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<br />2008 Contract Service Page (CSP) <br />Agency Name: North Olmsted Senior Center <br />A SERVICE GdAL STATEMENT ` "' <br />1 County Cuyahoga County <br />2 Nutrition Program Description Congregate Only (C1) <br />2 Service Name & Code Nutrition Education (12) <br />3 Service Definition One Session <br />5 Total Units Provided with Funds on Line B8 2 <br />6 Total Projected Unduplicated Clients to be Served: 100 <br />7 Total Projected Unduplicated Clients to be Served in each Priority Population <br />American Indian or Alaskan Native 0 <br />Asian 0 <br />Hispanic or Latino 3 <br />Black or African American p <br />NativeHawaiian or Other Pacific Islander p <br />In Poverty 46 <br />Disabled 28 <br />Rural 3 <br />Living Alone 141 <br />Frail 5 <br />Limited English Proficiency 0 <br />Caregiver 2 <br />Kinship Carer 1 <br />g Number of Unduplicated Clients from Line 6 not Classified in above Categories: <br />Number 100 <br />(auto calculates %) Percent 100% <br />9 Amount of Donation Suggested for Service $0.75 <br />10 Hours of Service Operation 12 p.m. - 1 p.m. <br />11 Location of Service Delivery North Olmsted Senior Center/Community Cabin <br />B PROPOSED°:FUNDING SOURCES <br />1 OAA Title III Funds $50.00 <br />2 Cash Match <br />3 In Kind Match <br />4 Subtotal $50.00 <br />5 Program Income <br />6 Client Cost Share <br />7 Other Funds (List Sources in Budget Narrative) <br />8 Total Service Budget $50.00 <br />9 OAA Title III Unit Cost $25.00 <br />10 Total Budget Unit Cost $25.00 <br />C MATCH CALCULATION <br />_ <br />~ <br />Federal Share 100°/0 <br />2 15% Provider Match (Catered Meals 40%) 0% <br />3 Total must Equal 100% 100% <br />D UNIT COST`DETAIL <br />o a os i ~n CostlUnit ercen age <br />1 Wages for Direct Service Workers $0 <br />00 0 <br />00% <br />2 Fringe Benefits . <br />. <br />$0.00 0.00% <br />3 Service Materials and Supplies $0.00 0.00% <br />4 Service Travel and Transportation $0.00 0.00% <br />5 Other Direct Service Costs $50.00 $25.00 100.00% <br />6 Subtotal Direct Service Costs $50.00 $25.00 <br />7 Indirect/ Overhead & Administrative Costs $0.00 0.00% <br />8 Tota! Service Budget $50.00 $25.00 1 0.00 /° <br />Older Americans Act Service Contract <br />