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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 /> Rent & Utilities $5,866 $6,480 $7,128 10% <br /> Supplies & Equipment $1,398 $2,740 $3,014 10% <br /> Travel &Training $195 $370 $407 10% <br /> Other Expenses: $10,300 $7,885 $8,674 10% <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 55,092 62,268 68,495 10% <br /> SURPLUS/(DEFICIT) FOR PERIOD: $(1,499) I $(16,168) I $(17,785) <br /> Main Application 5/25/2016 9:07:15 AM P of <br />