Attachment 4 OBAA TS No. 13 Proposal Cover Sheet 70RWMD22R00000010.pdf

Attachment 4 Proposal Cover Sheet Format

CWMD OBAA Cover Sheet Proposal

Submission Contains Does Not Contain Proprietary Information

Submission ID: CWMDOBAA-

FP-0##-XXXX

Solicitation Number: 70RWMD22R00000010 Topic Solicitation No.: 13

Proposed Amount: Proposed Duration (in months):

Title:

Executive Summary (less than 2500 characters w/ spaces)

Provide a brief summary of your concept’s anticipated performance relative to the research topic goals and current state-of-the-art solutions, and why, if the research is successful, it could have a strategic impact on the CWMD mission to counter attempts by terrorists or other threat actors to carry out an attack against the United States or its interests using a weapon of mass destruction. Describe what is unique about this proposed technology, how it fits within the topic area, and how it would, if successfully realized, have a significant impact on the CWMD mission objectives to prevent nuclear terrorism through nuclear detection and forensics. Provide a concise description of the scientific, technical, and/or engineering approach you propose to pursue and address in this effort. Describe the key aspects, core concepts or components and/or prototype device proposed and relevant details about how such will function or perform. This summary should contain enough information to fully capture the program concept/intent and should completely describe the overall program in its entirety without relying on other sections of the pitch paper.

Prime Organization Information

Organization Name: Organization Address 1:

Organization Address 2:

Organization City/Province: Organization State (2 letter designation):

Organization ZIP + Four:

Country:

Principal Investigator (PI) Information

PI First Name: PI Middle Initial:

PI Last Name:

PI Address 1: PI Address 2:

PI City/Province: PI State (2 letter designation):

PI ZIP + Four:

PI Phone (include area code): PI Fax (include area code):

PI E-mail:

Program Manager (PM) Information

PI First Name: PI Middle Initial:

PI Last Name:

PI Address 1: PI Address 2:

PI City/Province: PI State (2 letter designation):

PI ZIP + Four:

PI Phone (include area code): PI Fax (include area code):

PI E-mail:

President/Company Officer/Technical Representative (For Business and Financial Matters)

First Name: Middle Initial: Last Name:

Address 1: Address 2:

City/Province: State (2 letter designation):

ZIP + Four:

Phone (including area code):

Fax (including area code):

E-mail:

Subcontractor Information

Subcontractor Name:

First Name: Middle Initial: Last Name:

Phone (including area code): E-mail:

Attachment 4 Proposal Cover Sheet Format