OSP Subrecipient Request Form

The purpose of this form is to request all items necessary to issue a Subrecipient Agreement or a Professional Services (Consulting) Agreement under with sponsored research funding. Please include the following information along with the request form:

  • Detailed Statement of Work – Work the Subrecipient or Consultant will perform, including a listing of deliverables and a schedule for completing the tasks. This is not merely a copy of the proposal and should be a listing of tasks that you are asking the Subrecipient to undertake. The SOW will be incorporated and referenced through the Agreement. Please provide the SOW as a Microsoft Word document.
  • Itemized budget or fixed price payment/milestone schedule.
  • Copy of Consultant’s insurance certificate (if requesting a Professional Services Agreement)
  • A copy of the Source and Price Justification or Bid Summary and Checklist. CMU policy requires this be completed for any Subrecipient Agreement greater than $2,500.
  • Please ensure that Supplier Forms and W-9’s have been sent to Procurement/Taxation and the vendor has been added to Oracle.

The CMUPI or his/her Research Administrator should complete this form. If desired, the PI may send Section II to the Subrecipient for completion but the Subrecipient should complete only Section II.

Section I. CMU Information

A#020724Oracle P-T-A (for Purchase Order setup)423091B.1122591

Prime Sponsor National Science Foundation Prime Sponsor Award# CMMI-1734449

CMU Contact Information
CMU PI Contact Information
Name Christopher Atkeson
Email / CMU Business Manager/Research Administrator
Contact Information
Name Deborah Harvard
Phone 412-268-2996
Email

Please Contact OSP Subcontracts at 412-268-9527 or if you have any questions.

OSP Subrecipient Request Form

Section II. Subrecipient Information

Subrecipient’s Legal Name:
Stanford University / Subrecipient a Foreign Entity?
No Yes If yes, Country: ______
Subrecipient Period of Performance:
From: 05/15/2018 To: 08/31/2020 / Subrecipient Funding (Budget) Period (if different):
From: 05/15/2018 To: 09/30/2018
Subrecipient Agreement Amount (Total Awarded):
$600,997
Subrecipient Funded Amount: (Total Obligated)
$58,569 / Subrecipient Cost-Share Amount:$0
PSA Rate
$______ / PSA Not-To Exceed Amount
$______
Subrecipient PI Contact Information
Name __Steve H. Collins Title Associate Professor
Department Mechanical Engineering CollegeEngineering
Address 440 Escondido Mall Bldg. 520
City Stanford State _CA Zip 94305
Phone _(650) 723-3148__ Fax _N/A_ Email:

Subrecipient Administrative Contact Information

Name __Michala Welch Title Contract and Grants Officer

Department Office of Sponsored Research Pre Award. CollegeN/A

Address 3160 Porter Drive Suite 100

City Palo Alto State _CA Zip 94304

Phone _(650)736-7736__ Fax _N/A_ Email:

III. Technical Progress Reports or Deliverables to be submitted by Subrecipient PI to CMU PI(CMU PI should check all that apply):

Final

Annual

Quarterly

Monthly

Other (please explain)

IV.Export Control – please answer the questions below:

  1. Yes No Will any equipment, technology or information be provided to the subrecipient entity by the PI/research team? (If yes, please provide more information on what will be provided):
  1. Yes No Will any equipment, technology or information be provided to a foreign national or shipped/delivered to a location outside of the U.S.? (If yes, please provide more information on what will be provided):
  1. Yes No Will any funds be given or provided to an entity in Cuba, Iran, North Korea, Sudan or Syria? (If yes, please provide more information on the entity and its location):

V. Other:

The CMUPI attests to the following related to this subrecipient agreement:

  • TheCMU PI has no financial, management or ownership interest in the Subrecipient
  • No immediate family member of theCMU PI has a financial management, or ownership interest in this Subrecipient
  • The CMUPI is not a member of a partnership or limited liability company that has a financial, management, or ownership interest in the Subrecipient

If the CMUPI and/or his or her immediate family members have a financial, management or ownership interest in the Subrecipient, or if the CMU PIis a member of a partnership or limited liability company with a financial, management, or ownership interest in the Subrecipient, a relevant Conflict of Interest Management Plan must be in place with the Office of Research Integrity and Compliance and must specifically permit subcontracts from CMU to the Subrecipient. If a plan needs to be developed or amended, please contact to begin the process. For more information about CMU’s Conflict of Interest policy and process, please see

V. Other (Continued):

  • Please describe what confidential information, if any, will be shared and by what party.

CMU PI Signature:______Date:______

Typed name:Christopher Atkeson

Please Contact OSP Subcontracts at 412-268-9527 or if you have any questions.