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DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Supplies & Equipment $- $300 $330 10% <br /> Travel &Training $- $- $- 0 <br /> Other Expenses: 0 <br /> Please list 3 largest"Other Expenses": <br /> Insurance $1,799.00 <br /> Fundraising $865.00 <br /> Fees $1,325.00 <br /> $ $ $ <br /> Total Agency Expenses 4,218 4,824 6701 39% <br /> SURPLUS/(DEFICIT) FOR PERIOD: <br /> Main Application 5/25/2016 9:07:15 AM Pa 2 '7 o of <br />