Attachment_24thru28.pdf

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Attached to
PREVENT IDIQ MATO RFP Federal contract opportunity
Solicitation number
75N91023R00024
Issued by
Department of Health and Human Services National Institutes of Health National Cancer Institute

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Amendment_2_75N91023R00024_RFP_0002.pdf PDF
RFP_PREVENT_75N91023R00024_Amend02_no_DMS_0002.pdf PDF
Sol_75N91023R00024_Amd_0002.pdf PDF
Attachment_10thru14_REVISED_0002.pdf PDF
Questions__Answers_PREVENT_23R00024Amend1_0001.pdf PDF
Sol_75N91023R00024_Amd_0001.pdf PDF
Attachment_19thru23.pdf PDF
Attachment_16_17.pdf PDF
Attachment_10thru14.pdf PDF
RFP_PREVENT_75N91023R00024.pdf PDF
Attachment_1_2.pdf PDF
Attachment_18_Breakdown_of_Proposed_Estimated_Costs_Spreadsheet.xlsx XLSX spreadsheet
Attachment_3thru9.pdf PDF
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RFP

75N91023R00024

Attachments 24-28

Safety and Health, HHSAR 352.223-70 (DEC 2015)

a. To help ensure the protection of the life and health of all persons, and to help prevent damage to property, the Contractor shall comply with all Federal, State, and local laws and regulations applicable to the work being performed under this contract. These laws are implemented or enforced by the Environmental Protection Agency, Occupational Safety and Health Administration (OSHA) and other regulatory/enforcement agencies at the Federal, State, and local levels.

1. In addition, the Contractor shall comply with the following regulations when developing and implementing health and safety operating procedures and practices for both personnel and facilities involving the use or handling of hazardous materials and the conduct of research, development, or test projects:

I. 29 CFR 1910.1030, Bloodborne pathogens; 29 CFR 1910.1450, Occupational exposure to hazardous chemicals in laboratories;

and other applicable occupational health and safety standards issued by OSHA and included in 29 CFR part 1910. These regulations are available at https://www.osha.gov/.

II. Nuclear Regulatory Commission Standards and Regulations, pursuant to the Energy Reorganization Act of 1974 (42 U.S.C.

5801 et seq.). The Contractor may obtain copies from the U.S.

Nuclear Regulatory Commission, Washington, DC 20555-0001.

2. The following Government guidelines are recommended for developing and implementing health and safety operating procedures and practices for both personnel and facilities:

I. Biosafety in Microbiological and Biomedical Laboratories, CDC.

This publication is available at http://www.cdc.gov/biosafety/publications/index.htm.

II. Prudent Practices for Safety in Laboratories (1995), National Research Council, National Academy Press, 500 Fifth Street NW., Lockbox 285, Washington, DC 20055 (ISBN 0-309-05229-7). This publication is available at http://www.nap.edu/catalog/4911/prudent-practices-in-the-laboratory-handling-and-disposal-of-chemicals.

b. Further, the Contractor shall take or cause to be taken additional safety measures as the Contracting Officer, in conjunction with the Contracting Officer's Representative or other appropriate officials, determines to be reasonably necessary. If compliance with these additional safety measures results in an increase or decrease in the cost or time required for performance of any part of work under this contract, the Contracting Officer will make an equitable adjustment in accordance with the applicable ``Changes'' clause set forth in this contract.

c. The Contractor shall maintain an accurate record of, and promptly report to the Contracting Officer, all accidents or incidents resulting in the exposure of persons to

Attachment 24 75N91023R00024 https://www.osha.gov/ http://www.cdc.gov/biosafety/publications/index.htm http://www.nap.edu/catalog/4911/prudent-practices-in-the-laboratory-handling-and-disposal-of-chemicals http://www.nap.edu/catalog/4911/prudent-practices-in-the-laboratory-handling-and-disposal-of-chemicals toxic substances, hazardous materials or hazardous operations; the injury or death of any person; or damage to property incidental to work performed under the contract resulting from toxic or hazardous materials and resulting in any or all violations for which the Contractor has been cited by any Federal, State or local regulatory/enforcement agency. The report citing all accidents or incidents resulting in the exposure of persons to toxic substances, hazardous materials or hazardous operations; the injury or death of any person; or damage to property incidental to work performed under the contract resulting from toxic or hazardous materials and resulting in any or all violations for which the Contractor has been cited shall include a copy of the notice of violation and the findings of any inquiry or inspection, and an analysis addressing the impact these violations may have on the work remaining to be performed. The report shall also state the required action(s), if any, to be taken to correct any violation(s) noted by the Federal, State, or local regulatory/enforcement agency and the time frame allowed by the agency to accomplish the necessary corrective action.

d. If the Contractor fails or refuses to comply with the Federal, State or local regulatory/enforcement agency's directive(s) regarding any violation(s) and prescribed corrective action(s), the Contracting Officer may issue an order stopping all or part of the work until satisfactory corrective action (as approved by the Federal, State, or local regulatory/enforcement agencies) has been taken and documented to the Contracting Officer. No part of the time lost due to any such stop work order shall form the basis for a request for extension or costs or damages by the Contractor.

e. The Contractor shall insert the substance of this clause in each subcontract involving toxic substances, hazardous materials, or hazardous operations. The Contractor is responsible for the compliance of its subcontractors with the provisions of this clause.

(End of clause)

Attachment 24

REPORT OF GOVERNMENT OWNED, CONTRACTOR HELD PROPERTY

CONTRACTOR: CONTRACT NUMBER:

ADDRESS: REPORT DATE:

ADDRESS1:

ADDRESS2: FISCAL YEAR:

CITY:

STATE:

ZIP:

CLASSIFICATION BEGINNING OF

PERIOD

ADJUSTMENTS END OF PERIOD

#ITEMS VALUE GFP

ADDED

CAP

ADDED

DELETIONS #ITEMS VALUE

LAND >=$25K

LAND <$25K

OTHER REAL >=$25K

OTHER REAL <$25K

PROPERTY UNDER CONST

>=$25K

PROPERTY UNDER CONST

<$25K

PLANT EQUIP >=$25K

PLANT EQUIP <$25K

SPECIAL TOOLING >=$25K

SPECIAL TOOLING <$25K

SPECIAL TEST EQUIP >=$25K

SPECIAL TEST EQUIP <$25K

AGENCY PECULIAR >=$25K

AGENCY PECULIAR <$25K

MATERIAL >=$25K

(CUMULATIVE)

PROPERTY UNDER MFR

>=$25K

PROPERTY UNDER MFR

<$25K

SIGNED BY:

SIGNATURE DATE SIGNED:

NAME PRINTED Email

TITLE TELEPHONE

Report of Government Owned, Contractor Held Property (Rev 10/2014)

CONTRACTOR NON-DISCLOSURE AGREEMENT (NDA)

Each contractor/subcontractor who may have access to non-public information under their contract must sign the form: Commitment to Protect Non-Public Information – Contractor Agreement1. The Agreement is on the next page.

Please be aware that separate Agreements are required for each contract.

For NIH contractors registered in the NIH Enterprise Directory (NED) system:

• The NDA is now included in the full and refresher version of the NIH Security Awareness courses.

• The NDA is also available for direct electronic acceptance from the menu within the Security and Privacy Awareness Training system.

• Note: NIH contractors who will not be receiving an Active Directory (network) account can also use the NDA form on the next page.

For NIH contractors who are NOT registered in the NED system:

• The NDA form on the following page shall be used.

• The printed copy of the form must be signed and submitted to your Project Officer prior to performing any work on the contract. Other copies are retained and/or submitted as stated in the Agreement.

Note: Contractors are no longer required to upload a copy of their Agreement into the Security Awareness Tracking System.

1 HHS Rules of Behavior: HHS-OCIO-2010-0002.001S and HHS Contractor Oversight Guide, Appendix K http://intranet.hhs.gov/infosec/docs/policies_guides/ROB/HHS_OCIO_2010_0002.001S_HHS_Rules_of_Behavior_08262010.pdf http://intranet.hhs.gov/infosec/docs/policies_guides/COG/Contractor_Oversight_Guide.pdf

COMMITMENT TO PROTECT NON-PUBLIC INFORMATION

Contractor Agreement

Access to non-public information may be required in the performance of my official duties, while working under the following contract or subcontract with the National Institutes of Health (NIH): Contract Number _________________________________ between ________________________________ and my employer ______________________________.

(NIH I/C Name or Component) (Contractor’s Company)

Should I have access to non-public information, I agree that I shall not release, publish, or disclose such information to unauthorized persons. I shall protect such information and will employ all reasonable efforts to maintain the confidentiality of such information. These efforts shall be no less than the degree of care employed by NIH to preserve and safeguard sensitive information.

I agree that I shall immediately notify the NIH IT Service Desk of any suspected or confirmed unauthorized disclosure and/or misuse of sensitive information.

[ 301-496-4357 (local), 866-319-4357 (toll free), 301-496-8294 (TTY) or http://itservicedesk.nih.gov].

I understand that there are laws and regulations which provide for criminal and/or civil penalties for improper disclosure, including but not limited to:

a) 18 U.S.C. 641 (Public Money, Property or Records)

b) 18 U.S.C. 1832 (Trade Secrets)

c) 18 U.S.C. 1905 (Disclosure of Confidential Information)

d) 5 U.S.C. 552a (Privacy Act)

I have read and understand the requirements stated above and agree to adhere to them for the duration of time I work under a contract or subcontract with NIH. I understand that violation of the agreement may subject me to criminal and civil penalties.

Select one of the two options for signing this form:

1) Digital Signature 2) Manual Signatures (requires Witness)

Insert Digital Signature Type or Print Your Name: _____________________________

Signature: _________________________________________

Date: ___________________

Type or Print Witness Name: __________________________

Signature: _________________________________________

Date: ___________________

Copies are to be retained by:

1) NIH IC Project Officer

2) Individual Contractor

3) Contractor’s Company (Division of Contract Management) System http://itservicedesk.nih.gov/ http://itservicedesk.nih.gov

Instructions for Submitting Electronic Invoices via Email to the NIH Office of Financial Management (OFM) Effective April 23, 2020 (Updated October 30, 2020)

Page 1 of 5 Attachment 27, 4 Steps to Create the Invoice Submission Email

PLEASE READ THE BELOW INSTRUCTIONS THOROUGLY BEFORE SUBMITTING YOUR INVOICE

ELECTRONICALLY.

*Note: The key words (Vendor, PO, and Invoice), Colon (:) character following the keywords and the PIPE (|) character must be present to identify the information. The pipe (|) character is entered by pressing and holding the shift key and the backslash (\) key at the same time. The term “PO” is being used as a generic term to identify the award number [purchase order, contract, Blanket Purchase Agreement (BPA) call, task or delivery order] and must be used in the subject line, regardless of the specific type of your award.

Step 1:

Send invoices to the following email address:

invoicing@nih.gov

Step 2:

Subject line must follow this format for the invoice you are submitting (see note* below)

Step 3:

Attach the invoice to the email as either a PDF or Word document.

See Reminders below.

Step 4:

In the body of the email, type “Correspondence Email:” followed by your email address.

How to Properly Format the Subject Line of Your Email

EXAMPLE 1 – If Your Contract Includes a Contract Number AND an Order Number or Call Number:

Vendor: Name of the Contractor or Vendor|PO:Contract Number/Order Number or Call Number|Invoice:9999999

EXAMPLE 2 – If Your Contract ONLY Includes a Contract Number:

Vendor: Name of the Contractor or Vendor|PO:Contract Number|Invoice:9999999

EXAMPLE 3 – If Your Contract ONLY Includes an Order Number:

Vendor: Name of the Contract or Vendor|Order Number|Invoice:99999999

Screenshot of How to Locate the Contract Number and Order Number on Your SF 1449 (SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS Form)

The screenshot below shows where the Contract Number and Order Number are located on the SF 1449. The SF 1449 is provided to you by the NIH Contracting Officer upon awarding the contract. Please use the information on your SF 1449 to populate the correct Contract Number and Order Number in the subject line of your email invoice submission.

The Contract Number is required in order to process all invoices. The Contract Number is the same as the “PO” on the invoice email subject line. The Order Number is only applicable for certain contracts and can be found in field number 4, on the SF 1449 form. If your SF 1449 does not include an Order Number, then follow EXAMPLE 2 above to ensure the Subject line of your email is properly formatted.

Screenshot of How to Locate the Contract Number on Your SF 1447 (SOLICITATION/CONTRACT Form)

The screenshot below shows where the Contract Number is located on the SF 1447. The SF 1447 is provided to you by the NIH Contracting Officer upon awarding the contract. Please use the information on your SF 1447 to populate the correct Contract Number in the subject line of your email invoice submission.

The Contract Number is required in order to process all invoices. The Contract Number is the same as the “PO” on the invoice email subject line.

Screenshot of How to Locate the Contract Number and Release Number on Your OF 347 (ORDER FOR SUPPLIES OR SERVICES Form)

The screenshot below shows where the Contract Number and Order Number are located on the OF 347. The OF 347 is provided to you by the NIH Contracting Officer upon awarding the contract. Please use the information on your OF 347 to populate the correct Contract Number (if any) and Order Number in the subject line of your email invoice submission.

The Order Number is required in order to process all invoices. If there is no Contract Number, the Order number is the same as the “PO” on the invoice email subject line. The Contract Number is only applicable for certain contracts and can be found in field number 2, Contract Number, on the OF 347 form. If your OF 347 does not include a Contract Number, then follow EXAMPLE 3 on page 2 to ensure the Subject line of your email is properly formatted.

Subject Line Examples

For your reference, below is a chart listing examples of the correct and incorrect subject lines. Note: These are just examples, you must enter the applicable information for the invoice you are submitting.

Reminders

• Effective December 1, 2020, OFM will no longer accept hard copy vendor invoices sent to the OFM billing office via any shipping services (i.e., USPS, FedEx, UPS, DHL, etc.) or those delivered by any in-person drop off. OFM will not accept any invoices postmarked and/or delivered in-person on/after December 1, 2020. Please follow the electronic submission instructions on page 1. Failure to follow the above electronic submission instructions will result in invoice processing delays.

• Only invoices should be sent to the following mailbox: invoicing@nih.gov. Please do not send emails to this mailbox requesting a status of your invoice(s) and do not include the invoicing@nih.gov email address in your correspondence with NIH Institutes/Centers.

• You must submit only one invoice per email.

• Follow the system size limits that apply to the email and each invoice: individual email attachments cannot exceed

5 megabytes each; and the email plus all attachments cannot exceed a total of 30 megabytes.

• Clearly identify a valid and complete contract number on each invoice.

• Clearly identify an accurate DUNS number on each invoice.

Subject Line Correct Incorrect Vendor: XYZ Corp|PO:HHSN299202000053J/75X98019S00848|Invoice:XYASAD

XYZ Corp|PO # HHSN299202000053J \75X98019S00848|Invoice # XYASAD XYZ Corp| HHSN299202000053J \75X98019S00848|Invoice # XYASAD XYZ Corp| HHSN299202000053J \75X98019S00848| XYASAD Vendor: XYZ Corp,PO: HHSN299202000053J \75X98019S00848,Invoice:XYASAD Vendor: XYZ Corp|PO:HHSN299202000053J|Invoice:XYASAD

Vendor: XYZ Corp|PO:HHSN311201600011U|Invoice:XYASAD mailto:invoicing@nih.gov

• DO NOT include confidential information such as Social Security Numbers (do not include TIN if it is a Social Security Number).

The invoice attached to the email must be in a PDF or Word format. The date/time that a valid invoice is submitted electronically to the email box (invoicing@nih.gov) will be the same date/time logged as the invoice is received by NIH.

Questions?

Please direct inquiries regarding the status of invoices such as receipt of invoices, due date, or payment of invoices to the OFM Commercial Accounts Branch, Customer Service Office. The OFM Customer Service contact information and of methods to contact are available at the following OFM website https://ofm.od.nih.gov/Pages/Customer-Service.aspx and below.

The Customer Service Office is open Monday – Friday from 8:30 am to 5:00 pm (Eastern Standard Time) and is closed daily between 12:00 pm to 1:00 pm (Eastern Standard Time). The Customer Service Office phone number is 301-496-6088.

Instructions for Contractor/Vendor Courtesy Copy Electronic Invoice Submission to the Contracting Officer (CO):

The Contractor/Vendor shall send a cc: copy to the NIH Contracting Officer and the NIH Contracting Officer’s Representative (COR) stated in the award and the NIH Program point of contact when submitting the invoice to NIH/OFM for payment.

https://ofm.od.nih.gov/Pages/Customer-Service.aspx

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:

* Street 1

* City State Zip

Street 2

* Last Name

Prefix * First Name Middle Name

Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352

Approved by OMB

0348-0046

1. * Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. * Status of Federal Action:

a. bid/offer/application

b. initial award

c. post-award

3. * Report Type:

a. initial filing

b. material change

4. Name and Address of Reporting Entity:

Prime SubAwardee

* Name

* Street 1 Street 2

* City State Zip

Congressional District, if known:

6. * Federal Department/Agency: 7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a)

Prefix * First Name Middle Name

* Street 1

* City State Zip

Street 2

Suffix* Last Name

11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name: Prefix * First Name Middle Name

* Last Name Suffix

Title: Telephone No.: Date:

Federal Use Only: Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:

Completed on submission to Grants.gov

Completed on submission to Grants.gov

Attachment 16 75N91021R00004

Attachment_24_Safety_and_Health_HHSAR_Clause_352_223_70
Attachment_25_Govt_Owned_Prop
Attachment_26_Nondisclosure
CONTRACTOR NON-DISCLOSURE AGREEMENT (NDA)
For NIH contractors registered in the NIH Enterprise Directory (NED) system:
For NIH contractors who are NOT registered in the NED system:
COMMITMENT TO PROTECT NON-PUBLIC INFORMATION
Contractor Agreement
Attachment_27-Electronic_Invoicing_Instructions
Attachment_28_Disclosure_of_Lobbying_Activities_OMB_Form_SFLLL
Attachment_1&2.pdf
All_NONSOW_Attachments_PREVENT_1042023 1
All_NONSOW_Attachments_PREVENT_1042023 2
All_NONSOW_Attachments_PREVENT_1042023 3
Blank Page

Accessibility Report

Filename:

Nondisclosure.pdf

Report created by:

Organization:

[Enter personal and organization information through the Preferences > Identity dialog.]

Summary

The checker found no problems in this document.

Needs manual check: 0

Passed manually: 3

Failed manually: 0

Skipped: 1

Passed: 28

Failed: 0

Detailed Report

Document

Rule Name Status Description

Accessibility permission flag Passed Accessibility permission flag must be set

Image-only PDF Passed Document is not image-only PDF

Tagged PDF Passed Document is tagged PDF

Logical Reading Order Passed manually Document structure provides a logical reading order

Primary language Passed Text language is specified

Title Passed Document title is showing in title bar

Bookmarks Passed Bookmarks are present in large documents

Color contrast Passed manually Document has appropriate color contrast

Page Content

Rule Name Status Description

Tagged content Passed All page content is tagged

Tagged annotations Passed All annotations are tagged

Tab order Passed Tab order is consistent with structure order

Character encoding Passed Reliable character encoding is provided

Tagged multimedia Passed All multimedia objects are tagged

Screen flicker Passed Page will not cause screen flicker

Scripts Passed No inaccessible scripts

Timed responses Passed Page does not require timed responses

Navigation links Passed manually Navigation links are not repetitive

Forms

Rule Name Status Description

Tagged form fields Passed All form fields are tagged

Field descriptions Passed All form fields have description

Alternate Text

Rule Name Status Description

Figures alternate text Passed Figures require alternate text

Nested alternate text Passed Alternate text that will never be read

Associated with content Passed Alternate text must be associated with some content

Hides annotation Passed Alternate text should not hide annotation

Other elements alternate text Passed Other elements that require alternate text

Tables

Rule Name Status Description

Rows Passed TR must be a child of Table, THead, TBody, or TFoot

TH and TD Passed TH and TD must be children of TR

Headers Passed Tables should have headers

Regularity Passed Tables must contain the same number of columns in each row and rows in each column

Summary Passed Tables must have a summary

Lists

Rule Name Status Description

List items Passed LI must be a child of L

Lbl and LBody Passed Lbl and LBody must be children of LI

Headings

Rule Name Status Description

Appropriate nesting Skipped Appropriate nesting

Back to Top

CONTRACTOR:
CONTRACT NUMBER:
ADDRESS1:
ADDRESS2:
CITY:
STATE:
ZIP:
REPORT DATE:
FISCAL YEAR:
ITEMSLAND 25K:
VALUELAND 25K:
GFP ADDEDLAND 25K:
CAP ADDEDLAND 25K:
DELETIONSLAND 25K:
ITEMSLAND 25K_2:
VALUELAND 25K_2:
ITEMSLAND 25K_3:
VALUELAND 25K_3:
GFP ADDEDLAND 25K_2:
CAP ADDEDLAND 25K_2:
DELETIONSLAND 25K_2:
ITEMSLAND 25K_4:
VALUELAND 25K_4:
ITEMSOTHER REAL 25K:
VALUEOTHER REAL 25K:
GFP ADDEDOTHER REAL 25K:
CAP ADDEDOTHER REAL 25K:
DELETIONSOTHER REAL 25K:
ITEMSOTHER REAL 25K_2:
VALUEOTHER REAL 25K_2:
ITEMSOTHER REAL 25K_3:
VALUEOTHER REAL 25K_3:
GFP ADDEDOTHER REAL 25K_2:
CAP ADDEDOTHER REAL 25K_2:
DELETIONSOTHER REAL 25K_2:
ITEMSOTHER REAL 25K_4:
VALUEOTHER REAL 25K_4:
ITEMSPROPERTY UNDER CONST 25K:
VALUEPROPERTY UNDER CONST 25K:
GFP ADDEDPROPERTY UNDER CONST 25K:
CAP ADDEDPROPERTY UNDER CONST 25K:
DELETIONSPROPERTY UNDER CONST 25K:
ITEMSPROPERTY UNDER CONST 25K_2:
VALUEPROPERTY UNDER CONST 25K_2:
ITEMSPROPERTY UNDER CONST 25K_3:
VALUEPROPERTY UNDER CONST 25K_3:
GFP ADDEDPROPERTY UNDER CONST 25K_2:
CAP ADDEDPROPERTY UNDER CONST 25K_2:
DELETIONSPROPERTY UNDER CONST 25K_2:
ITEMSPROPERTY UNDER CONST 25K_4:
VALUEPROPERTY UNDER CONST 25K_4:
ITEMSPLANT EQUIP 25K:
VALUEPLANT EQUIP 25K:
GFP ADDEDPLANT EQUIP 25K:
CAP ADDEDPLANT EQUIP 25K:
DELETIONSPLANT EQUIP 25K:
ITEMSPLANT EQUIP 25K_2:
VALUEPLANT EQUIP 25K_2:
ITEMSPLANT EQUIP 25K_3:
VALUEPLANT EQUIP 25K_3:
GFP ADDEDPLANT EQUIP 25K_2:
CAP ADDEDPLANT EQUIP 25K_2:
DELETIONSPLANT EQUIP 25K_2:
ITEMSPLANT EQUIP 25K_4:
VALUEPLANT EQUIP 25K_4:
ITEMSSPECIAL TOOLING 25K:
VALUESPECIAL TOOLING 25K:
GFP ADDEDSPECIAL TOOLING 25K:
CAP ADDEDSPECIAL TOOLING 25K:
DELETIONSSPECIAL TOOLING 25K:
ITEMSSPECIAL TOOLING 25K_2:
VALUESPECIAL TOOLING 25K_2:
ITEMSSPECIAL TOOLING 25K_3:
VALUESPECIAL TOOLING 25K_3:
GFP ADDEDSPECIAL TOOLING 25K_2:
CAP ADDEDSPECIAL TOOLING 25K_2:
DELETIONSSPECIAL TOOLING 25K_2:
ITEMSSPECIAL TOOLING 25K_4:
VALUESPECIAL TOOLING 25K_4:
ITEMSSPECIAL TEST EQUIP 25K:
VALUESPECIAL TEST EQUIP 25K:
GFP ADDEDSPECIAL TEST EQUIP 25K:
CAP ADDEDSPECIAL TEST EQUIP 25K:
DELETIONSSPECIAL TEST EQUIP 25K:
ITEMSSPECIAL TEST EQUIP 25K_2:
VALUESPECIAL TEST EQUIP 25K_2:
ITEMSSPECIAL TEST EQUIP 25K_3:
VALUESPECIAL TEST EQUIP 25K_3:
GFP ADDEDSPECIAL TEST EQUIP 25K_2:
CAP ADDEDSPECIAL TEST EQUIP 25K_2:
DELETIONSSPECIAL TEST EQUIP 25K_2:
ITEMSSPECIAL TEST EQUIP 25K_4:
VALUESPECIAL TEST EQUIP 25K_4:
ITEMSAGENCY PECULIAR 25K:
VALUEAGENCY PECULIAR 25K:
GFP ADDEDAGENCY PECULIAR 25K:
CAP ADDEDAGENCY PECULIAR 25K:
DELETIONSAGENCY PECULIAR 25K:
ITEMSAGENCY PECULIAR 25K_2:
VALUEAGENCY PECULIAR 25K_2:
ITEMSAGENCY PECULIAR 25K_3:
VALUEAGENCY PECULIAR 25K_3:
GFP ADDEDAGENCY PECULIAR 25K_2:
CAP ADDEDAGENCY PECULIAR 25K_2:
DELETIONSAGENCY PECULIAR 25K_2:
ITEMSAGENCY PECULIAR 25K_4:
VALUEAGENCY PECULIAR 25K_4:
ITEMSMATERIAL 25K CUMULATIVE:
VALUEMATERIAL 25K CUMULATIVE:
ITEMSMATERIAL 25K CUMULATIVE_2:
VALUEMATERIAL 25K CUMULATIVE_2:
ITEMSPROPERTY UNDER MFR 25K:
VALUEPROPERTY UNDER MFR 25K:
ITEMSPROPERTY UNDER MFR 25K_2:
VALUEPROPERTY UNDER MFR 25K_2:
ITEMSPROPERTY UNDER MFR 25K_3:
VALUEPROPERTY UNDER MFR 25K_3:
ITEMSPROPERTY UNDER MFR 25K_4:
VALUEPROPERTY UNDER MFR 25K_4:
SIGNATURE:
DATE SIGNED:
NAME PRINTED:
Email:
TITLE:
TELEPHONE:
NIH Contract Number:
NIH I/C Name or Component:
Contractor's Compnay Name:
Type or Print Your Name:
Date:
Type or Print Witness Name:
Date_2:

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