Form_9.1.pdf

9.1 NOAA Small Business Innovation Research (SBIR) Phase I Cover Page

Solicitation No.: Closing Date:

Name of Submitting Firm:

Address of Firm (including Zip Code +4):

Title of Proposed Project:

Requested Amount: Proposed Duration: Solicitation Subtopic No.:

Solicitation Subtopic Title:

THE ABOVE ORGANIZATION CERTIFIES THAT:

1. It is a small business firm as defined in this Solicitation. Yes No

2. The primary employment of the principal investigator will be with the firm at the time of Yes No award and during the conduct of the research.

3. A minimum of two-thirds of research will be performed by this firm in Phase I. Yes No

4. It qualifies as a minority and disadvantaged small business as defined in this Solicitation. Yes No

5. It qualifies as a woman-owned small business as defined in this Solicitation. Yes No

6. It will permit the government to disclose contact information of the corporate official of your Yes No concern, if your proposal does not result in an award, to appropriate local and State-level economic development organizations that may be interested in contacting you for further information.

7. It authorizes contact information and project title to be provided to the NIST Manufacturing Yes No Extension Partnership (MEP) Program after awards have been announced.

8. This firm and/or Principal Investigator has has not submitted proposals for essentially equivalent work under other federal program solicitations, or has has not received other federal awards for essentially equivalent work.

9. The offeror and/or any of its principals are are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; and have have not within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for:

commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property; and are are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses.

10. It is a veteran-owned small business concern. Yes No

It is a service-disabled veteran-owned small business concern. Yes No

11. It is a HUBZone small business concern listed, on the date of this representation, on the Yes No List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material change in ownership and control, principal office of ownership or HUBZone employee percentage has occurred since it was certified by the Small Business Administration in accordance with 13 CFR Part 126; and

It is a joint venture that complies with the requirements of 13 CFR Part 126, and the Yes No representation above is accurate for the HUBZone small business concern, or concerns that are participating in the joint venture. [The offeror shall enter the name or names of the HUBZone small business concern or concerns that are participating in the joint venture]:

Each HUBZone small business concern participating in the joint venture shall submit a separate signed copy of the HUBZone representation.

PRINCIPAL INVESTIGATOR

Name: Title: Day Telephone No.:

Signature & Date: Email: Fax No.:

CORPORATE OFFICIAL (BUSINESS)

Name: Title: Day Telephone No.:

Signature & Date: Email: Fax No.:

OTHER INFORMATION

Year Firm Founded Number of Employees: Avg. Previous 12 mos. Currently

Has a proposal for essentially equivalent work been submitted to another agency? Yes No

If yes, what Agency?

Is your company registered in SAM? Yes No

Taxpayer Identification Number:

Data Universal Numbering System (DUNS) Number:

PROPRIETARY NOTICE

These data shall not be disclosed outside the Government and shall not be duplicated, used, or disclosed in whole or in part for any purpose other than evaluation of this proposal. If a funding agreement is awarded to this applicant as a result of or in connection with the submission of these data, the Government shall have the right to duplicate, use, or disclose the data to the extent provided in the funding agreement and pursuant to applicable law. This restriction does not limit the Government's right to use information contained in the data if it is obtained from another source without restriction. The data subject to this restriction are contained on pages _______________ of this proposal.

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

12. The company was not involved in the selection of any topic or subtopic. The company shall not participate in the review of the proposals.

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

Margaret.West Typewritten Text

13. The company is registered in SAM.gov and the Representations and Certifications are completed. The NAICS code 541712 is included in the registration.

Margaret.West Typewritten Text

Margaret.West Typewritten Text Yes

Margaret.West Typewritten Text No

Margaret.West Typewritten Text Yes

Margaret.West Typewritten Text No