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<br />Attachment A <br /> <br />State of North Carolina <br />Division of Social Services <br />Contract Application <br /> <br />A. <br /> <br />II. Fiscal provisions <br /> <br />Amount of Reimbursement: <br />Reimbursement under the terms of this agreement will be limited to a <br />maximum of: <br />$ 61,277.00 TOTAL * $ SSBG, CFDA IV-B, CFDA <br />No. 93.667:+ $ No. 93.645+ $ <br />$ 33,907.00 Fed.,CFDA 19,710.00 State + $ 7,660.00 County~ <br />No. 93.645 <br /> <br />Other (IdentifyJ---- <br /> <br />(Optional: County funds consist of $ <br /> <br />and $ <br /> <br />for <br /> <br />(funding source) <br /> <br />for <br /> <br />0) <br /> <br />(funding source <br /> <br />Maintenance of Eff~rt: <br /> <br />B. <br /> <br />( ) <br />(X) <br /> <br />1. N/A <br />2. The provider certifies that the funds to be used under this <br />contract do not replace or, supplant in any way, Federal, State or <br />local funds for already existing seriices. <br /> <br />1. <br /> <br />Method of Reimbursement: <br /> <br />For Purchase Contract (DSS-2497) Tota~ and Unit Cost: <br /> <br />C. <br /> <br />(0) <br /> <br />.. . ~Q} - - <br /> <br />2. <br /> <br />a. Reimbursement will be made in accordance with the current budget <br />approved by the Department and on file with both parties. The <br />amount of. reimbursement will be based on allowable expenditures made <br />in behalf of eligible clients, determined in accordance with <br />acceptable cost allocation methods. The Provider will report all <br />expenditures made under the terms of the contract. <br /> <br />- .b. Reimbur.sen1ent will be__m.ade.at.a.ll:[¡j;t; Gost. of $ p~r ~nit <br />of reimbursel1Ìent delivered to eligible clients for an estimated <br />number units. The Provider will document total expenditures <br />made under the terms of the contract to the Department within 30 <br />days after the termination of his contract, or as instructed by the <br />Department. Reimbursement which exceeds actual allowable cost will <br />be adjusted to actual allowable cost. <br /> <br />For Vendor Agreements (DSS-2252) Fixed Rate: <br /> <br />(X) <br /> <br />Reimbursement will be based on: <br /> <br />a. a standard fixed rate or <br /> <br />(0) <br /> <br />b. an individual rate. <br /> <br />\-~ <br />