Sample of Equipment Only Budget Justification

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.

Date Last Reviewed:  April 2021