Contract for Hourly Services

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Contract for Hourly Services Powered By Docstoc
					                                    Santa Clara County Social Services Agency

                                                      INFORMATION PAGE

CAUTION! The shaded boxes on this page are linked to the submittal forms, so it is imperative that you
do not move or delete this page.

The yellow tabs contained in this Workbook are instructions for completing the submittal forms.

The green tabs in this Workbook are the submittal forms that will become part of your contract.

Helpful hints are also included within the cells of each submittal form. The helpful hints will appear when
your mouse is over the cell.

DIRECTIONS: Enter the information in the shaded boxes below. The information you enter on this
page automatically fills in the corresponding sections in the submittal forms (green tabs).

                                                                  FILL OUT DATA IN SHADED BOXES
                           Agency Name

                          Program Name
          Abbreviated Agency Name
                         (Acronym)
           Abbreviated Project Name
                          (Acronym)


               Original Submittal Date
        Revision Date (if applicable)


   NEED HELP WITH THE FORMS? Call Shawna Smith, Senior Management Analyst
                             Social Services Agency Office of Contracts Management
                             333 W. Julian Street, Bldg. 1, Second Floor, San Jose, CA 95110
                             Telephone: (408) 491-6884 Email: Shawna.Smith@SSA.SCCGOV.Org




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                                   Santa Clara County Social Services Agency

                                             SUBMITTAL CHECKLIST

This Excel Workbook contains all of the County's required forms for your contract. The
submittal forms are in the green tabs.

The following check list is provided as a helpful tool to remind you of the forms that must be

Exhibit B
  o    Program Summary (formerly Project Summary)
  o    Staffing
  o    Service Delivery Goals
  o    Outcomes

Exhibit C
  o    Program Budget (formerly Project Budget)
  o    Budget Narrative
  o    Resource Table




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                                                 Santa Clara County Social Services Agency
                                               PROGRAM SUMMARY FORM INSTRUCTIONS

     The information included in your Program Summary must be consistent with the Proposal that your organization

          PROGRAM SUMMARY FORM
                                                       INSTRUCTIONS
                     FIELD NAME
                     Agency Name                       This field is automatically populated from the information you enter on the Information
                                                       page (red tab). Be sure to enter the official name of your Agency. If you are an agency
                                                       who is doing business under a different name, you must still include the official name of
                                                       the agency and specify the name that you are doing business under.
                             Submittal Date            This field is automatically populated from the information you enter on the Information
                                                       page (red tab). This date will remain the same throughout the entire fiscal year.

                             Program Name              This field is automatically populated from the information you enter on the Information
                                                       page (red tab). You must enter the name of the program that you are providing under
                                                       this contract.
                  Revision Submittal Date              This field is automatically populated from the information you enter on the Information
                                                       page (red tab). This field will remain empty (blank) unless you need to submit a revised
                                                       document (any of the Green Tabs). You must change the revision submittal date every
                                                       time you submit a revised document.
                Brief Program Description              Provide a brief description of your Program
                        Component 1, 2, 3              Select the appropriate direct service from the drop down menu.
                        Target Population              Enter the population that you are serving in each Component, e.g., Spanish-speaking,
                                                       treatment facility residents, elementary school students, etc.
                          Funding Category             Select the appropriate category from the drop down menu (see the Reference Table for
                                                       a more complete description of each funding category).
       Child Abuse (columns a1, a2, a3)                Activities/participants funded through the County's Child Abuse Council.

         Other Funding (columns b1, b2,                Activities/participants funded with matching funds provided by other funding sources.
                                   b3):                Include in-kind contributions in dollar amount and provide a narrative to clearly explain
                                                       the in-kind amount(s).
               Unduplicated Children 0-5               Each child is counted once.
                 Unduplicated Youth 6-18               Each youth is counted once.
            Unduplicated Adults 19-older               Each adult is counted once.
          Total Unduplicated Participants              This row includes formulas to automatically calculate the sum of all unduplicated
                                                       participants.
                   Duplicated Children 0-5             Children 0-5 who are counted more than once because they participate in multiple
                                                       activities.
                    Duplicated Youth 6-18              Youth 6-18 who are counted more than once because they participate in multiple
                                                       activities.
               Duplicated Adults 19-older              Adults 19+ who are counted more than once because they participate in multiple
                                                       activities.
             Total Duplicated Participants             This row includes formulas to automatically calculate the sum of all duplicated
                                                       participants.
       Number of Hours per Component                   Number of hours required per week to provide the activity (if group activitiy) times 48
                                                       weeks (generally) or number of hours required to provide service to each individual (if
                                                       individual activity) times the number of participants.
        Number of Hours per Participant                Number of hours per component/number of participants
                   Cost per Component                  Cost per Participant x Number of Participants (unduplicated count only)
                    Cost per Participant               Cost per Component/Number of Participants (unduplicated count only)
                          Cost per Hour                Cost per Component/Number of Hours of service per Component
              Start Date for Component                 Date contract begins
               End Date for Component                  Date contract ends
         Explain how you calculated the                Provide a detailed explanation of how you calculated the number of hours for
       number of hours for Component 1                 Component 1

         Explain how you calculated the                Provide a detailed explanation of how you calculated the number of hours for
       number of hours for Component 2                 Component 2

         Explain how you calculated the                Provide a detailed explanation of how you calculated the number of hours for
       number of hours for Component 3                 Component 3

       Explain services/activities that will           Explain the services and activities that will be paid for by matching funds, including but
           be paid for by matching funds               not limited to the matching fund source(s) and amounts, and specify if the funds are
                                                       restricted or unrestricted.


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                                         Santa Clara County Social Services Agency


                                    SERVICE DELIVERY GOAL FORM INSTRUCTIONS

TYPES OF SERVICES
List all activities to be provided under each component. Choose the type of service from the dropdown menu embedded within
the cell.

DIRECT SERVICES
Direct services means that the services must be provided to an individual or family, and the planned duration of the services
should be more than a one-time engagement event. If the participant only attends the direct service for one time and drops out,
they should still be counted under Direct Services category as the planned duration was for more than one time engagement.


COUNTING UNDUPLICATED (at the COMPONENT Level)
Clients may access multiple services and shall be counted once per component rendered during the reporting period. Count
families only when service is provided to the entire family.
Do not count members of a family as individuals if family is counted as one unit.

If a client is counted as a person with disabilities do not count them in another category.

COUNTING DUPLICATED (at the ACTIVITY Level): Clients may access multiple services and shall be counted for all the
services rendered during the reporting period.
                                                             Santa Clara County Social Services Agency

                                                 BUDGET FORM INSTRUCTIONS

When completing the Budget Submittal Form, please include only the amounts that you are requesting from the Child Abuse
Council.

Direct Costs are for activities or services that benefit specific projects, e.g., salaries for project staff and materials required for a
particularly project. Because these activities are easily traced to projects, their costs are usually charged to projects on an item-by-
item basis.

Indirect/Administrative Costs are costs associated with activities or services that benefit more than one project. Their precise
benefits to a specific project are often difficult or impossible to track; for example, it may be difficult to determine precisely how the
activities of the director of an organization benefit a specific project.

It is possible to justify the handling of almost any kind of cost as either direct or indirect. Labor cost, for example, can be indirect,
as in the case of maintenance personnel and executive officers; or they can be direct, as in the case of project staff members.
Similarly, materials such as miscellaneous supplies purchased in bulk (pencils, pens, paper) are typically handled as indirect costs,
while materials required for specific projects are charged as direct costs.

Annual Salary: Include the annual salary amount for each staff member (includes full-time and part-time positions).

Agency FTE: Include the number of full-time equivalent positions for your entire agency.

Contract FTE: List percentage of full-time equivalent allocated for this child abuse contract

Details for completing the Program Budget are included within the form itself. A helpful hint will appear
when you click on the cell.
                                                      STAFFING

You must list every person on your staffing plan who is listed on your budget.

Direct Services
Staff who are providing the service directly to the client. (direct supervision of employees who are providing the
direct service to the client)

Indirect Services
Administrative staff, such as accounting staff, adminsitrative support, CEO, CFO, anyone who is not providing a
direct service as described above.

Per Kathi
If you have contract staff, you must also include them in your staffing plan
Include in-kind staff also if they are identified as part of the matching funds.
If a contractor is providing long-term service, include them in your staffing plan.
If the contractor is the equivalent of a "guest speaker" you do not include them in the staffing plan.
o are providing the




o is not providing a
             REFERENCE TABLES - PLEASE DO NOT MOVE, CHANGE, OR DELETE


Types of Funding Categories (as defined by the State of California)
                                             Focused on broad prevention activies, e.g., outreach, public
Primary Prevention
                                             awareness, media.
Secondary Prevention
                                               Focused on specific groups or individuals, e.g., parent ed/support.
                                               Focused on individuals, e.g., short-term counseling - not to exceed
Early Intervention
                                               six months.

Outcome Reporting Timeframe
Quarterly
Semi-Annual

Commitment Codes                               Definition
1 = Firm Commitment                            You already have an agreement or letter confirming funding.
2 = Anticipated Renewal of Existing Funding    Continuation of current year funding.
3 = Anticipated Resource                       Projection based on prior fees or donations.
4 = Application Pending                        Application has been submitted, pending decision.
5 = Pre-Application                            Application has not been submitted, but we expect funding.

Types of Direct Service (must focus on child abuse prevention or intervention)
Day/Child Care                                Secondary Prevention
Family Counseling/Case Management             Early Intervention
Home Visiting                                 Early Intervention
Media                                         Primary Prevention
Outreach/Public Awareness Campaign            Primary Prevention
Parent Education and Support                  Secondary Prevention
Supervised Visitation                         Secondary Prevention

Activities                                     Definition
Day/Child Care                                 Must be focussed on child/teen education and support
Family Counseling/Case Management
Health Services
Home Visiting
Media
Multi-disciplinary Team Services
Outreach/Public Awareness Campaign
Parent Education and Support
Supervised Visitation
Teaching and Demonstrating
Transportation
Santa Clara County- Social Services Agency                                                                                                  EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2010-11                                                                                                      PROGRAM SUMMARY
Contract Period: July 1, 2010 – June 30, 2011                                                                                 Funding Source: Child Abuse Prevention
                                                                                                                                                                   -

                          Agency Name:                                                                                                  Submittal Date:
                         Program Name:                                                                                         Revision Submittal Date:

Brief Project Description




                                                Component 1                  Component 2                 Component 3



                       Target Population

                       Funding Category

                                                          Matching                     Other                      Matching    Child Abuse    Matching
                                           Child Abuse                Child Abuse                 Child Abuse
                                                           Funds                      Funding                      Funds         Total      Funds Total   Grand Total
                                               a1            b1            a2           b2             a3            b3        =a1+a2+a3    =b1+b2+b3
Unduplicated Children 0 – 5                                                                                                       0             0             0
Unduplicated Youth 6 – 18                                                                                                         0             0             0
Unduplicated Adults 19 & older                                                                                                    0             0             0
     Total Unduplicated Participants           0              0             0             0             0             0           0             0             0
Duplicated Children 0 – 5                                                                                                         0             0             0
Duplicated Youth 6 -18                                                                                                            0             0             0
Duplicated Adults 19 & older                                                                                                      0             0             0
        Total Duplicated Participants          0              0             0             0             0             0           0             0             0
# Hours per Component
# Hours per Participant
Cost per Component
Cost per Participant
Cost per Hour
Start Date for Component
End Date for Component

In the space below, please explain how you calculated the number of hours for Component 1.




In the space below, please explain how you calculated the number of hours for Component 2.




In the space below, please explain how you calculated the number of hours for Component 3.




In the space below, please explain the services or activities that will be paid for by other funding source(s).




                                                    Master Contract between the County of Santa Clara and _________________
                                                                                  Page 9 of 17
Santa Clara County- Social Services Agency                                                                 EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                               SERVICE DELIVERY GOALS
Contract Period: July 1, 2009 – June 30, 2010                                           Funding Source: CHILD ABUSE PREVENTION
                                                                                                                               -

                 Agency Name:                                                                             Submittal Date
                Program Name:                                                                    Revision Submittal Date

                                                            COMPONENT 1
                                                  Children                     Caregivers
UNDUPLICATED                       Children     w/Disabilities Caregivers     w/Disabilities          Description of Component
Planned Q1 (unduplicated)
Planned Q2 (unduplicated)
Planned Q3 (unduplicated)                                                                      Enter the name and brief description of the
Planned Q4 (unduplicated)                                                                                  component here.
             Total Unduplicated       0               0              0              0

                                                  Children                     Caregivers
ACTIVITY DUPLICATED                Children     w/Disabilities   Caregivers   w/Disabilities         Description for Each Activity




                Total Duplicated      0               0              0              0

                                                            COMPONENT 2
                                                  Children                     Caregivers
UNDUPLICATED                       Children     w/Disabilities Caregivers     w/Disabilities          Description of Component
Planned Q1 (unduplicated)
Planned Q2 (unduplicated)
Planned Q3 (unduplicated)                                                                      Enter the name and brief description of the
Planned Q4 (unduplicated)                                                                                  component here.
             Total Unduplicated       0               0              0              0

                                                  Children                     Caregivers
ACTIVITY DUPLICATED                Children     w/Disabilities   Caregivers   w/Disabilities         Description for Each Activity
                                       0
                                       0
                                       0
                                       0
                Total Duplicated       0              0              0              0

                                                            COMPONENT 3
                                                  Children                     Caregivers
UNDUPLICATED                       Children     w/Disabilities Caregivers     w/Disabilities          Description of Component
Planned Q1 (unduplicated)
Planned Q2 (unduplicated)
Planned Q3 (unduplicated)                                                                      Enter the name and brief description of the
Planned Q4 (unduplicated)                                                                                  component here.
             Total Unduplicated       0               0              0              0

                                                  Children                     Caregivers
ACTIVITY DUPLICATED                Children     w/Disabilities   Caregivers   w/Disabilities         Description for Each Activity
                                       0
                                       0
                                       0
                                       0
                Total Duplicated       0              0              0              0




           Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                  Page 10 of 17
Santa Clara County- Social Services Agency                                                     EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                  OUTCOMES
Contract Period: July 1, 2009 – June 30, 2010                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                   -

                      Agency Name:                                                          Submittal Date:
                     Program Name:                                                 Revision Submittal Date:

                                                      COMPONENT 1
                                                   Enter Component Name
ENGAGEMENT OUTCOMES                        Qtr 1            Qtr 2          Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes

SHORT-TERM OUTCOMES                        Qtr 1           Qtr 2           Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes

INTERMEDIATE OUTCOMES                      Qtr 1           Qtr 2           Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes




     Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                            Page 11 of 17
Santa Clara County- Social Services Agency                                                     EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                  OUTCOMES
Contract Period: July 1, 2009 – June 30, 2010                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                   -

                      Agency Name:                                                          Submittal Date:
                     Program Name:                                                 Revision Submittal Date:
                                                       COMPONENT 2
                                                   Enter Component Name
ENGAGEMENT OUTCOMES                        Qtr 1            Qtr 2          Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes

SHORT-TERM OUTCOMES                        Qtr 1           Qtr 2           Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes

INTERMEDIATE OUTCOMES                      Qtr 1           Qtr 2           Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes




     Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                            Page 12 of 17
Santa Clara County- Social Services Agency                                                     EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                  OUTCOMES
Contract Period: July 1, 2009 – June 30, 2010                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                   -

                      Agency Name:                                                          Submittal Date:
                     Program Name:                                                 Revision Submittal Date:
                                                       COMPONENT 3
                                                   Enter Component Name
ENGAGEMENT OUTCOMES                        Qtr 1            Qtr 2          Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes

SHORT-TERM OUTCOMES                        Qtr 1           Qtr 2           Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes

INTERMEDIATE OUTCOMES                      Qtr 1           Qtr 2           Qtr 3               Qtr 4          Total
Number of Participants                                                                                         0



Outcome Statement



Time Frame to Achieve Outcomes




     Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                            Page 13 of 17
Santa Clara County- Social Services Agency                                                                              EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                            STAFFING
Contract Period: July 1, 2009 – June 30, 2010                                                         Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                            -

                 Agency Name:                                                                                       Submittal Date:
                Program Name:                                                                              Revision Submittal Date:

Complete the table below for each staff person working in this project. You may copy/paste the table if you have more than five people
providing services under this Contract.

                                                                   Staff Member #1
                           Name
                            Title
     Direct or Indirect Services
     Duties/Activities Provided
       Education, Experience,
            and Qualifications
Language/Cultural Competence


                                                                   Staff Member #2
                           Name
                            Title
     Direct or Indirect Services
     Duties/Activities Provided
       Education, Experience,
            and Qualifications
Language/Cultural Competence


                                                                   Staff Member #3
                           Name
                            Title
     Direct or Indirect Services
     Duties/Activities Provided
       Education, Experience,
            and Qualifications
Language/Cultural Competence


                                                                   Staff Member #4
                           Name
                            Title
     Direct or Indirect Services
     Duties/Activities Provided
       Education, Experience,
            and Qualifications
Language/Cultural Competence


                                                                   Staff Member #5
                           Name
                            Title
     Direct or Indirect Services
     Duties/Activities Provided
       Education, Experience,
            and Qualifications
Language/Cultural Competence




                                    Master Contract between the County of Santa Clara and __________________________
                                                                      Page 14 of 17
Santa Clara County- Social Services Agency                                                                            EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2010-11                                                                                     PROGRAM BUDGET
Contract Period: July 1, 2010 – June 30, 2011                                                          Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                              -

                       Agency Name:                                                                                  Submittal Date:
                      Program Name:                                                                         Revision Submittal Date:

DIRECT EXPENSES
SECTION 1: PERSONNEL EXPENSES (Direct Service Staff Only)
 A                 B                         C                     D             E           F             G                H             I
             Position Title                Name               Annual Salary Agency % of time            CAC Direct       Matching       Total
 1a                                                                            FTE       devoted to     Costs (D*F) 0     Funds                 0
 1b                                                                                                                 0                           0
 1c                                                                                                                 0                           0
 1d                                                                                                                 0                           0
 1e                                                                                                                 0                           0
 1f                                                                      Subtotal Salaries & Wages                  0               0           0
 1g                                                       Fringe Benefits @ (% of Salary & Wages)                                               0
 1h                                                  TOTAL SECTION 1: PERSONNEL EXPENSES                             0              0           0

SECTION 2: CONTRACT & HOURLY STAFF EXPENSES (Direct Service Only)
 2a                                                                                                                                             0
 2b                                                                                                                                             0
 2c                                                                                                                                             0
 2d                                                                                                                                             0
 2e                                                                                                                                             0
 2f                                                            Subtotal Contract & Hourly Expenses                   0              0           0
 2g                           Other Costs Associated with Contract/Hourly Staff (e.g., Workers Comp)                                            0
 2h                               TOTAL SECTION 2: CONTRACT & HOURLY STAFF EXPENSES                                  0              0           0

SECTION 3: OPERATING EXPENSES
 3a Rent                                                                                                                                        0
 3b Utilities                                                                                                                                   0
 3c Insurance                                                                                                                                   0
 3d Office Supplies                                                                                                                             0
 3e                                                                                                                                             0
 3f                                                                                                                                             0
 3g                                                       TOTAL SECTION 3: OPERATING EXPENSES                        0              0           0

INDIRECT EXPENSES (Maximum 10% of Total Budget)
SECTION 4: INDIRECT PERSONNEL EXPENSES
              Position Title            Name              Annual Salary Agency        Contract          CAC Indirect     Matching       Total
 4a                                                                          FTE        FTE             Costs (D*F) 0     Funds                 0
 4b                                                                                                                  0                          0
 4c                                                                                                                  0                          0
 4d                                                                                                                  0                          0
 4e                                                                                                                  0                          0
 4f                                                        Subtotal Indirect Personnel Expenses                      0              0           0
 4g                                        Fringe Benefits @ (% of Salary and Wages Expense)                                                    0
 4h                                    TOTAL SECTION 4: INDIRECT PERSONNEL EXPENSES                                  0              0           0

SECTION 5: INDIRECT EXPENSES - OTHER
 5a                                                                                                                                             0
 5b                                                                                                                                             0
 5c                                                                                                                                             0
 5d                                                                                                                                             0
 5e                                                 TOTAL SECTION 5: INDIRECT EXPENSES - OTHER                       0              0           0

  6                                                                       TOTAL DIRECT EXPENSES                      0              0           0

  7                                                                     TOTAL INDIRECT EXPENSES                      0              0           0

  8                                                                      TOTAL PROPOSED BUDGET                       0              0           0




                             Master Contract between the County of Santa Clara and _______________________________
                                                                   Page 15 of 17
Santa Clara County- Social Services Agency                                                                  EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                          BUDGET NARRATIVE
Contract Period: July 1, 2009 – June 30, 2010                                                Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                    -

                        Agency Name:                                                                  Submittal Date:
                       Program Name:                                                         Revision Submittal Date:

DIRECT EXPENSES
SECTION 1: PERSONNEL EXPENSES (Direct Service Staff Only)
enter narrative here




Fringe Benefits for Direct Staff (line 1g on your Program Budget)
enter narrative here




SECTION 2: CONTRACT & HOURLY STAFF (Direct Service Only)
enter narrative here




Other Costs Associated with Contract/Hourly Staff (line 2g on your Program Budget)
enter narrative here




SECTION 3: OPERATING EXPENSES
enter narrative here




INDIRECT EXPENSES
SECTION 4: INDIRECT PERSONNEL EXPENSES
enter narrative here




Fringe Benefits for Indirect Personnel Expenses
enter narrative here




SECTION 5: INDIRECT EXPENSES - OTHER
enter narrative here




                            Master Contract between the County of Santa Clara and __________________________
                                                               Page 16 of 17
Santa Clara County- Social Services Agency                                                                                   EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                                             RESOURCE TABLE
Contract Period: July 1, 2009 – June 30, 2010                                                                 Funding Source: CHILD ABUSE PREVENTION
                    Agency Name:                                                                                                                     -
                     Project Name:
                                                                                                                             Submittal Date
                                                                                                                    Revision Submittal Date

PLEASE Include all funding sources, both Child Abuse and matching funds for FY 2009-2010
                A                                       B                            C                         D                 E                 F
                                                                                                                                              % Difference
                                                                                      Commitment        FY 09/10 Dollar   FY 10/11 Dollar     Year to Year
Source of Funds                                 Name or Type of Funds                   Code*              Amount            Amount             (E-D)/D




Total Resources

         Matching Amount                          Requested Amount

                                                                                     Amount

                                                                                     % of Total Project Budget
Matching amount must be a minimum of 10% of total program budget

        Commitment Code*             Definitions
               1                     Firm Commitment - Already have an agreement or letter confirming funding
               2                     Anticipated Renewal of Existing Funding - Continuation of current year funding
               3                     Anticipated Resource - Projection of previous fees or donations
               4                     Application Pending - Application has been submitted, no confirmation at this time
               5                     Pre-Application - Not yet submitted and expect funding




                  Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                         Page 17 of 17

				
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Description: Contract for Hourly Services document sample