Certifications (continued):
5. Biosafety Committee
Yes No
If "Yes,"
A copy of the Biosafety Committee approval form is attached.
A copy of the Biosafety Committee approval will be forwarded to the Grants and Research Office before research
begins.
6. Conflict of Interest
(applicable PHS, NIH, NSF, DDHS or any other program requiring federal financial disclosure)
Subrecipient Organization/Institution hereby certifies that it has an active and enforced conflict of interest policy
that is consistent with the provision of 42 CFR Part 50, Subpart F "Responsibility of Applicants for Promoting Objectivity
in Research." Subrecipient also certifies that, to the best of Institution's knowledge, 1) all financial disclosures have been
made related to the activities that may be funded by or through a resulting agreement, and required by its conflict of
interest policy; and 2) all identified conflicts of interest have or will have been satisfactorily managed, reduced or
eliminated in accordance with subrecipient's conflict of interest policy prior to the expenditures of any funds under
resultant agreement.
Not applicable because project is not being funded by PHS, NIH, NSF or DHHS
7. Cost Sharing/Matching:
Yes No
In-Kind:
Yes No
Cost sharing, Matching and/or In-Kind amounts and justification should be included in the subrecipient's budget.
8. Certification Regarding Debarment & Suspension
Yes No
Subrecipient certifies that neither it nor the principals are presently debarred, suspended, proposed for debarment, declared
ineligible or voluntarily excluded from participation in any Federal department or Agency. Subawards to any entity or
individual included in the federal excluded Parties are prohibited.
The appropriate programmatic and administrative personnel involved in this application are prepared to establish and
administer the necessary inter-institutional agreement(s) consistent with prime sponsor policies.
Subrecipient Institutional Official
Office:
Name:
Title:
Date:
Please return this form to the University of St. Thomas Grants and Research Office:
Dr. David Steele, Director
AQU 319
2115 Summit Ave.
St. Paul, MN 55105
dfsteele@stthomas.edu
Notes (use to explain use of other F&A rate, Fringe Benefit rate or pertinent information necessary to this agreement you wish to share:
Not Needed
Cash:
