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State ofNotth Carolita <br />Division of Social Services . <br />Contract Application Page fi of ] <br />O 2. The provider certifies Ihmugh the contract budge[ ntlached W this contract that <br />the matching share m available. Funkier, it is agreed that Ne provider will <br />report all pmgmm vests incurted each month relating to this contract on the <br />D59-15]1. Howeveq reimbursement will be limited to the ftderel/state <br />fituncial participation rote. <br />(X) 3. The comty depamnem of social services is providing the match. <br />G. Provider Fees (For Pwchaze Contracts ONyJ <br />O 1. The Provider agrees to pay the DepartrnenVDivisiov up ro S <br />Administrative Fre az payment in full for the adrrdtdsvation of the contract. <br />The amowt ofthe fee is five pemmt of the matching share contibuted by the <br />Provider. <br />O 2. The Provider agrees to pay the Departrnwt ep to $ Cedtificafiov Fee <br />as payment in fidl for the detemdnaifion and certification ofdient eligibility. <br />The amowt ofthe fee is five percent of the natching share connibumd by the <br />Providtt. <br />Motdmring and Certificafion Fees, when applicable, will be deducted from the <br />amount to be revnbmsed. <br />