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Cost Allocation Budget <br /> A B C D E F G H <br /> Percent Estimated Estimated <br /> Percent of no. of no. of <br /> of Total Program billable persons <br /> for funded persons or or <br /> Agency Total Program by CDBG CDBG- families families <br /> Budget Activity Description ($) ( %) Program ($) ( %) Funded ($) benefitted benefitted <br /> 92 550 <br /> Labor: $767,830.00 50.13% $384,936.00 3.90% $15,000.00 <br /> Supplies: $399,118.00 9.49% $37,859.00 0.00% <br /> Materials: #DIV /0! #DIV /0! <br /> Operations /Maintenance: #DIV /0! #DIV /0! <br /> TOTAL($) $1466,948.00 36.23% $422,795.00 3.55% $15,000.00 <br /> Cost per service unit (Divide CDBG <br /> Grant by # <br /> persons /families /households <br /> benefited $163.04 $163.04 $27.27 <br /> * Any line item request for reimbursement that is greater than 10% of the original estimated CDBG- budgeted line item <br /> must be approved in writing by DOH Director. <br /> Unless agreed to otherwise by the parties to this agreement, one hundred percent <br /> (100 %) of clients served with funding under this agreement must be low income as <br /> defined by U.S. Department of Housing & Urban Development for San Mateo County. <br /> The current low income standards for San Mateo County can be found at <br /> www.smchousing.orq. Family income will be documented by a statement of income <br /> signed by the client or verified by pay stubs, income tax returns, report of benefits, <br /> pensions or other suitable verification of income. <br /> 2. NEPA Exemption: CDBG funding for the program activity funded in this Agreement is <br /> exempt from environmental review (ER) in accordance with the National Environmental <br /> Protection Act under 24 CFR Part 58 sec.58.34 (4). Should DOH determine that the <br /> activity is not exempt under the aforementioned regulation, DOH will notify Contractor <br /> that an ER will be prepared and that any non -staff costs to undertake the ER will be <br /> deducted from the proceeds of the funding provided in this Agreement. In no case will <br /> funds be disbursed to Contractor until an ER determination has been made and /or <br /> completed to the satisfaction of the DOH, as the case may be. <br /> 3. Required Quarterly Reportina: Contractor shall submit to DOH a Quarterly Performance <br /> Report within 30 days of the end of each quarter. These reports may be accessed from <br /> DOH Rev. September. 2010 <br /> FOCC 515,000 CDBG <br /> Page 11 of 21 <br />