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,~ <br />20Ct9 Contract Service Page (CSP) <br />Agency Name: North Olmsted Senior Center <br />A SERVICE GOAL STA <br />TEMENT <br />1 County Cuyahoga County <br />2 Funding Category III E <br />3 Service Name & Code Support Group (Caregiver) (16) <br />4 Service Definition One (1) Hour <br />5 Total Units Provided with Funds on Line B8 5 <br />6 Total Projected Unduplicated Clients to be Served: 30 <br />7 Total Projected Unduplicafed;Clients to;be Served in each. Priority Population <br />American Indian or Alaskan Native 0 <br />Asian p <br />Hispanic or Latino ~ <br />Black or African American 0 <br />Native Hawaiian or Other Pacific Islander 0 <br />In Poverty 2 <br />Disabled 1 <br />Rural p <br />Living Alone 10 <br />Frail 3 <br />Limited English Proficiency p <br />Caregiver 30 <br />Kinship Carer 0 <br />Number and Percent:of Unduplicated Clients from Line'6 not`Classified in above <br />8 .Categories: <br />Number 0 <br />Percent 0% <br />9 Amount of Donation Suggested for Service $0.50 <br />10 Hours of Service Operation Wednesdays or"Fridays-lunchtime <br />11 Location of Service Delivery North Olmsted Senior Center <br />B PROPOSED'FUNDING SOURCES <br />1 OAA Title III Funds $1,000.00 <br />2 Cash Match $968.52 <br />3 In Kind Match $78 75 <br />4 Subtotal $2, 047.27 <br />5 Program Income $15:00 <br />6 Client Cost Share <br /> <br />7 Other Funds (List Sources in Budget Narrative) <br />8 Total Service Budget $2,052;7 <br />9 OAA Title III Unit Cost $200.00 <br />10 Total Budget Unit Cost $492;45 <br />C` MATCH CALCULATION - <br />1 Federal Share 49% <br />2 15% Provider Match (Catered Meals 40%) 51 <br />3 Total must Equal 100% 100% <br />D UNIT COST DETAIL <br /> _ <br />o a os ~ rn _.., _,, <br />CostlUnit ercen age <br />1 Wages for Direct Service Workers <br /> $0.00 0.00% <br />2 Fringe Benefits $128.52 $25.70 6.23% <br />3 Service Materials and Supplies $1,000.00 $200.00 48.49% <br />4 Service Travel and Transportation $0.00 0.00% <br />5 Other Direct Service Costs $93.75 $18.75 4.55% <br />6 Subtotal Direct Service Costs $1,222.27 $244.45 <br />7 Indirect/ Overhead 8~ Administrative Costs $840.00 $168.00 40.73% <br />8 Total Service Budget $2,062.27 $412.45 100.00 ° <br />Older Americans Act Service Contract <br />