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					                                                      'BUDGET SUPPORT SHEET2009 - I
                                                          General Information



Date:


Name of the Applicant's Organization:
Taxpayer ID number of the Offeror's Organization:



Address of Applicant's Offices:


Street Address
City
State
Zip Code


Legal Address of the Organization:
(If different from above)
Street Address
City
State
Zip Code


Address for Official Contact (Reimbursments, Reports, etc.) :
(If different than above)
Street Address
City
State
Zip Code


Signature of Offerors' Authorized Agent:


Name of Offerors' Authorized Agent:



Authorized Agent's Title / Position:


Region Included in Proposal:
Counties Served


Budget/Reimbursment Contact Person:
Phone Number of Contact Person:


Program Data Entry Contact Person:
Phone Number of Contact Person:
                                      BUDGET SUPPORT SHEET II
                                       Personnel Salaries, Wages and Fringe

Organization Name:                                                                               0

Date:                                                 January 0, 1900



Position/Title                         % of          Salary & Fringe          Total Annual                                     Breakdown
      Employee Name               FTE in GEOWX         All Sources            GEOWX Salary           % Admin   Admin $       % Oper    Operations $   % T&TA   T&TA $       % Non-GEOWX


              Director
                                                                                             0                           0                        0                     0

           Management
1)                                                                                           0                           0
2)                                                                                           0                           0                        0                     0
3)                                                                                           0                           0                        0                     0

        Financial/Accounting
1)                                                                                           0                           0                        0                     0
2)                                                                                           0                           0                        0                     0
3)                                                                                           0                           0                        0                     0
4)                                                                                           0                           0                        0                     0

  Outreach/Clerical/Secretarial
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


      Inventory / Purchasing
1)                                                                                           0                           0                        0                     0
2)                                                                                           0                           0                        0                     0
3)                                                                                           0                           0                        0                     0


          Field Supervisors
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

        Auditors/Inspectors
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

          Field Technicians
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
                                                         TOTAL                               0                           0                        0                     0
                                                            BUDGET SUPPORT SHEET 2009 - IIIA
                                                                 Administration Costs

                                                                 Administration

Staff
                    Total Adminstrative Staffing Costs:                                    $0.00

Other Administrative Costs:
Telephone
Space Rent
Utilities
Postage
Dues, Memberships
Printing, Reproduction
Advertising, Publicity
Office Supplies
Reference Books and Subscriptions
Other Office Related Expenses (List):




                     Other Administrative Costs Total : $0.00


                                  Administration Total: $0.00
                                                                BSS 2009- III B
                                                                    Operations

Employment of Supervisory Personnel & Labor
Subcontractor Labor
Operations in-house Salaries Total:                                               $0.00
                              Total Operations Labor $0.00

Energy Conservation Materials:
In house EC Materials
Sub Contractor EC Materials
                                    EC Materials Total: $0.00

Travel Expenses
Lodging
Per Diem
Fuel
Other Travel Related Expenses
                                 Total Travel Expenses: $0.00

Vehicle Costs
Tires
License and Insurance
Vehicle Maintenance & Repair
Other Vehicle Operation Expenses (list below)

                                   Total Vehicle Costs: $0.00

Tools, Equipment and Miscellaneous
Hand Tools
Non-Capital Equipment
Rent for Equipment or Vehicles
Protective Clothing and Equipment
Maintenance of Tools and Equipment
Other Related Expenses (List):


                   Tools, Equipment and Misc. Total: $0.00

Operations Space
Supplies
Telephone (Warehouse/Operations Offices)
Utility Expenses (Warehouse/Operations Offices)
Vehicle Parking
Space Rental (Warehouse/Operations Offices)
                             Operations Space Total: $0.00


TOTAL OPERATIONS:                                      $0.00
                                                                       BSS 2009- III C

  Health and Safety Materials
  In house H&S Materials
  Subcontractor H&S Materials
                                         H&S Materials Total $0.00

  Est. Labor Hours for in house Health & Safety:
  Avg. in house Labor Cost/Hr (Wages & Fringe):
                  Est in house Labor Cost for Health & Safety: $0.00
  Est. Labor Hours for subcontracor Health & Safety:
  Avg. subcontractor Labor Cost/Hr (Wages & Fringe):
            Est subcontractor Labor Cost for Health & Safety: $0.00
                                      Total Health and Safety $0.00

( Financial Audit

  Insurance
  Liability Insurance
  Pollution Occurrence Insurance
                                             Insurance Total: $0.00

  Capital Equipment
  Capital Expenditures Using Allocated Funds
  $$ requested from State Pool
                                    Capital Equipment Total: $0.00


  Training & Technical Assistance
  In house T&TA                                               $0.00
  Subcontractor T&TA
                                                 T&TA Total: $0.00
                                                     Budget Support Sheet 2009 - IV
                                                         E$P Budget Summary

                    (Entries made to the BSS III spreadsheets will automatically total and transfer to this sheet.)

Administration
Staff                                                                             $0.00
Other                                                                             $0.00
                                            Total                                 $0.00

Operations
Labor                                                                             $0.00
Energy Conservation Materials                                                     $0.00
Space                                                                             $0.00
Tools, Equipment and Misc.                                                        $0.00
Travel Expenses                                                                   $0.00
Vehicle Costs                                                                     $0.00
                                            Total                                 $0.00

Health and Safety                                                                 $0.00

Financial Audit                                                                   $0.00

Insurance                                                                         $0.00

Capital Equipment                                                                 $0.00

Training & Tech. Assistance                                                       $0.00

                                     Grand Total                                  $0.00


Authorized Agency Signature:                                                                       Date:______________________


Authorized GEO Signature:                                                                          Date:______________________
                                    Budget Support Sheet 2009 - VII
                                       Other Funding Sources
Organization Name                                                     0

Date                                                      January 0, 1900


Source of              Cash                     In-Kind                   Program Costs Defrayed         Budget Category
Other Funding       Contributions             Contributions               by Other Funding Source Other Funding is Applied To




Totals:                             $0.00                     $0.00                         $0.00
                                Budget Support Sheet 2009 - VIII
                               CAPITAL EQUIPMENT INVENTORY
Item Description   ID #      Date           Original             Fund Source    Use   Condition
                          Purchased      Purchase Price          for Purchase
                                Budget Support Sheet 2009 - VIII
                                CAPITAL EQUIPMENT REQUEST
Item Description   ID #      Date           Original             Fund Source    Use   Condition
                          Purchased      Purchase Price          for Purchase
  INSTRUCTIONS:

Item Description:      Make, model and year of the item.
  For example - 2002 Ford F-150 pick-up; 2000 Krendl XYZ

ID #:         Generally the VIN for vehicles; serial number for
  other capital equipment. Alternatively, an ID number
  corresponding to an internal inventory system.

Date Purchased:        Month and year that the organization
 took ownership of the item.

Purchase $ Amount & Fund Source:                The total amount
 paid for the vehicle (all sources); note percentage paid via
 E$P funds (only if NOT 100%); note the specific fund source
 (DOE or LEAP), as listed on the purchase approval documentation.

Use:         Particularly for vehicles, list how the vehicle is
 currently used within the agency's E$P operation (furnace crew; insulation crew; etc.; auditing;
 inspecting; materials transportation; supervision/miscellaneous; etc.)

Condition: List the current status of the item, in terms of its
 functionality (good, fair, poor; not functional)