Exhibit D Budget Proposal Submission Form .xlsx
XLSX spreadsheet 56 KB Posted
- Solicitation number
- RFP IHFA 2016000036 2
- Issued by
- Denver County, Denver City, Colorado
About this file
This is an Exhibit D Budget Proposal Submission Form prepared by the Colorado Department of Human Services for the TGYS (Targeting Goods and Services) Evidence-Based Training/Technical Assistance project. The form is structured to capture cost proposals across four distinct budget periods: Phase One, Phase Two, Phase Three, and Additional Project Work/Data, with a consolidated summary section combining Phases 1, 2, and 3. The template is designed for vendors to itemize personnel services, supplies and operating expenses, financial assistance to sub-grantees, travel, subcontracts, and indirect costs across each project phase. Each section requires vendors to identify the Scope of Work (SOW) objectives and activities supported by budgeted items, specify match or in-kind contributions, and differentiate between amounts requested from CDHS and other funding sources.
The budget form contains no pre-filled cost data, with all line items showing $0.00 values across all expenditure categories, indicating this is a blank template awaiting vendor completion. The form requires detailed information for personnel services including gross monthly salary, monthly fringe benefits, percentage of FTE on the project, number of months, position title, employee name, and description of work with SOW section references. Vendors must also provide fiscal contact information and program contact details for each phase. The consolidated summary sheet aggregates personnel services, supplies and operating expenses, financial assistance, travel, contractual costs, indirect costs, total match or in-kind contributions, and the total amount requested from CDHS across all three primary project phases. No specific budget caps, funding amounts, or contract term information is indicated in this template document.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit B - HIPAA Business Associate Agreement.doc | DOC document | |
| Exhibit E Sample Option Letter.doc | DOC document | |
| TA Evidence Based Practices QA.docx | DOCX document | |
| Exhibit A - Sample State Contract.docx | DOCX document | |
| Exhibit C Additional SOW Provisions.docx | DOCX document | |
| Exhibit F Signature page.doc | DOC document | |
| 2016000036 TGYS v2.docx | DOCX document |
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Text version
Proj Phase One
| VENDOR - Exhibit D Cost Proposal Budget - PHASE ONE | |
| Prepared by the Colorado Department of Human Services |
| Offeror Name | Program Contact Name, Title, Phone and Email | |
| Budget Period | Fiscal Contact Name, Title, Phone and Email | |
| Project Name | TGYS- Evidence-Base Training/Technical Assistance |
| Expenditure Categories | Match or In-Kind (If Applicable) | Total Amount Requested from CDHS | |||||||
| Personnel Services | Gross Monthly Salary | Monthly | |||||||
| Fringe | Percent of FTE on Project | Number of Months | |||||||
| Position Title/Employee Name | Description of Work (for hourly employees, please include the hourly rate and number of hours in your description). Include # of months budgeted. Also SOW section numbers they will work on. | ||||||||
| $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 | |||||||||
| $0.00 | |||||||||
| Total Personnel Services | |||||||||
| (including fringe benefits) | $0.00 | $0.00 | 0% | $0.00 | $0.00 | ||||
| Supplies & Operating Expenses | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Supplies | |||||||||
| & Operating Expenses | $0.00 | $0.00 | |||||||
| Financial Assistance -Subgrants, etc. (for Phase 3) | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| Sub-Grants to Sub-Grantees (If Applicable) | $0.00 | ||||||||
| Other Costs associated with Sub-Grantees (e.g. stipends, travel support, events, etc). | $0.00 | ||||||||
| $0.00 | |||||||||
| Total Financial Assistance to Sub-Grantees | $0.00 | $0.00 | |||||||
| Travel | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Travel | $0.00 | $0.00 | |||||||
| Subcontracts | |||||||||
| Item | Subcontractor Entity Name and/or Description of Item. | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDPHE | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Contractual | $0.00 | $0.00 | |||||||
| SUB-TOTAL AMOUNT REQUESTED BEFORE INDIRECT | $0.00 | ||||||||
| Indirect | |||||||||
| Item | Description of Item (description is not necessary for the negotiated rate agreement) | ||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Indirect | $0.00 | $0.00 | |||||||
| TOTAL MATCH OR IN KIND | $0.00 | ||||||||
| Phase One - TOTAL AMOUNT REQUESTED FROM CDHS | $0.00 |
Proj Phase Two
| VENDOR - Exhibit D Cost Proposal Budget - PHASE TWO | |
| Prepared by the Colorado Department of Human Services |
| Offeror Name | Program Contact Name, Title, Phone and Email | |
| Budget Period | Fiscal Contact Name, Title, Phone and Email | |
| Project Name | TGYS- Evidence-Base Training/Technical Assistance |
| Expenditure Categories | Match or In-Kind (If Applicable) | Total Amount Requested from CDHS | |||||||
| Personnel Services | Gross Monthly Salary | Monthly | |||||||
| Fringe | Percent of FTE on Project | Number of Months | |||||||
| Position Title/Employee Name | Description of Work (for hourly employees, please include the hourly rate and number of hours in your description). Include # of months budgeted. Also SOW section numbers they will work on. | ||||||||
| $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 Personnel Services | |||||||||
| (including fringe benefits) | $0.00 | $0.00 | 0% | $0.00 | $0.00 | ||||
| Supplies & Operating Expenses | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Supplies | |||||||||
| & Operating Expenses | $0.00 | $0.00 | |||||||
| Financial Assistance -Subgrants, etc. (for Phase 3) | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| Sub-Grants to Sub-Grantees (If Applicable) | $0.00 | ||||||||
| Other Costs associated with Sub-Grantees (e.g. stipends, travel support, events, etc). | $0.00 | ||||||||
| $0.00 | |||||||||
| Total Financial Assistance to Sub-Grantees | $0.00 | $0.00 | |||||||
| Travel | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Travel | $0.00 | $0.00 | |||||||
| Subcontracts | |||||||||
| Item | Subcontractor Entity Name and/or Description of Item. | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDPHE | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Contractual | $0.00 | $0.00 | |||||||
| SUB-TOTAL AMOUNT REQUESTED BEFORE INDIRECT | $0.00 | ||||||||
| Indirect | |||||||||
| Item | Description of Item (description is not necessary for the negotiated rate agreement) | ||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Indirect | $0.00 | $0.00 | |||||||
| TOTAL MATCH OR IN KIND | $0.00 | ||||||||
| PHASE TWO-TOTAL AMOUNT REQUESTED FROM CDHS | $0.00 |
Proj Phase 3
| VENDOR - Exhibit D Cost Proposal Budget - PHASE THREE | |
| Prepared by the Colorado Department of Human Services |
| Offeror Name | Program Contact Name, Title, Phone and Email | |
| Budget Period | Fiscal Contact Name, Title, Phone and Email | |
| Project Name | TGYS- Evidence-Base Training/Technical Assistance |
| Expenditure Categories | Match or In-Kind (If Applicable) | Total Amount Requested from CDHS | |||||||
| Personnel Services | Gross Monthly Salary | Monthly | |||||||
| Fringe | Percent of FTE on Project | Number of Months | |||||||
| Position Title/Employee Name | Description of Work (for hourly employees, please include the hourly rate and number of hours in your description). Include # of months budgeted. Also SOW section numbers they will work on. | ||||||||
| $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 Personnel Services | |||||||||
| (including fringe benefits) | $0.00 | $0.00 | 0% | $0.00 | $0.00 | ||||
| Supplies & Operating Expenses | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Supplies | |||||||||
| & Operating Expenses | $0.00 | $0.00 | |||||||
| Financial Assistance -Subgrants, etc. (for Phase 3) | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| Sub-Grants to Sub-Grantees (If Applicable) | $0.00 | ||||||||
| Other Costs associated with Sub-Grantees (e.g. stipends, travel support, events, etc). | $0.00 | ||||||||
| $0.00 | |||||||||
| Total Financial Assistance to Sub-Grantees | $0.00 | $0.00 | |||||||
| Travel | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Travel | $0.00 | $0.00 | |||||||
| Subcontracts | |||||||||
| Item | Subcontractor Entity Name and/or Description of Item. | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDPHE | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Contractual | $0.00 | $0.00 | |||||||
| SUB-TOTAL AMOUNT REQUESTED BEFORE INDIRECT | $0.00 | ||||||||
| Indirect | |||||||||
| Item | Description of Item (description is not necessary for the negotiated rate agreement) | ||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Indirect | $0.00 | $0.00 | |||||||
| TOTAL MATCH OR IN KIND | $0.00 | ||||||||
| PHASE THREE-TOTAL AMOUNT REQUESTED FROM CDHS | $0.00 |
Addtional Proj Work or Data
| VENDOR - Exhibit D Cost Proposal Budget - ADDITIONAL PROJECT WORK/DATA | |
| Prepared by the Colorado Department of Human Services |
| Offeror Name | Program Contact Name, Title, Phone and Email | |
| Budget Period | Fiscal Contact Name, Title, Phone and Email | |
| Project Name | TGYS- Evidence-Base Training/Technical Assistance |
| Expenditure Categories | Match or In-Kind (If Applicable) | Total Amount Requested from CDHS | |||||||
| Personnel Services | Gross Monthly Salary | Monthly | |||||||
| Fringe | Percent of FTE on Project | Number of Months | |||||||
| Position Title/Employee Name | Description of Work (for hourly employees, please include the hourly rate and number of hours in your description). Include # of months budgeted. Also SOW section numbers they will work on. | ||||||||
| $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 Personnel Services | |||||||||
| (including fringe benefits) | $0.00 | $0.00 | 0% | $0.00 | $0.00 | ||||
| Supplies & Operating Expenses | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Supplies | |||||||||
| & Operating Expenses | $0.00 | $0.00 | |||||||
| Financial Assistance -Subgrants, etc. (for Phase 3) | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| Sub-Grants to Sub-Grantees (If Applicable) | $0.00 | ||||||||
| Other Costs associated with Sub-Grantees (e.g. stipends, travel support, events, etc). | $0.00 | ||||||||
| $0.00 | |||||||||
| Total Financial Assistance to Sub-Grantees | $0.00 | $0.00 | |||||||
| Travel | |||||||||
| Item | Description of Item | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDHS | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Travel | $0.00 | $0.00 | |||||||
| Subcontracts | |||||||||
| Item | Subcontractor Entity Name and/or Description of Item. | List SOW objective/activity number(s) this budget item supports | Rate | Quantity | Match or In kind (if applicable) | Total Amount Requested from CDPHE | |||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Contractual | $0.00 | $0.00 | |||||||
| SUB-TOTAL AMOUNT REQUESTED BEFORE INDIRECT | $0.00 | ||||||||
| Indirect | |||||||||
| Item | Description of Item (description is not necessary for the negotiated rate agreement) | ||||||||
| $0.00 | |||||||||
| $0.00 | |||||||||
| Total Indirect | $0.00 | $0.00 | |||||||
| TOTAL MATCH OR IN KIND | $0.00 | ||||||||
| ADDITIONAL PROJ. WORK or DATA_TOTAL AMOUNT REQUESTED FROM CDHS | $0.00 |
Consol. Summary Phase 1 2 and 3
| VENDOR - Exhibit D Cost Proposal Budget- Summary - Phase 1,2,3. | |
| Prepared by the Colorado Department of Human Services |
| Offeror Name | Program Contact Name, Title, Phone and Email | |
| Budget Period | Fiscal Contact Name, Title, Phone and Email | |
| Project Name | TGYS- Evidence-Base Training/Technical Assistance |
| Expenditure Categories | Match or In-Kind (If Applicable) | Total Amount Requested from CDHS | ||||||
| Personnel Services | Gross Monthly Salary | Monthly | ||||||
| Fringe | Percent of FTE on Project | Number of Months | ||||||
| Total Personnel Services | ||||||||
| (including fringe benefits) | $0.00 | $0.00 | ||||||
| Supplies & Operating Expenses | ||||||||
| Total Supplies | ||||||||
| & Operating Expenses | $0.00 | $0.00 | ||||||
| Financial Assistance -Subgrants, etc. (for Phase 3) | ||||||||
| Total Financial Assistance to Sub-Grantees | $0.00 | $0.00 | ||||||
| Travel | ||||||||
| Total Travel | $0.00 | $0.00 | ||||||
| Subcontracts | ||||||||
| Total Contractual | $0.00 | $0.00 | ||||||
| SUB-TOTAL AMOUNT REQUESTED BEFORE INDIRECT | $0.00 | |||||||
| Indirect | ||||||||
| Total Indirect | $0.00 | $0.00 | ||||||
| TOTAL MATCH OR IN KIND | $0.00 | |||||||
| TOTAL AMOUNT REQUESTED FROM CDHS | $0.00 |
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