WW Budget Template 01.22.15.pdf
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- Attached to
- Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program
- Opportunity number
- CDC-RFA-DP13-130203CONT15
- Issued by
-
Department of Health and Human Services
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WW BUDGET TEMPLATE
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WISEWOMAN Budget
WISEWOMAN
Budget Template
The following navigation bar is available on all worksheets
Click a tab to jump to the corresponding sheet:
Instructions:
You may use this template to prepare a budget for WISEWOMAN. Please refer to the supplemental guidance document for more information.
For program specific fiscal guidance, please refer to the Technical Assistance and Guidance Document previously shared.
Carryover Requests: When submitting carryover requests, please submit a separate budget template labeled ‘carryover request’
Notes on Data Entry:
All light yellow cells are available for user input.
Conditional formatting may highlight cells red if values are missing, not valid, or violate program rules.
[Enter State/Tribal Program Name]
Home Summary Personnel Contracts Consultants Equipment Supplies Travel Other Matching
Home Page 1/20/2015 1 of 82
Direct Non Direct
Salary and Wages -$ -$ -$ 33% Minimum Match
Fringe Benefits -$ -$ -$ Total Matching Funds -$
Contractual Costs -$ -$ -$ Actual Match % #DIV/0!
Consultant Costs -$ -$ -$
Equipment -$ -$ -$ 10 % Maximum Administrative Cost
Supplies -$ -$ -$ Total Admin Costs -$
Travel -$ -$ -$ Actual Admin % #DIV/0!
Other -$ -$ -$
Direct Costs -$ -$ -$
Indirect Costs N/A N/A N/A
TOTAL -$ -$ -$
Percent of Total #DIV/0! #DIV/0!
[Enter State/Tribal Program Name] - Budget Summary
Service Type Object Class Total
Summary 1/20/2015 2 of 82
Personnel Salary and Fringe
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Allocation of Cost by Service Type
Fringe
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Personnel Salary and Fringe 1/20/2015 3 of 82
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Justification
Justification
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 4 of 82
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Salary and Fringe 1/20/2015 5 of 82
Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 6 of 82
Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 7 of 82
Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 8 of 82
Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 9 of 82
Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 10 of 82
Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 11 of 82
Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 12 of 82
Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 13 of 82
Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 14 of 82
Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 15 of 82
Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 16 of 82
Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Personnel Cost
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 17 of 82
Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Name Position Title Annual Salary and Wages
% Paid by This
Grant Months Salary and Wages
Fringe (%) Fringe ($) if not % Fringe Total Planned
Direct
Non Direct
Direct
Non Direct
Total Allocated
Allocation 0.0% 0.0% $ - $ - $ -
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Personnel Cost
Fringe
Allocation of Cost by Service Type
Justification
Fringe
Allocation of Cost by Service Type
Personnel Salary and Fringe 1/20/2015 18 of 82
Personnel Salary and Fringe 1/20/2015 19 of 82
Contracts
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Consultant Costs
Equipment
Basic Information Itemized Costs
Salary and Wages
Fringe Benefits
Scope of Work
Method of Accountability
Supplies
Travel
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Subcontract Costs
TOTAL DIRECT COSTS
Allocation of Cost by Service Type
Consultant Costs
Equipment
Indirect Costs ($)
Basic Information Itemized Costs
Salary and Wages
Fringe Benefits
Contracts 1/20/2015 20 of 82
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Method of Accountability
Allocation of Cost by Service Type
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Scope of Work
Supplies
Travel
Contracts 1/20/2015 21 of 82
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Subcontract Costs
TOTAL DIRECT COSTS
Contracts 1/20/2015 22 of 82
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Contracts 1/20/2015 23 of 82
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
Contracts 1/20/2015 24 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Salary and Wages
Fringe Benefits
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Contracts 1/20/2015 25 of 82
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Method of Accountability
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Contracts 1/20/2015 26 of 82
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Indirect Costs ($)
TOTAL INDIRECT COSTS
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Allocation of Cost by Service Type
Subcontract Costs
Contracts 1/20/2015 27 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$ Equipment
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
TOTAL FOR CONTRACT
Contracts 1/20/2015 28 of 82
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Method of Accountability
Allocation of Cost by Service Type
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Scope of Work
Supplies
Contracts 1/20/2015 29 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Subcontract Costs
Contracts 1/20/2015 30 of 82
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Contracts 1/20/2015 31 of 82 e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
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Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
Contracts 1/20/2015 32 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Salary and Wages
Fringe Benefits
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Contracts 1/20/2015 33 of 82
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Method of Accountability
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Contracts 1/20/2015 34 of 82
<enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Indirect Costs ($)
TOTAL INDIRECT COSTS
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Allocation of Cost by Service Type
Subcontract Costs
Contracts 1/20/2015 35 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$ Equipment
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
TOTAL FOR CONTRACT
Contracts 1/20/2015 36 of 82
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Method of Accountability
Allocation of Cost by Service Type
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Scope of Work
Supplies
Contracts 1/20/2015 37 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Subcontract Costs
Contracts 1/20/2015 38 of 82
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Contracts 1/20/2015 39 of 82 e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
Contracts 1/20/2015 40 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Salary and Wages
Fringe Benefits
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Contracts 1/20/2015 41 of 82
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Method of Accountability
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Contracts 1/20/2015 42 of 82
<enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Indirect Costs ($)
TOTAL INDIRECT COSTS
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Allocation of Cost by Service Type
Subcontract Costs
Contracts 1/20/2015 43 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$ Equipment
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
TOTAL FOR CONTRACT
Contracts 1/20/2015 44 of 82
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Method of Accountability
Allocation of Cost by Service Type
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Scope of Work
Supplies
Contracts 1/20/2015 45 of 82
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Subcontract Costs
Contracts 1/20/2015 46 of 82
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Contracts 1/20/2015 47 of 82 e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Justification
Name of Contractor -$
Method of Selection -$
Justification for Sole
Source Selection
Period of Performance -$
Deliverabl e Cost
<enter description>
Other <enter description>
Other <enter description>
Direct
Non Direct
Direct
Non Direct
Total
Allocated Other
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - -$
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
TOTAL DIRECT COSTS
Equipment
Scope of Work
Supplies
Travel
Salary and Wages
Fringe Benefits
Consultant Costs
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Basic Information Itemized Costs
Method of Accountability
Allocation of Cost by Service Type
Subcontract Costs
Contracts 1/20/2015 48 of 82
Indirect Costs ($)
TOTAL INDIRECT COSTS
TOTAL FOR CONTRACT
Contracts 1/20/2015 49 of 82
Consultants
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
BASE COMPENSATION
SUBTOTAL
Travel
Per Diem (total for all days consultation)
Basic Information Itemized Costs
Number of Days of
Consultation
Expected Daily Rate of
Compensation
Basic Information Itemized Costs
Number of Days of
Consultation
Expected Daily Rate of
Compensation
TOTAL FOR
CONSULTANT
BASE COMPENSATION
SUBTOTAL
Travel
Per Diem (total for all days consultation)
SuppliesAllocation of Cost by Service Type
EXPENSES SUBTOTAL
Consultants 1/20/2015 50 of 82
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Travel
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
Number of Days of
Consultation
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
TOTAL FOR
CONSULTANT
Consultants 1/20/2015 51 of 82
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
EXPENSES SUBTOTAL
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Consultants 1/20/2015 52 of 82
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
Consultants 1/20/2015 53 of 82
<enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Consultants 1/20/2015 54 of 82
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
Consultants 1/20/2015 55 of 82
<enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$ Expected Daily Rate of
Compensation
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Consultants 1/20/2015 56 of 82
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
BASE COMPENSATION
SUBTOTAL
Consultants 1/20/2015 57 of 82
<enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Consultants 1/20/2015 58 of 82
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
Method of Accountability -$
Direct
Non Direct
Direct
Non Direct
Total
Allocated
Deliverable
Cost
<enter description>
Allocation 0.0% 0.0% $ - $ - $ - Other <enter description>
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Travel
TOTAL FOR
CONSULTANT
Basic Information Itemized Costs
Number of Days of
Consultation
Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
Expected Daily Rate of
Compensation
BASE COMPENSATION
SUBTOTAL
Consultants 1/20/2015 59 of 82
<enter description>
Other <enter description>
Other <enter description>
Other <enter description>
Justification
Name of Consultant
Organizational Affiliation -$
Nature of Services to Be
Rendered
Relevance of Service to the Project
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Direct
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Allocation of Cost by Service Type Supplies
EXPENSES SUBTOTAL
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Travel
TOTAL FOR
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Number of Days of
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Consultants 1/20/2015 62 of 82
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Nature of Services to Be
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Number of Days of
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Per Diem (total for all days consultation)
Allocation of Cost by Service Type Supplies
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BASE COMPENSATION
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Travel
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Consultants 1/20/2015 63 of 82
Direct
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Direct
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Total
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