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HomeMy WebLinkAboutC03-186 State Tobacco Education and Prevention PartnershipCo.~-I~s~-z-L S~TOBACCO EDUCATION AND PREVENTION PART HIP APPLICATION BUDGET AND/OR EXPENDITURE REPORT FORM FOR THE PERIOD: July 1, 2003 through June 30, 2004 AGENCY: Eagle County HHS Annual ;It of FTE/ Total SOURCE OF FUNDS Salary Rate months Budget Fringel Ind Pct Amount Required OTHER' Requested / Received from CDPHE PERSONAL SERVICES: Fringe Benefits: Total Personal Services DIRECT OPERATING F_)(PENSES Printing/Cop g Poste e/Shi ing Rent/Utllities Tale hone, Fax, Internet Access Office Su Iles $909.00 $909.00 Office E uI ment Corn afar E ui ment Meeting Ex ense $500.00 $500.00 Media Expense P ram Cost) Staff Develo ment -Registrations Stall Development - Membershi Subscri ons Educational Materials Program Cost) Miscellaneous nse Total0 ratio $1,409.00 $1,409.00 TRAVEL In-State $1,035.00 $1,035.00 Out-oP-State Total Travel $1,035.00 $1,035.00 CONTRACTUAL Consultant Costs (Program Cost $18,465.00 $18,465.00 Contrect Treiners/S keys (Program Cost) Data Collection Program Cost) Total Contractual $18,465.00 $18,465.00 Total Direct Costs Personal Services+O ratio +Travel+Contrectual $20,909.00 $20,909.00 ADMINISTRATIVE INDIRECT COSTS Pct Indirect Percentage 10.0% $2,091.00 $2,091.00 Totat Indirect Costs $2,091.00 $2,091.00 TOTAL PROJECT COST $23,000.00 $23,000.00 •"Other" Funding Sources (Matching Funds) Not required for this grant. 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U ~ W r%1 ~o °. ATTACHN~NT 1: Statement of Disclosure :~ By signing this statement, the applicant states that no affiliation or contractual relationships, direct or indirect, exists with tobacco companies or owners, affiliates, subsidiaries, holding companies or companies involved in any way in the production, distnbution, promotion, sales or use of tobacco products. Signed: Title: Chairman, Board of County Commissioners Organization: Eagle County Government Date: July 1, 2003