Exhibit C - Budget with Justification Form.xlsx
XLSX spreadsheet 20 KB Posted
- Attached to
- RFP-Managed Care at YSCs
- Solicitation number
- RFP IKAA 2026000150 3
- Issued by
- Pueblo County, Colorado
About this file
This is a Budget with Justification Form (Exhibit C) issued by the Colorado Department of Human Services, Division of Youth Services, for use in responding to the RFP-Managed Care at YSCs solicitation. The form serves as a template for offerors to submit detailed budget information associated with their proposals for managed care services at Youth Services Centers (YSCs). The document requires offerors to provide comprehensive budget justifications organized by expenditure category, including administrative personnel services, administrative operating expenses, direct staff personal services, contractual services, and supplies and operating expenses including travel.
The budget template establishes specific requirements for cost justification and documentation. Offerors must justify all personnel by position title and describe the role and expected contribution of budgeted staff, including the percentage of full-time equivalency (FTE) if applicable. Fringe benefit calculations must be detailed with component breakdowns including insurance, paid time off, and pension contributions. For contractual services, offerors must describe subcontractor selection methods, work to be performed, expected deliverables, and cost calculation methodologies. The form accommodates indirect costs, cost allocation, and profit only when accompanied by negotiated rate agreements or approved indirect rate plans. All line items require rate, quantity, and total amount calculations, with subtotals provided for administrative costs, direct costs, and indirect costs before arriving at the total amount requested from CDHS.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit D Contract Template, Terms & Conditions v 4.13 Final Locked.docx.pdf | ||
| Addendum 1_Answers.docx | DOCX document | |
| Addendum 2 .docx | DOCX document | |
| Exhibit A DYS Accounting Requirements.docx | DOCX document | |
| Exhibit B HIPAA BAA (Business Associate Agreement).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 .