Attachment_8_Cost_Breakdown_Form.docx

Attachment 8 RFQ No. NIHLM2013704(B) Full and Open

Attachment 8 RFQ No. NIHLM2013704(B) Full and Open

Cost Breakdown Form

HIV/AIDS Community Information Outreach Project 2013

Organization: _____________________ Date Submitted: _________________

Period Covered: ________________________

EXPENDITURE CATEGORY

COST

DIRECT LABOR

PROFESSIONAL PERSONNEL

SUPPORT PERSONNEL

FRINGE BENEFITS

EQUIPMENT

SUPPLIES

TRAVEL

COMMUNICATIONS

REPRODUCTION

OTHER COSTS (SPECIFY)

CONSULTANTS

DOCUMENT DELIVERY

TOTAL DIRECT COST

[MODIFIED TOTAL DIRECT COST]

OVERHEAD/IDC (____ %)

TOTAL

Does your organization currently have a negotiated indirect cost rate agreement with any U.S. Government agency? __Yes __ No (If Yes, please identify agency________________________________________)

Will you require the purchase of equipment in the performance of this proposed contract? Yes No

Do you now hold any contract for the same or similar work called for by this proposed solicitation with any other government agency? __ Yes __ No (If yes, please identify contract and agency_______________ ____________________________________________________________________________________)

· If travel is proposed, provide statement addressing the following details on destination(s); duration of trip(s); number of travelers; and cost per trip, broken down by cost elements, e.g., airfare, lodging, and meals.

· If consultants are proposed, provide name(s), rate(s), and number of hours/days.

NOTE: The above categories are examples only and are not meant to be all-inclusive.