Organization Name: Healthy Youth Clinic (HYC)
Project Type: Equipment-Only
Project Name: HYC East Clinic Equipment Purchase
Total ARP-Capital Funding Request = $100,000
Total Project Cost = $116,000
HYC will use ARP-Capital funding to purchase movable equipment. The proposed list of items, each with a useful life of at least one year, are shown in the equipment list and will be used to support services at our existing site location Health Youth Clinic – East Service Site. This equipment will result in improved services to the patient population. The total HYC project cost is $116,000.
This project will be funded by $100,000 in ARP-Capital funds and by $16,000 in funds to be paid directly by HYC out of funds in hand.
|LINE NUMBER||ALLOWABLE COSTS—ARP-Capital||UNALLOWABLE COSTS|
|Line 1—Administrative and legal expenses||$0 – No funds are requested to support the administration costs of this project.|
|Line 2—Land, structures, right- of-way, appraisals, etc.||$0 – Not allowable in equipment-only projects.|
|Line 3—Relocation expenses and payments||$0 – Not allowable in equipment-only projects.|
|Line 4—Architectural and engineering fees||$0 – Not allowable in equipment-only projects.|
|Line 5—Other architectural and engineering fees||$0 – Not allowable in equipment-only projects.|
|Line 6—Project inspection fees||$0 – Not allowable in equipment-only projects.|
|Line 7—Site work||$0 – Not allowable in equipment-only projects.|
|Line 8—Demolition and removal||$0 – Not allowable in equipment-only projects – costs to dispose of old equipment and furnishings are not allowable.|
|Line 9—Alteration/ Renovation (Construction)||$0 – Not allowable in equipment-only projects – costs to make permanent connections to utilities are not allowable.|
|Line 10—Equipment||$116,000 is the total for equipment.
See attached itemized list.
Total = $116,000
|Line 11—Miscellaneous||$0 – For Equipment-only projects, please list all items on line 10.|
(Allowable and Unallowable Costs)
(The sum of Lines 1 through 11)
|Line 13—Contingencies||$0 – Not allowable in equipment-only projects|
(The sum of lines 12 and 13)
|Line 15—Project (program) income||Not Applicable|
|Line 16—TOTAL PROJECT COSTS
(Allowable and Unallowable)
(Sum of allowable and unallowable costs from Line 14 above)
|Line 17—GRANT funding requested
(Note: round to the nearest whole dollar amount)
SEE APPENDIX A: Allowable and Unallowable Costs in the Notice of Funding Opportunity.