ATTACHMENT 4 - Supplemental Volume Cover Sheet.pdf

Supplemental Volume Cover Sheet Reference the Broad Agency Announcement (BAA) instructions for supplemental volume submission requirements. For items requiring additional information please utilize the continuation pages.

Proposer Name:

Mailing Address:

DUNS Number:

Cage Code:

Proposal Number:

Proposal Expiration Date:

Authorized Negotiators:

Name: Name:

Title: Title:

Email: Email:

Phone: Phone:

Identification of team members (e.g. subcontractors/consultants):

Name: % of Effort

Name: % of Effort

Name: % of Effort

Name: % of Effort

Name: % of Effort

Name: % of Effort

Name: % of Effort

Name: % of Effort

Name: % of Effort

Name: % of Effort

Representations and Certifications:

Is System for Award Management (SAM) Registration complete?

Have the required additional representations and certifications been completed and included as part of the supplemental volume per the instructions outlined in the BAA?

Patents:

Are there any patents, patent applications, or inventions which the Proposer may be required to license in order to perform the work described in the Proposer’s proposal, or which the Government may be required to license to make or use the deliverables of the contract should the Proposer’s proposal be selected for award?

If yes, provide required details below.

Data Rights Assertions List:

Has the required Data Rights Assertions List been completed and included as part of the supplemental volume per the instructions outlined in the BAA?

Subcontracting Plan:

Is the Proposer a large business?

Will any portion of the effort be performed in the United States?

Is the total proposed value, including option periods, in excess of $700,000.00?

If yes to all of the above, has a subcontracting plan been completed and included as part of the supplemental volume per the instructions outlined the BAA?

Organizational Conflict of Interest:

Does the Proposer believe a potential conflict of interest exists?

If yes, has an email notification been provided as required? Date of email:

Does the Proposer and/or proposed subcontractors provide scientific, engineering and technical assistance (SETA), A&AS or similar support, through an active contract or subcontract, to any DTRA technical office(s), the Joint Program Executive Office for Chemical and Biological Defense (JPEO), Assistant to the Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs (ATSD-NCB), or the Office of the Special Assistant for Chemical and Biological Defense and Chemical Demilitarization Programs

(OSA (CBD&CDP))?

If yes to any of the above, provide required disclosure below:

Describe actions taken to avoid, neutralize, or mitigate the conflict:

Human Subjects:

Will proposed research involve human subject or materials?

If yes, provide required details below.

Animal Use:

Will proposed research involve animal studies or animal work?

If yes, provide required details below.

Biological Defense Research Program (BDRP) Requirements:

Will proposed research involve select agent?

If yes, provide required details below.

Statement of Current and Pending Support:

Is any current or pending support for related work receiving, or potentially receiving, financial support?

If yes, provide required details below.

Accounting System Status:

Does the Proposer have an accounting system that has been determined to be adequate for determining costs applicable to the contract?

If yes, has evidence of accounting system adequacy been included as part of the supplemental volume per the instructions outlined in the BAA?

If no, has a modified pre-award checklist been completed and included as part of the supplemental volume per the instructions outlined in the BAA?

Forward Pricing Rate Agreement/Provisional Billing Rate Agreement:

Has the required rate agreement documentation, or indirect rate details if no agreement has been made with a Government representative, been included as part of the supplemental volume per the instructions outlined in the BAA?

Collaboration with a Department of Defense (DoD) Laboratory:

Has the Proposer proposed collaboration with a DoD laboratory?

If yes, has the letter of intent from that laboratory’s Commander been included as part of the supplemental volume per the instructions outlined in the BAA?

Federally Funded Research and Development Centers (FFRDC):

Is the Proposer or any proposed subcontractor a FFRDC?

If yes, has documentation from the FFRDC sponsor authorizing performance been included as part of the supplemental volume per the instructions outlined in the BAA?

DoD FFRDCs:

Is the Proposer or any proposed subcontractor a DoD FFRDC?

Is a member of the FFRDC’s board of directors or trustees simultaneously serving on the board of directors or trustees of a profit-making company under contract to DoD?

If yes to both, has a DoD approved conflict of interest policy been included as part of the supplemental volume per the instructions outlined in the BAA?

Department of Energy (DoE) FFRDCs:

Is the Proposer or any proposed subcontractor a DoE FFRDC?

If yes, has documentation from the FFRDC sponsor authorizing performance been included as part of the supplemental volume per the instructions outlined in the BAA?

Continuation Page:

Continuation Page: