Proposal Cover Page

PROPOSAL COVER PAGE

1. Submit to:

2. Is this proposal being submitted to another Agency? If yes, please list.

3. Proposal valid until (min. of 6 mos):

4. Data Universal Numbering System (DUNS No.) – REQUIRED INFORMATION:

5. Commercial and Government Entity (CAGE) Code – REQUIRED INFORMATION:

6. Registered in SAM and SAM expiration date: Yes/No

7. Name and address to which award should be made:

8. Check appropriate box(es) if this proposal includes any of the items listed below:

Historical Places Biosafety Facility

Genetically Engineered Organisms Limited Rights Data

Unlimited Rights Government Purpose Rights Data

Proprietary Data Animal Use

Human Use

9. Title of Proposed Project:

10. Proposed Amount:

11. Proposed Duration (1-60 mos):

TYPED NAMES / TELEPHONE No. / FAX No. / EMAIL
Principal Investigator/
Project Director (PI/PD):
Co-PI/PD:
Primary administrative representative authorized to conduct negotiations:
Alternate administrative representative authorized to conduct negotiations
Authorized Representative Signing for applicant organization:
Title: / By signing and submitting this proposal, the Offeror is providing the certifications contained in this BAA
Signature: Date: