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to <br />State of North Carolina <br />Division of Social Services <br />Contract Application <br />Page 6 of <br />O 2. The provider certifies through the contract budgeC attached to this contract that <br />the matching share in available. Further, it is agreed that the provider will <br />report all program costs incurred each month relating to this contract on the <br />DSS-1571. 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 />(N/A) 1. The Provider agrees to pay the DepartmentlDivision up to <br />Administrative Fee as payment in full for the administration of the contract, <br />The amount of the fee is five percent of the matching shaze contributed by <br />the Provider. <br />(N/A) 2, The Provider agrees to pay the Deparhnent up to $ Certification Fee <br />as payment in full for the determination and certification of client <br />eligibility. The amount of the fee is five percent of the matching share <br />contributed by the Provider, <br />Monitoring and Certification Fees, when applicable, will be deducted from the <br />amount to be reimbursed. <br />