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<br />WORKSHEET TO EXHIBIT A <br />Community Development Block Grant Program <br />P.o. Box 391, Redwood City, CA 94064 <br /> <br />Name of Agency: Mental Health Association of San Mateo County <br />Address and Zip Code: 2686 Spring Street, Redwood City, CA 94063 <br />Activity Name: Spring Street Shelter <br />Fiscal Year 2005-2006 <br /> <br />A. Salary and Wa~es »»»»»»»»»» <br />Position Hours @ $ = Budget <br />Shelter Site Manaç¡er Full-time 40 hours per week $ 4,136.00 <br />7.5 FTE Shelter Staff 40 hours per week $ 7,600.00 $ 53,948.56 <br />Total Salary and Wages $ 7,600.00 $ 58,084.56 <br />B. Frinae Benefits <br />Health Insurance $ $ 4,806.00 <br />Life Insurance $ $ - <br />Retirement $ $ 879.00 <br />Workmen's Compensation $ $ 6,636.00 <br />State Unemployment Insurance $ $ 1,161.00 <br />Other Personnel Costs (Mileage) $ $ 68.00 <br />Total Frin~e Benefits $ $ 13,550.00 <br />C. Office <br />Telephone $ $ 810.00 <br />Office Suppies $ $ 81.00 <br />Postaç¡e $ $ 41.00 <br />Duplicating Costs $ $ 1,500.00 <br />Total Office Costs $ $ 2,432.00 <br />D. Marketin~/Outreach <br />Promotion $ $ <br />Traininç¡ $ $ <br />Advertisina $ $ <br />Total Miscellaneous $ $ <br />E. Fiscal Management <br />Accountinç¡ $ $ <br />Auditinç¡ $ $ <br />Total Fiscal Management $ $ <br />F. Operations <br />Instructional materials 1$ $ <br />Activities $ $ <br />G. Other Budget Line Items*: <br />Food and Housekeepinç¡ $ 2,400.00 $ 2,430.00 <br />Utilities $ 3,038.00 <br />Total Other Budget Line Items $ 2,400.00 $ 5,468.00 <br />Total Operations $ 10,000.00 $ 79,534.56 <br /> <br />* Please fill this section if the line items listed in your application are not found in the listed examples above. <br />