Attachment (C) AMS-Form-032.pdf

The only official copy of this file is the one online on the shared network drive (t drive).

Before using a printed copy, verify that it is the most current version by checking the rev. no. and effective date.

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. 2.0

Effective Date: September 23, APPROVED BY:

Dedra Blood / 9/23/24 Patent Certification

Contractor: Please check the appropriate box:

Contract Number: ☐ Interim Certification or ☐ 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 throughout the reporting period.

2. There were no subcontracts or purchase orders related to this contract 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:

Please check the appropriate box: Certification includes ☐ or does not include ☐ all subcontracts:

TITLE INVENTOR(S) DATE REPORTED iEDISON # DOE “S” #

Attach additional sheet(s) if needed.

4. The completion date of this contract is: ________________________________________

5. The following period is covered by this certification:

To Month Day Year Month Day Year

6. Contractor Signature: _________________________________ Title: __________________________________

Address: ___________________________________________________________________________________

Date of Certification:

ATTACHMENT C