RFP 202602 Dementia Caregiver Support Services BW.xlsx

XLSX spreadsheet 51 KB Posted

Attached to
Dementia & Caregiver Support Services
Solicitation number
202602
Issued by
Kenosha County, Kellnersville Village, Wisconsin

About this file

This is a budget worksheet template prepared by the Kenosha County Department of Human Services for use in RFP 202602 regarding Dementia Caregiver Support Services. The template is designed to capture comprehensive budget information from bidding organizations, including detailed personnel costs, benefit allocations, and other program expenses. The document does not specify response dates, due dates, site visits, bidder meetings, award dates, or contract terms, as it functions as a blank budget submission form to be completed by prospective contractors rather than as a formal RFP document.

The budget template consists of five primary worksheets that require bidders to itemize salary allocations and full-time equivalent (FTE) positions with degree level classifications, calculate benefit costs including FICA, health insurance premiums, unemployment compensation, and retirement contributions, summarize total program expenses across multiple cost categories, provide detailed explanations for contracted services and equipment purchases exceeding $500, and identify any other revenue sources offsetting the program budget. The template permits for-profit agencies to include a maximum five percent profit margin and supports both actual reimbursement and unit-rate budget methodologies. Bidders must not exceed the program funding level specified by the Department of Human Services, and the template includes provisions for administration allocation rates with required detailed calculation methodology explanations. The document is version 141104 and includes protected worksheets with designated unprotected areas for data entry identified by blue shading.

View the file

Other files

File Type Posted
RFP 202602 Dementia Caregiver Support Services.pdf PDF

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

1. FTE & Salary Allocation

Kenosha County Department of Human Services Budget Worksheet #1 -- FTE & Salary AllocationVersion: 141104
Contract ID:Entered by Kenosha CountyEnter Agency Name Here
Enter Dates of Contract Here
Please enter all information as indicated by BLUE font color and shaded in BLUE.
Enter Program Name Here
PositionFirst NameLast NameDegree LevelEnter Annual Salary regardless of time allocated to ProgramTotal FTEDirect Staff FTEAdmin/ Clerical/ SupervisionAllocation of Salary to Program
1- 0- 0
2- 0- 0
3- 0- 0
4- 0- 0
5- 0- 0
6- 0- 0
7- 0- 0
8- 0- 0
9- 0- 0
10- 0- 0
11- 0- 0
12- 0- 0
13- 0- 0
14- 0- 0
15- 0- 0
16- 0- 0
17- 0- 0
18- 0- 0
19- 0- 0
20- 0- 0
21- 0- 0
22- 0- 0
23- 0- 0
24- 0- 0
25- 0- 0
26- 0- 0
27- 0- 0
28- 0- 0
29- 0- 0
30- 0- 0
31- 0- 0
32- 0- 0
33- 0- 0
34- 0- 0
35- 0- 0
36- 0- 0
37- 0- 0
38- 0- 0
39- 0- 0
40- 0- 0
41- 0- 0
42- 0- 0
43- 0- 0
44- 0- 0
45- 0- 0
46- 0- 0
47- 0- 0
48- 0- 0
49- 0- 0
50- 0- 0
Total Time Allocation- 0- 0- 0- 0- 0

Date printed: &D &A Version: 141104

2. Benefit Allocation

Kenosha County Department of Human Services Budget Worksheet #2 -- Benefit AllocationVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here
Please enter all information as indicated by BLUE font color and shaded in BLUE.

Annual amounts should be entered. The last column will adjust to the actual FTE % allocated to the program as shown on the Time Allocation worksheet (#1).

Annual Salary and Benefit CalculationEnter Program Name Here
PositionAnnual SalaryFICAAnnual Health Insurance Premiums (if applicable)State and Federal UC (if applicable)Retirement (if applicable)Other ExplanationOther $Total Annual BenefitsAllocated Program Benefits
1-- 0- 0- 0- 0
2-- 0- 0- 0- 0
3-- 0- 0- 0- 0
4-- 0- 0- 0- 0
5-- 0- 0- 0- 0
6-- 0- 0- 0- 0
7-- 0- 0- 0- 0
8-- 0- 0- 0- 0
9-- 0- 0- 0- 0
10-- 0- 0- 0- 0
11-- 0- 0- 0- 0
12-- 0- 0- 0- 0
13-- 0- 0- 0- 0
14-- 0- 0- 0- 0
15-- 0- 0- 0- 0
16-- 0- 0- 0- 0
17-- 0- 0- 0- 0
18-- 0- 0- 0- 0
19-- 0- 0- 0- 0
20-- 0- 0- 0- 0
21-- 0- 0- 0- 0
22-- 0- 0- 0- 0
23-- 0- 0- 0- 0
24-- 0- 0- 0- 0
25-- 0- 0- 0- 0
26-- 0- 0- 0- 0
27-- 0- 0- 0- 0
28-- 0- 0- 0- 0
29-- 0- 0- 0- 0
30-- 0- 0- 0- 0
31-- 0- 0- 0- 0
32-- 0- 0- 0- 0
33-- 0- 0- 0- 0
34-- 0- 0- 0- 0
35-- 0- 0- 0- 0
36-- 0- 0- 0- 0
37-- 0- 0- 0- 0
38-- 0- 0- 0- 0
39-- 0- 0- 0- 0
40-- 0- 0- 0- 0
41-- 0- 0- 0- 0
42-- 0- 0- 0- 0
43-- 0- 0- 0- 0
44-- 0- 0- 0- 0
45-- 0- 0- 0- 0
46-- 0- 0- 0- 0
47-- 0- 0- 0- 0
48-- 0- 0- 0- 0
49-- 0- 0- 0- 0
50-- 0- 0- 0- 0
Total Benefits- 0- 0- 0- 0- 0- 0- 0- 0

Date printed: &D &A Version: 141104

3. Total Expense Summary

Kenosha County Department of Human Services Budget Worksheet #3 -- Total Expense SummaryVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here
Please enter all information as indicated by BLUE font color and BLUE shaded area.
Total Expense Summary
Enter Program Name Here
1Salary Allocation - Worksheet 1- 0
2Benefit Allocation - Worksheet 2- 0
Total Personnel Costs- 0
OTHER EXPENSES:
3Contracted Program (Enter detail found on Worksheet 4)- 0
4Contracted Other (Enter detail found on Worksheet 4)- 0
5Equipment Purchases (Single Item Purchase over $500 AND useful life of more than 1 year) Enter individual descriptions on Worksheet 4- 0
6Other (Enter detail found on Worksheet 4)- 0
7Data Processing
8Staff Training/Development
9Staff Travel
10Insurance
11Interest
12Legal & Accounting
13Licenses
14Postage
15Printing
16Rent - Building
17Rent - Equipment
18Repair & Maintenance
19Building Depreciation
20Supplies
21Non-Payroll Taxes
22Telephone
23Utilities
Sub-Total Other- 0
Sub-Total including Personnel- 0
Administration Allocation Rate

A DETAILED EXPLANATION OF CALCULATION METHOD USED MUST BE ATTACHED

Administration Allocation Rate
A DETAILED EXPLANATION OF CALCULATION METHOD USED MUST BE ATTACHED- 0
Expected Profit (Maximum 5%) (FOR PROFIT AGENCIES ONLY)0%
Total PROGRAM Budget- 0
Offset by Other Revenue Sources as Listed on Tab 5- 0
Total Agency Budget to be used for DHS Contract--Must NOT exceed Program Funding level as specified by Department of Human Services- 0
STOP HERE IF ACTUAL REIMBURSEMENT BUDGET HAS BEEN REQUESTED. CONTINUE ON ONLY IF UNIT RATE BUDGET HAS BEEN REQUESTED.
Optional: Input units based on Previous Years Actuals
Total Units-Calculated based on Time Allocation Worksheet from Direct Staff Column (DS FTE x 2080 x 75%)- 0
Cost Per Unit/Program$ - 0

Date Printed: &D &A Version: 141104

4. Other Services Explanation

Kenosha County Department of Human Services Budget Worksheet #4 - Detail of Other ExpensesVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here
Please enter all information as indicated by BLUE font color and BLUE shaded area.
List Detail of Other Services
Tab 3 Line 3 - Must provide detail explanation including consultant name and degree level if applicable:Enter Program Name Here
Contracted Program

Contracted Other:

List Equipment over $500 with a useful life of more than 1 year:

Other Expenses

Total - 0

Date Printed: &D &A Version: 141104

5. Revenue Sources (Optional)

Kenosha County Department of Human Services Budget Worksheet #5 -- Other Revenue SourcesVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here

Please enter all information as indicated by BLUE font color and BLUE shaded area.

List Other Revenue Sources by Program
Enter source of revenue here:Enter Program Name Here
Total Other Revenue Sources- 0
Use of above revenue sources--Provide detailed explanation:

Budget - Unit Rate &A Version: 141104

Utility Worksheet

Utility Worksheet
Field NameValueDescription
Workbook Type9Budget - Unit Rate
Template Version141104(Read-Only) Template Version Number
Workbook IDID of workbook as stored in tlog_CMS_ContractWorkbook
Contract IDForeign Key to the system ID for the Contract
Creation DateDate the Workbook was created
AuthorPerson creating the workbook
Upload DateDate the Workbook was uploaded

Revision History

Revision History
DateDeveloperNotes
5/22/06BR- Added Utility Worksheet
- Added Revision History Worksheet
- Added Macro 'UpdateFooter '
- Added Version # to display
- General formatting (font size, display %)
7/27/06BR- Protected all Worksheets
Note: Blue shaded areas are unprotected
- Corrected cell reference error (Benefit Allocation Worksheet Col B)
8/1/06EJSheet One, Columns D & E - Display 3 decimal places.
6/12/07BRSheet 3 - Decreased size of Column B to 32.57 (was not printing on OOD color printer)
10/22/09BRSheet 3 - Added Cell C38
Sheet 3 - Updated formula for Cell B38 to check for value in Cell C38
11/4/14BRSheet 1 - Added columns 'First Name', 'Last Name', 'Degree Level'
- Added Lists Worksheet (Hidden)

Lists

Degree Level
Advanced Practice Nurse Practitioner
Bachelors Degree
Masters Degree
Psychiatrist/MD
Less than Bachelor’s Degree
PhD Psychologist/Doctoral
Registered Nurse/Licensed Practical Nurse
Qualified Treatment Trainee

File details come from the government source that posted it. Updated .