APPLICATION-DHS.ST.SVIP-COVID-Phase 1 Application Template.docx

Department of Homeland Security Innovation OTS Application COVID-19 Response & Future Mitigation

***DELETE INSTRUCTIONS BEFORE APPLICATION SUBMISSION***

Department of Homeland Security Innovation OTS Application Instruction Sheet COVID-19 Response & Future Mitigation

General Instructions:

You may delete the instructions, but you may not rearrange or delete any of the numbered sections in the application itself. All sections of the application must be completed, or your application will not be compliant.

Please review COVID-19 Response & Future Mitigation Technical Call document before submitting your application. The application cannot exceed 10 pages, including the architectural Intellectual Property diagram. These instructions can be removed in the application submission.

The deadline for submitting an application is 9/30/20 at 12:00 PM PT. To be considered for this award, please complete this application, save it as a PDF, and send it via email to dhs-silicon-valley@hq.dhs.gov prior to the close date and time. Applications received after the closing date and time will not be considered for review, no exceptions. DHS S&T will evaluate all compliant applications before the deadline.

In order to receive an award, you must set up a user account and register your company in www.sam.gov. This does not need to be done at the application phase but must be done if the applicant is chosen to pitch.

DHS may decide to close the OTS Call early. If this action occurs, DHS will publish a notification in beta.SAM.gov 30 days prior to closing the Call.

SECTION 1- GENERAL INFORMATION

1.3 Provide a synopsis of the proposed project, describe what makes it potentially revolutionary, and must include answers to the following questions:

· What are you trying to do?

· How is it done today?

· What are the limitations to your solution?

· Who would benefit and what would the impact be if you are successful?

· How much would it cost, and how long would it take?

1.4 Please tell us how you heard about the program and/or this specific Call (e.g. tech accelerator, venture capitalist, startup, media, beta.SAM.gov, etc.)

SECTION 2- COMPANY INFORMATION

2.1 This should match your DUNS Number.

2.2 If you do not have a DUNS number, you cannot apply to this program. You may apply for a DUNS number at https://www.dnb.com/duns-number.html

2.5 Use the check boxes to certify that your company adheres to the eligibility requirements detailed in section 4 of the SVIP Other Transaction Solicitation (HSHQDC-16-R-B0005) (as updated on January 29, 2020). If you do not meet the eligibility requirements, you are not eligible to apply to this program. Any questions regarding eligibility can be sent to the SVIP Team at dhs-silicon-valley@hq.dhs.gov.

2.6 Describe your company and its financials –

1. How old is it?

2. Where is it located (e.g. multiple locations, sales/R&D in U.S. and other countries)?

3. What level of outside investment has your company received?

4. From whom (Angel, Accelerator, or equivalent)? Please provide name of organization and POC. Please provide information on each of your company’s previous financing rounds, if any, including: a) Size of investment round, b) Lead investors and major investors, c) Closing date, d) Non-U.S. Investors, if any.

5. What is your annualized run-rate based on your current weekly/monthly revenue?

6. What is your current monthly burn rate?

7. What is your month-over-month revenue growth rate (USD)?

8. How much revenue did you book in the past 12 months?

9. Are you cash flow positive?

10. How many active customers or users do you currently have?

11. Who is your target market?

2.7 Number of current employees for the company listed on this application: This number should only include employees and full-time equivalents (FTEs). Calculations for FTEs must account for and include affiliated businesses—such as parent companies and subsidiaries—that are either in or outside of the USA..

2.8 Describe the management team:

1. What is their background and history (e.g. previous startups, successful exits, etc.)?

2. What are the qualifications and technical expertise of the key project personnel?

2.9 Investors:

· Has your company received outside investments? Check either yes or no

· If yes, please provide the following for each round of funding:

· Size of investment round

· Lead investors and major investors – including type of organization, POC, amount of investment, closing date

· Any and all non-U.S. investors of any investment size – including country of origin, type of organization, POC, amount of investment, closing date

SECTION 3- Technical Information

3.1 Technology Description- You must address the following questions:

1. How is your technology relevant to the Homeland Security problem outlined? You should demonstrate a good understanding of the technical challenges, present a credible (even if risky) plan to achieve the project’s goal, and it should result in a viable product.

2. What are you trying to do?

3. How will your technology work? Articulate your objectives technically and succinctly.

4. What is novel about your solution?

5. Why do you think your solution will succeed?

6. What are the technical challenges inherent in your solution and what is your plan to mitigate these risks?

7. How do you intend to measure progress and success?

8. What commercial market(s) are you already pursuing?

3.2 Innovation-

1. In what ways does your solution push the state-of-the-art?

2. What is novel about your solution as compared to others?

3. How does your solution compare or compete with those currently in the market?

3.3 Homeland Security Application-

1. How would you apply the DHS funding to adapt your product to the DHS use cases as outlined in the OTS Call?

3.4 Prototype Maturity:

1. Describe the maturity of the working prototype.

2. Describe the prototype that will be delivered at the conclusion of the phase to which this application pertains.

3.5 Work Statement (PHASE 1 ONLY):

This is a Phase 1 application. Provide a detailed description of the work you will perform specific to Phase 1.

1. Clearly identify tasks and subtasks that will be carried out throughout the course of a 6 to 9-month investment period in order to get to a proof of concept demonstration stage.

2. Provide the schedule of performance. Please list all Deliverables you plan to submit to the Government in Section 4, Chart 1 that meet the Objectives defined by the Government for that phase. For purposes of the Other Transaction Agreement (OTA), a Milestone is defined as a developmental stage in the product development cycle which marks an achievement of one or more project Objective(s), whereas a Deliverable in this case is something actually delivered to the Government, be it technical data, reports, computer software, or other project-related items that allows the Government to evaluate your progress in meeting the Objective. For example, you may implement a software algorithm as a milestone towards meeting a Project Objective, but you may only submit a report of the functionality combined with a demo of the software working as a Deliverable to the Government.

3.5(a) Please also include a Gantt-style chart, like the example below, to detail the breakdown of tasks and when they will be completed. Note any task dependencies as appropriate.

3.5(a)- Sample Gantt-style chart below

Phase 1

Task 1

Task 2

3.7 Description of Overall Approach for All 4 Phases

Describe the overall vision for this project across all 4 Phases. What is the intended outcome and final Deliverable to the Government? How does it complement or match your existing commercial roadmap? Provide as a deliverable a draft version of your commercialization plan for this technology that will be developed and/or adapted using the funding sought.

SECTION 4- COST INFORMATION

Please provide a rationale for the total cost of the project. You should provide a detailed breakout of how the money would be spent and how prices and rates were determined.

Milestones must match the payable milestones described in the work statement.

For purposes of the OTA, a Milestone is defined as a developmental stage in the product development cycle which marks an achievement of a project goal(s), whereas a Deliverable in this case is something actually delivered to the Government, be it technical data, reports, computer software, or other project-related items.

At a minimum, Travel costs must include 1 (one) three-day trip to Washington, DC. An estimated travel cost breakdown is required with the application submission. Per diem lodging rates can be found at: GSA Per Diem Rates. While vendors will not be able to claim government rates, travelers should attempt to make cost effective travel arrangements.

SECTION 5- LICENSE / RIGHTS OF ACCESS TO INFORMATION

Under this effort, companies shall retain ownership of the intellectual property rights to capabilities/technologies resulting from their proposed approach. It is the Government’s intent to obtain unlimited use rights to all reports delivered to the Government; and a limited use right to all applicable project data, materials, and/or technologies for the purpose of testing and evaluating the project, and any outputs, and capabilities. This does not grant the applicant the right to withhold delivery of Technical Data created or used in performance of the OTA upon request by the Government.

5.1 “Background Intellectual Property” is any intellectual property, proprietary information, trade secrets, or confidential know-how that is existing as of the date of execution of the Other Transaction Agreement and is intended to be used in performance of such Other Transaction Agreement.

5.2 Applicants expecting to use, but not to deliver, commercial open source tools or other materials in implementing their approach may be required to indemnify the U.S. Government against legal liability arising from such use when demonstrated on a Government owned or controlled network or environment.

5.3 If applicants desire to use their own or a third party’s proprietary background intellectual property (or both) as the basis of their proposed approach, in whole or in part, they should: 1) Clearly identify background intellectual property and its proposed particular use(s); 2) Explain how the Government will be able to reach its program goals (including transition) with the proprietary model offered; and 3) Provide possible nonproprietary alternatives in any area that might present transition difficulties or increased risk or cost to the U.S. government under the proposed proprietary solution.

If selected for award, you will need to provide documentation proving ownership or possession of appropriate licensing rights to all materials, data and/or technologies that will be used for the proposed project.

5.4 IP Architecture Diagram

As part of this application, you must include an architectural diagram that differentiates any background IP (including both your proprietary IP and any third-party IP) you are bringing to the project from any IP developed under this project. The diagram should clearly lay out the IP for the elements of the solution proposed. The application, including the IP diagram, cannot exceed 10 pages. Note: The diagram provided in the application is an EXAMPLE. Your diagram can be in any format you wish.

Company Name Application Date

***DELETE INSTRUCTIONS BEFORE APPLICATION SUBMISSION***

Insert appropriate marking to protect any proprietary or business sensitive information.

*DO NOT REMOVE* - Application Template – 6/8/20 Insert appropriate marking to protect any proprietary or business sensitive information.

*DO NOT REMOVE* - Application Template – 7/7/20

SECTION 1- GENERAL INFORMATION

SECTION 2- COMPANY INFORMATION

Company Logo

2.5 Please certify the following eligibility requirements for the company listed in the application.

2.5 (a) In order to be eligible for SVIP, an applicant must be a nontraditional Government contractor. This means “…an entity that is not currently performing and has not performed, for at least the one-year period preceding the selection of sources” by the Government “…any contract or subcontract for the Department of Homeland Security that is subject to full coverage under the cost accounting standards pursuant to 41 U.S.C. 1502. We have also provided a link to 9903-201-2 for your convenience.

☐ I hereby certify that I have read the definitions provided under “41 U.S.C. 1502” and that the company listed on this application qualifies as a non-traditional Government contractor pursuant to “41 U.S.C. 1502“

2.5 (b) When applying for a Phase 1, applicants must not have been a party to any Federal Acquisition Regulation (FAR) based contracts (to include Small Business Innovation Research (SBIR)) and/or Federally awarded grants or cooperative agreements with a combined total of more than $1,000,000 in the past 12 months from date of application, whether as a prime contractor or subcontractor.

☐ I hereby certify that the company listed on this application has not been a party to any FAR based contracts, grants and/or cooperative agreements with a combined total of more than $1,000,000 in the past 12 months from the date of this application, whether as a prime contractor or subcontractor.

2.5 (c) When applying for Phase 1, applicants must have fewer than 200 employees or full-time equivalents (FTE)s. Calculations for FTEs must take into account and include affiliated businesses, such as parent companies and subsidiaries, that are either in or outside of the USA.

☐ I hereby certify that the company and all of its affiliated businesses, such as parent companies and subsidiaries, that are either in or outside of the USA has fewer than 200 employees and/or FTEs, total.

2.6 Company Description:

2.7 Number of current Employees for the company listed on this application:

2.8 Management Team:

2.9 Investors: Please provide all of the details referenced in the instructions section and check the applicable box below.

Have you received Foreign investments? ☐ Yes ☐ No If yes, please provide the information listed in the instructions section 2.9

2.10 Financial Health:

2.11 Customers:

SECTION 3- TECHNICAL INFORMATION

3.1 Technology Description:

3.2 Innovation:

3.3 Homeland Security Application

3.4 Prototype Maturity:

3.5 Work Statement (PHASE 1 ONLY):

3.5(a)- Sample Gantt-style chart Phase 1

Task 1

Task 2

3.6 Total Phase I Period of Performance in Months.

3.7 Description of Overall Approach for All 4 Phases:

SECTION 4- COST AND DELIVERABLE INFORMATION

Total Phase 1 Cost

*The total cost cannot exceed $200,000 and must reflect Phase 1 costs only. Please round numbers for all associated costs in all charts to the nearest dollar.

Note: Payments are triggered by reasonable milestone achievement and completion of Deliverable(s). However, upfront payment may be made if there is an initial cost of materials.

Chart 1 - Milestone Cost Roll Up

Labor: Materials: Travel: Total:

1.1

Ex: Month 1

1.2

Ex: Month 2

Labor: Materials: Travel: Total:

Total

CHART 2 -Labor Per Milestone Chart

TOTALS

CHART 3 -Materials, Hardware and Software Cost

CHART 4-Travel Costs

*Misc includes tolls, airport parking, etc.

**At a minimum, Travel costs must include 1 (one) three-day trip to Washington, DC.

SECTION 5- LICENSE / RIGHTS OF ACCESS TO INFORMATION

5.1 What Background IP are you bringing in to the project?

5.2 Include all proprietary claims to results, prototypes, deliverables, or systems supporting and/or necessary for the use of the research, results, prototypes, and/or deliverables.

5.3 Will your company require a License Agreement for this Phase 1? ☐ Yes ☐ No If yes, you will be required to provide a copy of your license agreement if you are selected for a pitch.

5.4 Please list third-party licenses you will be using.

5.5 IP Architecture Diagram

Background IP

Project Funded IP image1.png