Attachment D Patent AMS-FORM-032.pdf

Attachment D

Date Printed 1/10/2020 1 of 1 Date Approved 07/19/17

PROCUREMENT AND PROPERTY MANAGEMENT DIVISION

BROOKHAVEN NATIONAL LABORATORY

Managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy

ACQUISITION MANAGEMENT SYSTEM FORM

Form No. AMS-Form-032

Revision No. 1.0

APPROVED BY:

Anthony Guadagni / 7/19/17

PPM Manager/Date

Patent Certification

Contractor: Interim Certification

Contract Number: Final Certification

Contractor hereby certifies that :

1. All procedures for identifying and disclosing subject inventions as required by the patent clause of the contract have been followed thought the reporting period.

2. There were no subcontracts or purchase orders involving research, development, and demonstration except as follows:

3. No inventions or discoveries were made or conceived in the course of or under this contract other than the following (Certification includes , does not include all subcontracts):

TITLE INVENTOR DATE REPORTED DOE “S” NO.

4. The completion date of this contract is as follows:

5. The following period is covered by this certification:

To

Month Day Year Month Day Year

Contractor Signature

Title

Address Date of Certification