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DocuSign Envelope ID:24839407-DB2D-47A2-B399-3BEA061662C1 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> b.) Program Budget Detail <br /> What is the cost to deliver your project/program? List each project/program element in the table below, <br /> including the cost of each element, the quantity and unit of measure, and the subtotal for each element. <br /> Where necessary, allocate costs to the use of shared space, vehicles or equipment. <br /> Example Program: Credit Counseling Class <br /> Cost Elements Cost($) Quantity/Unit of Measure Subtotal ($) <br /> Credit Counseling Teacher–in class $25 96 hours (8 hrs/mth x 12 months) $2,400 <br /> Credit Counseling Teacher—class prep $25 48 hours (4hrs/mth x 12 mths) $1,200 <br /> Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 <br /> Materials $25 120 course packets/credit reports $3,000 <br /> Total $9,000 <br /> Complete the table below for the project/program for which you are requesting funds. <br /> Attach additional rows/pages, as needed. <br /> Program: Meals for the homebound <br /> Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) <br /> Food (meals, trays, supplies) 4.67 45,000 210,000 <br /> Salaries 18.40 2,500 hours 46,000 <br /> Insurance/licenses/audit/website 13,000 <br /> Rent/utilities/Supplies 6,000 <br /> Postage/printing 3,000 <br /> Other 12,000 <br /> Total 290,000 <br /> C.) Cost per Unit <br /> Actual 2014-15 Estimated 2015-16 Projected 2016-17 <br /> Total Cost of Program 257,071 277,030 293,417 <br /> Total # of Units 38,000 meals/250 41,000 meals/265 45,000 meals/290 <br /> people people people <br /> $6.77 a meal/ $6.76 a meal/ $6.52 a meal/ <br /> Cost Per Unit $1,028 per $1,045 per person $1,011per person <br /> person (annual) (annual) (annual) <br /> Main Application 5/24/2016 9:18:54 AM P 20 of 2 " <br />