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Project/
Program:
Michele Marchand
Phone #:
Contractor Name:
Person Completing Form:
Item
1000 - PERSONNEL SERVICES
1110 Salaries (Full- & Part-Time)
1300 Fringe Benefits
1400 Other Employee Benefits2
SUBTOTAL - PERSONNEL SERVICES
2000 - SUPPLIES
2100 Office Supplies
2200 Operating Supplies3
2300 Repairs & Maintenance Supplies
SUBTOTAL - SUPPLIES
3000 - 4000 OTHER SERVICES &
CHARGES
3100 Expert & Consultant Services
3140 Contractual Employment
3150 Data Processing
3190 Other Professional Services4
3210 Telephone
3220 Postage
3300 Automobile Expense
3310 Bus Tickets
3400 Advertising
3500 Printing & Duplicating
3600 Insurance
3700 Public Utility Services
3800 Repairs & Maintenance
3900 Rentals - Buildings
Rentals - Equipment
4210 Education Expense
4290 Other Miscellaneous Expenses5
4999 Administrative Costs/Indirect Costs6
SUBTOTAL - OTHER SERVICES &
CHARGES
TOTAL EXPENDITURES
HSD
$
$
120,000.00
44,000.00
$ 164,000.00 $
$
$
$
$
10,000.00
3,000.00
13,000.00 $
2,000.00
$
$
15,000.00
59,751.00
$
$
$
$
5,000.00
35,000.00
10,000.00
20,000.00
5,000.00
$
$
$ 151,751.00 $
$ 328,751.00 $
$
$
$
$
Total $
To
4
10,000.00
10,000.00
10,000.00
30,000.00
$ 100,000.00
$
85,000.00
$
30,000.00
$
75,000.00
Total $ 290,000.00
Cleaning Supplies
Food Service Supplies
Toilet Paper, Paper Towels, etc
To
Administrative Costs/Indirec
below:
6
$
$
$
1,000.00
20,000.00
4,000.00
Total $
25,000.00
To
Administrative Costs/Indirect Costs: Human Services Department policy places a fifteen percent (15%) cap
for agency indirect costs, based on the total contract budget. Restrictions related to federal approved rates
still apply.
6
Yes
Other1
Total Project
$
$
45,984.00 $
23,398.00 $
$
$ 69,382.00 $
165,984.00
72,398.00
238,382.00
$ 10,000.00 $
$ 15,000.00 $
$
5,000.00 $
$ 30,000.00 $
10,000.00
30,000.00
8,000.00
48,000.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
15,000.00
10,000.00
800.00
40,000.00
90,000.00
5,000.00
10,000.00
75,000.00
40,000.00
45,000.00
30,000.00
$
$
$
$
$
15,000.00
8,000.00
800.00
25,000.00
30,249.00
$
$
$
$
5,000.00
###
40,000.00
30,000.00
25,000.00
25,000.00
$
$209,049.00
$308,431.00
$
$
360,800.00
647,182.00
$
$
$
$
Total $
10,000.00
5,000.00
15,000.00
No
Contractor Name:
Project/Program:
hours/week
# of Hours Hourly
FTE
Employed Rate
1.00
1,976 $12.00
1.00
1,976 $12.00
1.00
1,976 $12.00
3.00
5,928 $12.00
1.00
1,976 $12.00
Michele Marchand
(206) 956-0334
18,000.00
18,000.00
18,000.00
54,000.00
12,000.00
120,000.00
Fund Source
Fund Source
$
$
$
$
Personnel Benefits:
FICA
Pensions/Retirement
Industrial Insurance
Health/Dental
Unemployment Compensation
Other Employee Benefits
Subtotal - Personnel Benefits:
TOTAL PERSONNEL COSTS (SALARIES & BENEFITS):
9,000.00
35,000.00
$
$
44,000.00
164,000.00
chand
34
ource(s)
Other1
$
$
$
$
$
$
$
$
$
$
$
$
$
Total Program
5,712.00
5,712.00
5,712.00
17,136.00
11,712.00
$
$
$
$
$
$
45,984.00 $
23,712.00
23,712.00
23,712.00
71,136.00
23,712.00
165,984.00
3,698.00
6,000.00
800.00
15,400.00
2,500.00
12,698.00
6,000.00
800.00
50,400.00
2,500.00
72,398.00
238,382.00
$
$
$
$
$
$
28,398.00 $
74,382.00 $