HR001119S0040_Attachment_3_Proposal_Template_Adm_National_Policy_v2.docx

HR001119S0040 Manta Ray Attachment 3 Administrative and National Policy Requirements Document Template

The Administrative and National Policy Requirements document must be completed in full and included as part of the proposal submission. Do not delete any portion of this document.

All pages shall be formatted for printing on 8-1/2 by 11 inch paper with 1-inch margins and font size not smaller than 12-point. Font sizes of 8- or 10-point may be used for figures, tables, and charts.

The Administrative and National Policy Requirements document must be in .pdf, .odx, .doc, or .docx formats. Submissions must be written in English.

No page limit has been specified for the Administrative and National Policy Requirements document.

Source Selection Information – See FAR 2.101 and 3.104

DARPA-BAA-16-22 2

<PRIME ORGANIZATION LOGO>

HR001119S0040

Administrative and National Policy Requirements

Proposal Title

Proposer Organization

Proposer Reference Number, if any

Address:

Telephone:

E-mail:

Address:

Telephone:

E-mail:

Technical Area

Phase 2 ROM: $ Phase 3 ROM: $ Total: $

Date Proposal was Prepared

Proposal Validity Period (minimum 180 days)

Table of Contents

HR001119S0040 5

Team Member Identification [Using the following format, provide a list of all team members including the prime, subcontractor(s), and consultant(s), as applicable. Identify specifically whether any are a non-U.S. organization or individual, FFRDC and/or Government entity. If a team member is acting in an individual capacity mark the Organization as “Self.”]

Prime

Subcontractors/Consultants

Organizational Conflict of Interest Affirmations and Disclosure Are any of the proposed individual team members or their respective organizations (whether prime or subcontractor or consultant) currently providing SETA or similar support to DARPA?

No Yes [If yes, identify the DARPA Office(s) being supported and provide the prime contract number(s) and descriptions of the proposed action (or action already taken) to avoid, neutralize or mitigate the conflict.] Refer to Section III.B of the BAA for more information.

Requirements for teams that include Government Entities and/or Federally Funded Research and Development Centers (FFRDCs) Are any of the team member organizations (prime or subcontractor) a Government entity or FFRDC? No Yes [If yes, provide the information outlined below in accordance with BAA Section III.A.]

a. Proof of Eligibility to Propose [Provide documentation citing the specific authority that establishes the applicable team member’s eligibility to propose to Government solicitations and compete with industry; include: (1) statutory authority; (2) contractual authority; (3) supporting regulatory guidance; and (4) evidence of agency approval for applicable team member participation. For FFRDCs, this documentation must be in the form of a letter on official letterhead from their sponsoring organization and must also include a statement of compliance with the terms and conditions of the associated FFRDC sponsor agreement, as applicable.]

b. Statement of Unique Capability [Provide a statement that demonstrates the work to be performed by the Government entity or FFRDC team member is not otherwise available from the private sector.]

Animal Use Does the proposed work involve animal use? No Yes [If yes, provide a brief description of the plan for Institutional Animal Care and Use Committee (IACUC) review and approval, in accordance with BAA Section IV.B.3.d]

Intellectual Property (IP) In accordance with BAA Section IV.B.3.h provide the following information, as applicable. Note: the Government will assume unlimited rights to all IP not explicitly identified as restricted in the proposal.

a. Technical Data and Computer Software Are you asserting any IP restrictions on any technical data or computer software that will be delivered to the Government?

No Yes [If yes, list all proprietary claims to results, prototypes, deliverables or systems supporting and/or necessary for the use of the proposed research, results, prototypes and/or deliverables. Provide a short summary for each item asserted with less than unlimited rights that describes the nature of the restriction and the intended use of the intellectual property in the conduct of the proposed research. Use the following format for these lists.]

NONCOMMERCIAL

Asserted Rights Category

Name of Person Asserting Restrictions

COMMERCIAL

Asserted Rights Category

Name of Person Asserting Restrictions

b. Patents Does the proposed effort involve using patented inventions that are owned by or assigned to the proposing organization or individual?

No Yes [If yes, provide documentation proving ownership or possession of appropriate licensing rights to all patented inventions to be used for the proposed project. If a patent application has been filed for an invention, but it includes proprietary information and is not publicly available, provide documentation that includes: the patent number, inventor name(s), assignee names (if any), filing date, filing date of any related provisional application, and summary of the patent title, with either: (1) a representation of invention ownership; or (2) proof of possession of appropriate licensing rights in the invention (i.e., an agreement from the owner of the patent granting license to the proposer).]

Human Subjects Research (HSR) Does the proposed work involve HSR? No Yes [If yes, provide evidence of or a plan for review by an institutional review board (IRB), in accordance with BAA Section IV.B.3.d]