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<br />rev'\xJ G;for <br /> <br /> WORKSHEET TO EXHIBIT A <br /> Community Development Block Grant Program <br /> P. o. Box 391, Redwood City, CA 94064 <br />Name of Agency: HIP \'(()'.J).(\') (.(",lrvv-J '5 v I\. M....+-c ù (ji <br />Address and Zip Code : -~(p""¡ $ù~ C '"'1'1 U\ <br />Activity Name 1-1 ¿ '(Y'JL & h.",( I ,,) <br />A. Salary and Wages »»»»»»»»» <br />Position Hours @ $ = Budaet <br />p(~,("""" P,r(v¥J( S 'iPt. vh.....L,¡ t1G,'Y\l )h&r,l1<- Stvi4 $ $ <br />e¿:tC D D(,rlló"\'. r~ ~¡(~(VYl'" ..J $ $ <br />Total Salary and Waaes I $ ) ï" 6:lð $ ¡vI, ð-Oi) <br />B. Frinae Benefits <br />Health Insurance $ '3 Ù (0 ~ I $ I ""( '10 <br />Life Insurance $ ~ 10 J'ì $ ,~ 0 <br />Retirement $ ;;2 ~ 1 '16, $ I /ï r <br />Workmen's Compensation $ cf '-f.7D $ )7 ,- <br />State Unemployment Insurance $ S 8'8 q $ JSJ" <br />Other Personnel Costs (Specify) $ ~ ert;J. $ 170 <br />Total Fringe Benefits $ 7, 91Î $ 3fo;J.S <br />C. Office <br />Telephone $ 'J '1 ùù $ ';;> ø. 0 <br />Office Supplies $ -:ly: K- SO $ 110 <br />PostaQe $ ~.S7j $ S.) <br />Duplicating Costs $ ¡ ~~.s- $ 3 r <br />Total Office Costs $ I' 0 Cta $ y;;;¡û <br />D. MarketinalOutreach <br />Promotion $ ,-/, ';) 1 í $ <br />Trainina $ I. "'>7.J $ <br />Advertising $ ~.JJO $ SS <br />Total Miscellaneous $ x-J., (Ó;) $ Sf <br />E. Fiscal Management <br />Accounting $ l( '1S 0 $ I )ÖD <br />AuditinQ $ $ <br />Total Fiscal Management $ Lt. <is iJ $ I, 100 <br />F. Operations <br />Instructional materials $ $ <br />Activities $ $ <br />G. Other Budget Line Items *: -1 {"wc \ OveJ <br />T(\ ~v(l...n(J Sv~~~,{,p-hU'l)) ~n+ LLo¡'Y) p......-t-rtL- $ S~IÎ I $ <br />Total Operations $ y :)ù¡{o \.{ ð" $ ;)ú¡Oùû <br /> <br />* Please fill this section if the line items listed in your application are not found in the listed examples <br />above. <br />