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HomeMy WebLinkAboutC03-111 Corporation for National and Community ServiceATTACIiMENT 3 PART I - FACESHEET OMB No. 3045-0035 Egniration Date 3/31/05 APPLICATION FOR FEDERAL ASSISTANCE 1. TYPE OF SUBMISSION: Application ®Noa-Construction 2. DATE SUBMITTED TO CORPORATION FO 3. a DATE RECEIVED BY STATE 3.b. STATE APPLICATION IDENITFffit NATIONAL AND COMMUNITY SBRVICB (CNCS): O5 / 05 / 0 3 4. a DATE RECIIVID BY CNCS: 4.b. cNCS GRANT NUMBBR: ' 03SR034317 5. APPLICANT INFORMATION ~~ NAME: NAME AND CONTACT INFORMATION FOR PROIBCT DIRECTOR OR OTHIs1i PBRSON Eagle CO GOVt. Alth & Human $VCS. TO BBCONTACTBDONMATTBRSINVOLVINGTHISAPPLICATION(giveareacodes): ORGANIZATIONAL UNIT: ADDRESS(give.streeraadres cQV,cararty,stateandaip~deJ: NAME: Jacki Allen-Benson 500 Broadway TELh'PxoNENUMBER:(970 )328 -8818 Eagle, CO 81631 FAX NUMBER: (970) 328 - 8829 INTBRNEf E-MAII. ADDRESS: 6. ffivIPLOYBR IDENTIFICATION NUMBER (EJNJ: 7.a TYPB OF APPLICANT: (enter appn~priate letter fa bos) - A. State H. Independent School Dishict B. County I. State Corrtrolled Institution of Higher Learning S. TYPE OF APPLICATION (Check epprolaiata box): C. Municipal I. Privem University ^NEW ^NEW/PREVIOUS GRANTBE D. Tovvnslrip K Iii®Tnbe ^CONTINUATION ®AMENDMENT B. Inte[atate L. Individual F. Inienntmicipal M. ProfitOrgauizefioa G. Special District N. Private Non-Profit Org®izsUiUioa If Revision, ~ eppropaiate letter(s) in box(es): O. Other (specify) A. AUGMENTATION: ® B. BUDGET RBVISION: ^ 7.b. CNCSAPPLICANT CHARACTERLSITCS C. NO COST EXTSNSJON: ^ to (enter date) Enter opproprrate rnde bt each b1mJc E. °~ ~ ~"°"~~ ^ 9. NAMB OF FBDHRAL AGENCY: Corporation for National and Community Service 10. CATALOG OF FIDERAL DOMESTIC ASSISTANCE NUNIDII2: 11. a TITLE OF APPLICANT'S PROJECT: ® ® Rural Resort RSVP Name of Program ' 12. AREAS AFFECTED BY PROJECT (List Cities Countle~ Staley etc.J: 1 l .b. CNCS PROGRAM INTTIATTVE (IF' ANY) Eag1e.C0 Basalt, Eagle, Gypsum, Minturn Vail, McCoy, Summit CO, billion, Frisco 13. PROPOSID PROJECT: START DATE: O7 30 03 END DATE: 07 30 04 14. ESTIMATID FUNDING: Chec k applicable box: Yr 1: Q Yr.2 Q or Yr 3: 15. IS APPLICATION SUBJBCT TO REVIEW BY STATE EXECUTIVE a ~~ $ ORDBR 12372 PROCBSS7 26 191 a YES. TIiLSPREAPPLICATION/APPLiCATIONWASMADEAVAnaRt.u b. APPLICANT $ TO THE STATH EXECUTIVE ORDER 12372 PROCESSS FOR 6 883 ~~ oN: c. STATE $ DATE -O- b. NO. ®PROGRAM IS NOT COVERED BY E.O.12372 d LOCAL $ ^ OR PROGRAM HAS NOT BEEN SELECTID BY STATE FOR -O- REVIEW e. OTHER $ -0- 16. IS THE APPLICANT DELINQUENT ON ANY FIDERAL DEBT? f. TOTAL $ ^ YES If "Yes," attach an explanation. ~ NO 3 17. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS EEEN DULY AUTHORIZED BY THE GO VERNINO HODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WII'H THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. a TYPED NAME OF AUTHORIZID RBPRESENTATIVE: b. TITLE a TELBPHONE NUMBER Michael Ga agher hairman, Board of County ast F ~e DATE SIGNED: Commissioners 04-29-03 ModiS"ed Sta~rd~orm~NSS~/~(Itev. 3/03 to conform to the CNCS eGrants system) Run by JALLEN_B . ~ RPl_BGT 424 on April 22, 2003 6:55 PM ." EAGLE/SUMMIT CO RSVP EAGLE CO.GOVT HLTH & HUMAN SVCS Application ID: 03SR034317 Budget Dates: Total Amt CNCS Share Grantee Share Excess Amount Section I. Volunbaer Support Expenses A. Project Personnel Expenses 9,027 9,027 0 0 B. Pt3rsonnel Fringe Benefits FICA 691 691 0 0 Health Insurance 4,090 4,090 0 0 Retirement 0 0 0 0 Lffe Insurance 0 0 0 0 Total $4,781 $4,781 $0 $0 C. Project Staff Travel Local Travel 1,000 1,000 0 0 Long Distance Travel 560 560 0 0 Total $1,560 $1,560 $0 $0 D. Equiprrent 1,923 0 1,923 0 E Supplies 660 0 660 0 F. Contractual and Consultant Services 1,924 1,924 0 0 I. Other Volunteer Support Costs 3,600 3,300 300 0 J. IndQect Costs Section I. Subtotal $23,475 $20,592 $2,883 $0 Section II. Volunteer Expenses A. Other Volunteer Costs Meals 0 0 0 0 Unfforms 0 0 0 0 Insurance 199 199 0 0 Recognition 1,000 0 1,000 0 Volunteer Travel 8,400 5,400 3,000 0 Total $9,599 $5,599 $4,000 $0 Section II. Subtotal $9,599 $5,599 $4,000 $0 Budget Totals $33,074 $28,191 $6,883 $0 Funding Percen~ges 79.2% 20.8% Form424A Modffied SF-424A (4/88 and 12197) Page 1 Budget Narrative for 03SR034~ ~ Page 1 of 3 ., Budget Narrative: EAGLE/SUMMIT CO RSVP for EAGLE CO GOVT HLTH & HUMAN SVCS Section I. Volunteer Support Expenses A. Project Personnel Expenses Positionll'itle -Qty -Annual Salary% Time CNCS Share Grantee Share Total Amount ~~ss Amount volunteer co-ordinator: - 1 person(s) at 9027 each x 100 % usage 9,027 0 9,027 0 CATEGORY Totals 9,027 0 9,027 0 B. Personnel Fringe Benefits Item -Description CNCS Share Grantee Share Total Amount Excess Amount FICA: .0765% 691 0 691 0 Health Insurance: 4,090 0 4,090 0 Retirement: 0 0 0 0 Life Insurance: 0 0 0 0 CATEGORY Totals 4,781 0 4,781 0 C. Project StafF Travel Local Travel Purpose -Calculation CNCS Share Srharee Total Amount Amon t regional collaboration meetings: 2899 miles @ .345 1,000 0 1,000 0 CATEGORY Totals 1,000 0 1,000 0 Long Distance Travel Purpose -Destination -Trans. Amount-Meals/ Lodging -0ther CNCS Share Grantee Total Amount Excess Travel Share Amount Collaboration and training meetings: Denver- Grand Junction- 560 0 560 0 Meals 270 LodginglTrans 290 Other 0 CATEGORY Totals 560 0 560 0 D. Equipment hops://egrants.cns.gov/pls/cns~lsgUcn bgtnarr.prt bgmarr?C_GRNT ID=03SR034317&I.. 4/22/2003 Budget Narrative for 03SR034~ ~ Page 2 of 3 Item/Purpose-Qty -Unit Cost CNCS Share Grantee Share Total Amount Excess Amount Computer/printer/fax: -3 x 641 0 1,923 1,923 0 CATEGORY Totals 0 1,923 1,923 0 E. Supplies Item/ Purpose-Calculation CNCS Share Grantee Share Total Amount Excess Amount paper-pens-notepads-mailing etc.: $55 per month general office 0 660 660 0 materials CATEGORY Toils 0 660 660 0 F. Contractual and Consultant Services Purpose -Calculation CNCS Share Grantee Share Total Amount Excess Amount Administration Supervision:: 52 hours @ 37.00 1,924 0 1,924 0 CATEGORY Totals 1,924 0 1,924 0 I.Other Volunteer Support Costs Item CNCS Share Grantee Share Total Amount Excess Amount Water Evaluation Test Kits: 3,300 300 3,600 0 CATEGORY Totals 3,300 300 3,600 0 J. Indirect Costs Rate Type -Claimed-Rate CNCS Share Grantee Share Total Amount Excess Amount CATEGORY Totals 0 0 0 0 SECTION Totals 20,592 2,883 23,475 0 Section 11. Volunteer Expenses A. Other Volunteer Costs Grantee Excess Item -Description CNCS Share Share Total Amount amount https://egrants.cns.gov/pls/cns~lsgUcn_bgtnarr.prt_bgtnarr?C_GRNT ID=03SR034317&x.. 4/22/2003 ,.. ,Budget Narrative for 03 SR03~ ~ Page 3 of 3 Meals: 0 0 0 0 Unfforms: 0 0 0 0 Insurance: 34 @ 5.85 199 0 199 0 Recognition: 34 @ 30.00 0 1,000 1,000 0 Volunteer Travel: 28000 @.30 Large Mountainous geographic region. Travel largest obstacle to volunteering in rural Colorado. 5,400 3,000 8,400 0 CATEGORY Totals 5,599 4,000 9,599 0 SECTION Totals 5,599 4,000 9,599 BUDGET Totals 26,191 6,883 33,074 ~~ Source of Funds Section Description Section I. Volunteer Support Expenses Section II. Volunteer Expenses https://egrants.cns.gov/pls/cns~lsgUcn_bgtnarr.prt_bgtnarr?C_GRNT ID=03SR034317&I.. 4/22/2003