Hs Health Capital Request

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Hs Health Capital Request

  1. 1. No. Equipment/Project Cost 1 JEEP LIBERTY STATE CONTRACT Attach additional information as necessary
  2. 2. Justification CONTRACT
  3. 3. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: HEALTH YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition x 1. Essential x 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Vehicle Quantity: 1 Description: Jeep Liberty Estimated Cost : $State contract cost (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit:
  4. 4. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit: Attach additional information as necessary
  5. 5. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit: Attach additional information as necessary
  6. 6. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit: Attach additional information as necessary
  7. 7. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit: Attach additional information as necessary
  8. 8. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit: Attach additional information as necessary
  9. 9. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit: Attach additional information as necessary
  10. 10. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit:
  11. 11. Attach additional information as necessary
  12. 12. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit:
  13. 13. Attach additional information as necessary
  14. 14. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit:
  15. 15. Attach additional information as necessary
  16. 16. CITY OF HOBOKEN CAPITAL EQUIPMENT / PROJECT REQUEST (5 Year Plan) BUDGET YEAR: 2010 DEPARTMENT: YEAR REQUESTED: Check Check Type of item One Priority One 1. Additional Acquisition 1. Essential 2. Replacement 2. Badly Needed 3. New Item 3. Desirable 4. Improvement 4. Nice to Have 5. Renovation or Reconstruction Item / Project Name: Quantity: Description: Estimated Cost : (per item and total - attached detailed cost estimate) (Note any additional costs to operating budget as well. (ex. maintenance cost etc.) ) Justification / Benefit:
  17. 17. Attach additional information as necessary
  18. 18. 5 (E) 5(C) 5 (D) FIVE YEAR CAPITAL BUDGET PLAN 2 2014 LOCAL UNIT: 2012 2013 3 4 (B) 4 (C) 5 (A-E) 5 (A) 5 (B) 4 (A) PLANNED FUNDING SERVICES FOR CURRENT YEAR- 2010 FUNDING AMOUNTS PER BUDGET YEAR 1 GRANTS PROJECT ESTIMATED CAPITAL IN AID AND OTHER DEBT ESTIMATED PROJECT TITLE NUMBER TOTAL COST IMPROVEMENT FUND FUNDS AUTHORIZED TOTAL COST 2010 2011 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL ALL PROJECTS - - - - - - - - - -

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