Attachment__6_-_Additional_Info.doc

DOC document 64 KB Posted

Attached to
Pipeline Safety Research and Development Announcement
Solicitation number
DTPH5616RA00001
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Attachment 6 - Additional Info

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Other files

File Type Posted
Attachment__3_-_Team_Project_Activities.doc DOC document
DTPH5616RA00001_Announcement_Amendment__1_-_Innovation_with_Inspecting_Unpiggable_Natural_Gas_Pipelines.pdf PDF
DTPH5616RA00001_Q A.pdf PDF
Attachment__4_-_Project_Deliverables.doc DOC document
Attachment__1_-_General_Guidelines_Co-Funded.pdf PDF
Attachment__2_-_Budget_Summary.doc DOC document
DTPH5616RA00001_Announcement_-_Innovation_with_Inspecting_Unpiggable_Natural_Gas_Pipelines.pdf PDF
Attachment__5_-_Deliverable-Milestone_Schedule.xlsx XLSX spreadsheet
Attachment__7_Standard_Title_VI_Non-Discrimination_Assurances.pdf PDF

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DTPH5616RA00001

Full Proposal

Attachment 6

ADDITIONAL INFORMATION

Institution/Firm:
Proposal # (if any):
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

DUNS number:
Taxpayer/Federal Identification Number:

Banking Information (electronic payment)

Bank Name:
Account Type:
Account #:
ABA Routing No:

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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