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c. The Grantee shall also submit a final grant report; the Agency will retain 20% of the grant amount until this report <br />is received and approved by the Agency. <br />d. The Grantee shall complete all reports in a prescribed format, which shall be provided by the Agency. <br />5. Agency's Duties: <br />The Agency shall pay the Grantee in the manner and in the amounts specified in the Contract Documents. The total <br />amount paid by the Agency to the Grantee under this Contract shall not exceed $132,000. This amount consists of <br />$132,000 in State funds. <br />[ ] a. There are no matching requirements from the Grantee. <br />[X ] b. The Grantee's matching requirement is $39,600, which shall consist of: <br />[ ] In-kind [ ]Cash <br />[ ]Cash and In-kind [X] Cash and/or In-kind <br />The contributions from the Grantee shall be sourced from non-federal funds. <br />The total contract amount is $171,600. <br />6. Conflict of Interest Policy: <br />The Agency has determined that the Grantee is not subject to N.C.G.S. 143C-6-23(b) (2007). <br />7. Statement of No Overdue Tax Debts: <br />The Agency has determined that the Grantee is not subject to N.C.G.S. 143C-6-23(c). <br />8. Reversion of Unexpended Funds: <br />Any unexpended grant funds shall revert to the Agency upon termination of this Contract. <br />9. Reporting Requirements: <br />The Agency has determined that the Grantee is not subject to the reporting requirements mandated by <br />N.C.G.S. 143C-6-23. <br />10. Payment Provisions: <br />Upon execution of this Contract, the Grantee shall submit to the Agency Contract Administrator a completed "Request <br />for Payment" form, to be provided by the Agency, for an amount not to exceed $25,000. Thereafter, all "Request for <br />Payment" forms shall be submitted no more often than monthly and shall be supported by appropriate invoices, or <br />other types of billing documents. The Grantee may request from the Agency all remaining funds less 20°k of the <br />awarded grant amount (refer to Paragraph 4, Line c). At a later date, but prior to the expiration date of the contract, <br />the Grantee may request the final payment, which is the remaining 20°k of the awarded grant amount, upon the <br />Grantee's submission of a final grant report determined to be in compliance with the Agency's reporting specifications. <br />The Grantee shall submit all requests for payment for the month of June and return any unspent funds, relating to this <br />contract period, to the Agency no later than June 15. All payments are contingent upon fund availability. <br />If this Contract is terminated prior to the original end date, the Grantee may submit a final "Request for Payment" <br />form. All unexpended funds shall be returned by the Grantee to the Agency within 60 days of the contract termination <br />date. The Grantee shall also provide the Agency with a final report, in a format provided by the Agency, within 60 <br />days of the contract termination date. The final report will be used by the Agency to determine the amount, if any, of <br />expended funds to be returned to the Agency by the Grantee. <br />Payment shall be made in accordance with the Contract Documents and as described in the Scope of Work, <br />Attachment B. <br />M58~NCD Form 0009A Grarrt Cover Sheet CqD <br />Eff. 9/2005 Revised 08/08 <br />Revised 5/06, 7/07 Page 2 of 12 <br />