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. | |
| Line 12—SUBTOTAL (Allowable and Unallowable Costs) |
$116,000
(The sum of Lines 1 through 11) |
|
| Line 13—Contingencies | $0 – Not allowable in equipment-only projects | |
| Line 14—SUBTOTAL | $116,000 (The sum of lines 12 and 13) |
|
| Line 15—Project (program) income | Not Applicable | |
| Line 16—TOTAL PROJECT COSTS (Allowable and Unallowable) |
$116,000 (Sum of allowable and unallowable costs from Line 14 above) |
|
| Line 17—GRANT funding requested (Note: round to the nearest whole dollar amount) |
$100,000 |
SEE APPENDIX A: Allowable and Unallowable Costs in the Notice of Funding Opportunity.