Attachment 5 - Additional Info 693JK323RA0001.doc

DOC document 74 KB Posted

Attached to
FY23 - Research Announcement #9
Solicitation number
693JK323RA0001
Issued by

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Other files

File Type Posted
Questions and Answers RFQ 693JK323RA0001.docx DOCX document
RA 693JK323RA0001 Notice.doc DOC document
Attachment 4 - Budget Summary 693JK323RA0001.pdf PDF
Attachment 1 - Team Project Activities 693JK323RA0001.doc DOC document
Attachment 6 - Title VI Non Discrimination Assurances 693JK323RA0001.docx DOCX document
Attachment 3 - Deliverable-Milestone Schedule 693JK323RA0001.xlsx XLSX spreadsheet
Attachment 7 - Research Topics 693JK323RA0001.docx DOCX document
Attachment 8 - Terms and Conditions RA693JK323RA0001.docx DOCX document
Attachment 2 - Project Deliverables 693JK323RA0001.doc DOC document

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U.S. Department of Transportation (USDOT)

RA #693JK322RA0001

Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #5

ADDITIONAL INFORMATION

Institution/Firm:
Proposal Title:
Type of Business (profit, non-profit):

Size (check all that apply):

FORMCHECKBOX

Small Business FORMCHECKBOX Small Disadvantaged Business

FORMCHECKBOX

8(a) Business FORMCHECKBOX Woman Owned Business

FORMCHECKBOX

HUBZone Business FORMCHECKBOX Veteran Owned Business

FORMCHECKBOX

SDVOB FORMCHECKBOX

Large Business

UEI Number:
Taxpayer/Federal Identification Number:

Contractor/Team Project Officials

Contractor/Team Program Manager / Principle Investigator

Name:
Address:
E-Mail:
Telephone:
Fax:

Contractor/Team Program Financial Administrator

Name:
Address:
E-Mail:
Telephone:
Fax:

Contractor/Team Technical Coordinator

Name:
Address:
E-Mail:
Telephone:
Fax:

System for Award Management (SAM)

Is your organization registered in www.SAM.gov? Yes FORMCHECKBOX No FORMCHECKBOX

If you answered Yes above, please indicate the date of your latest SAM update:

/ FORMTEXT

Cost-Share Certification

Please certify that the proposed cost-share for this project is in accordance with 2 CFR 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Section 306, Cost Sharing or Matching.

Name of Person Certifying:

Signature:

Date:

FORMTEXT

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