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, 25 <br /> State of North Carolina <br /> Division of Social Services <br /> Contract Application Page 6 of 8 <br /> • <br /> ( ) 2. The provider certifies through the contract budget attached to <br /> this contract that the matching share is available. Further, <br /> it is agreed that the provider will report all program costs <br /> incurred each month relating to this contract on the DSS-1571. <br /> However, reimbursement will be limited to the federal/state <br /> financial participation rate. <br /> ( x) 3. The county department of social services is providing the match. <br /> G. Provider Fees .(For Purchase Contracts Only) <br /> ( ) 1. The Provider agrees to pay the Department/Division up to $ <br /> Administrative Fee as payment- in full for the administration of the <br /> contract. The amount of the fee is five percent of the matching <br /> share contributed by the Provider. <br /> • <br /> ( ) 2. The Provider agrees to pay the Department up to $ Certifica- <br /> tion Fee as payment in full for the determination and certification <br /> of client eligibility. The amount of the fee is five percent <br /> of the matching share contributed by the Provider. <br /> Monitoring and Certification Fees, when applicable, will be deducted <br /> from the amount to be reimbursed. <br /> • <br /> • <br /> P <br /> DSS-1292 (4/87) <br /> Family Services <br />