent on the project during the contract period.
| Total Amount Requested from CDHS | |||
| $0.00 | |||
| $0.00 | |||
| $0.00 | |||
| $0.00 | |||
| $0.00 | |||
| $0.00 | |||
| $0.00 | |||
| $0.00 | |||
| $0.00 | |||
| Total Administrative Personal Services (including benefits) | $0 | ||
| Administrative Operating | |||
| Item | Description of Item |
: Item Description should include the rationale for the costs budgeted and a description of how cost estimates are calculated.
Examples of supplies & operating expenses: printing/copying, postage/shipping, phone/fax/internet, general office supplies, meetings supplies, etc.
| Rate | Quantity | Total Amount Requested from CDHS | ||
| $0.00 | ||||
| $0.00 | ||||
| $0.00 | ||||
| $0.00 | ||||
| $0.00 | ||||
| $0.00 | ||||
| $0.00 | ||||
| $0.00 | ||||
| Total Administrative Operating Expenses | $0 | |||
| SUB-TOTAL ADMINISTRATIVE COSTS | $0 | |||
| Direct Staff Personal Services |
Position Title Description of Work Public Health & Environment:
Enter budget justification for the employee or position title. Justification should address the role and expected contribution of budgeted personnel.
If less than full FTE, indicate in the description the % FTE worked for your agency.
Describe how fringe is projected and what components are included (insurance, paid time off, pension, etc).
Gross or Annual Salary Deborah J. Polk: Enter the employee's annual (12 month) gross salary.
Benefits Deborah J. Polk: Enter the total amount of fringe for the employee based on their annual salary.
Percent of Time on Project Deborah J. Polk: Enter the percentage of the employee's time spent on the project during the contract period.
| Total Amount Requested from CDHS | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| $0.00 | |||||
| Total Direct Staff Personal Services | |||||
| (including benefits) | $0 | ||||
| Contractual Services | |||||
| Subcontractor Name | Description of Item |
: Include all subcontracts required to complete the proposed work plan.
Describe how the subcontractors will be selected, the work to be performed, expected deliverables, and a brief description of how costs were calculated.
Examples include: consulting, outsourced evaluation, media/advertising agency, etc.
| Rate | Quantity | Total Amount Requested from CDHS | ||
| $0 | ||||
| $0 | ||||
| $0 | ||||
| $0 | ||||
| $0 | ||||
| $0 | ||||
| $0 | ||||
| Total Contractual | $0 | |||
| Supplies & Operating Expenses (including Travel) | ||||
| Item | Description of Item |
: Item Description should include the rationale for the costs budgeted and a description of how cost estimates are calculated.
Examples of supplies & operating expenses: printing/copying, postage/shipping, phone/fax/internet, general office supplies, meetings supplies, etc.
Public Health & Environment:
Enter budget justification for the employee or position title. Justification should address the role and expected contribution of budgeted personnel.
If less than full FTE, indicate in the description the % FTE worked for your agency.
Describe how fringe is projected and what components are included (insurance, paid time off, pension, etc).
Deborah J. Polk: Enter Budget Period Dates
Deborah J. Polk: Enter the employee's annual (12 month) gross salary.
Deborah J. Polk: Enter the total amount of fringe for the employee based on their annual salary.
Deborah J. Polk: Enter the percentage of the employee's time spent on the project during the contract period.
Public Health & Environment:
Enter budget justification for the employee or position title. Justification should address the role and expected contribution of budgeted personnel.
If less than full FTE, indicate in the description the % FTE worked for your agency.
Describe how fringe is projected and what components are included (insurance, paid time off, pension, etc).
Deborah J. Polk: Enter the employee's annual (12 month) gross salary.
Deborah J. Polk: Enter the total amount of fringe for the employee based on their annual salary.
Deborah J. Polk: Enter the percentage of the employee's time spent on the project during the contract period.
| Rate | Quantity | Total Amount Requested from CDHS | |
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| $0 | |||
| Total Direct Supplies & Operating | $0 | ||
| SUB-TOTAL DIRECT COSTS | $0 | ||
| SUB-TOTAL BEFORE INDIRECT | $0 | ||
| Indirect/Cost Allocation/Profit | |||
| Item | Description of Item |
Applicants requesting indirect must provide CDHS with a copy of their indirect rate plan or cost allocation plan.
CDHS will honor state or federal negotiated rate agreements.
Any projected profit also should be included here and detailed.
Operational expenses that support this program but not included in an indirect rate plan, may be included in the Supply and Operating category of the budget.
| Total Amount Requested from CDHS | |
| Indirect rate/Cost Allocation/Profit |
Public Health & Environment:
If applicable, please provide your negotiated Indirect Cost rate and the basis (e.g.. total direct costs, salary, salary + fringe, etc.) in the description of item. Provide a copy of the approved rate agreement.
Applicants requesting indirect without a negotiated rate must provide a copy of their indirect rate plan or cost allocation plan.
Any allocated profit would also be included here and broken down.
Indirect (modified or additional base) Public Health & Environment:
If your Indirect Cost rate is modified based on specific budget line items, please include additional rates in this section.
Example: Additional indirect rate on contractual costs
: Include all subcontracts required to complete the proposed work plan.
Describe how the subcontractors will be selected, the work to be performed, expected deliverables, and a brief description of how costs were calculated.
Examples include: consulting, outsourced evaluation, media/advertising agency, etc.
: Item Description should include the rationale for the costs budgeted and a description of how cost estimates are calculated.
Examples of supplies & operating expenses: printing/copying, postage/shipping, phone/fax/internet, general office supplies, meetings supplies, etc.
| Total Indirect | $0 | ||
| TOTAL | $0 |
Exhibit C Budget
Page &P of &N V. 1 Jan 2013
File details come from the government source that posted it. Updated .