09.06.22 FIN Original Budget Submission Shared Services Grant — File 22-1441

Department of Public Health Office of Local and Regional Health Public Health Excellence Grant Program for Shared Services Budget & Request For Budget Revision Page 1 BOH (City / Town / Lead Community) Program Name Somerville Public Health Excellence for Shared Services Vendor Code Fiscal Year Service Contract Number Today's Date VC6000192138 2022 June 22, 2021 Note: Please complete this entire form, including all line items. CURRENT Proposed Proposed Program Component FTE BUDGET Changes +/- New Budget Justification (A) (B) (C) (D) 1. Direct Care/Prog. Support Staff Program Coordinator/Point of Contact 1.00 65,000.00 $ - $ 65,000.00 $ Program coordination, POC Epidemiologist 1.00 65,000.00 $ - $ 65,000.00 $ Research, data interp, policy, prog e - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ SUB TOTAL 2.00 130,000.00 $ - $ 130,000.00 $ Fringe Be 23.53% 30,589.00 $ - $ 30,589.00 $ 23.53% of subtotal Payroll Taxes 16,211.00 $ - $ 16,211.00 $ 12.47% of subtotal 1. Total Direct Care/ Program Staff 176,800.00 $ - $ 176,800.00 $

Program Budget & Request For Budget Revision Page 2 BOH (City / Town / Lead Community) Program Name Vendor Code Fiscal Year Service Contract Number Today's Date Note: Please complete this entire form, including all line items. CURRENT Proposed Proposed Program Component BUDGET Changes +/- New Budget Justification (A) (B) (C) (D) 2. Other Direct Care/Program Research and data support (contractor) 20,000.00 $ - $ 20,000.00 $ Research legwork, data mgmt Office supplies 6,000.00 $ - $ 6,000.00 $ Data mgmt software, gen supplies Youth Health Survey - 3 communities 30,000.00 $ - $ 30,000.00 $ Tool dev, printing, distrib, compilatio Community Health Assess survey tool - 3 commun 28,000.00 $ - $ 28,000.00 $ Purchase of best practice tools - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 2. Total Other Direct/Program 84,000.00 $ - $ 84,000.00 $ Occupancy Program Facility - $ - $ - $ Facility Operations, Maint. and Furn. - $ 3. TOTAL OCCUPANCY - $ - $ - $ SUB TOTAL: 1 + 2 + 3 260,800.00 $ - $ 260,800.00 $ Administrative Support Applicable Policy Cap 4. AGENCY ADMIN. SUPPORT 39,120.00 $ - $ 39,120.00 $ 15% admin 5. CAPITAL BUDGET (Attach Schedule) $0.00 - $ - $ TOTAL 1+ 2 + 3 + 4 + 5 299,920.00 $ - $ 299,920.00 $ FOR DPH USE ONLY FOR DPH USE ONLY FOR DPH USE ONLY FOR DPH USE ONLY Reviewed by: Comments: Approved by:

Date: Program Budget & Request For Budget Revision Capital Budget Worksheet Page 3 BOH (City / Town / Lead Community) Program Name Public Health Excellence for Shared Services Vendor Code Fiscal Year Service Contract Number MTCP ID# Today's Date Capital Budget Item To Be Need for Item Quantity Estimated Estimated Purchased Unit Cost Total Cost $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Cost $0.00 Title to all equipment purchased under this capital budget shall vest with the governmental purchasing unit of the Department of Public Health. The Commonwealth of Massachusetts shall retain title to all assets purchased in in accordance with this capital budget.