Fillable Subaward Commitment Form (Marine Biological Laboratory)

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Subaward Commitment Form (Marine Biological Laboratory)

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  • 44 check-boxes
  • 70 other fields

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File type: PDF

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Subaward Commitment Form
All subrec
ipients m
ust c
omple
te t
his
form
whe
n
submitting
a
proposal to
the
Marine
Biological
Laboratory
.
It
provides
a
c
hecklist of
docume
nts
and
ce
rtifications
re
quire
d
by sponsors,
as
we
ll
as
an
area
for
the
authoriz
ed
offic
ial to
sign.
Any
work
be
gun
and/or
expe
nse
s
incurre
d
prior
to
exe
cution
of
a
subaward
agre
e
ment
are at
t
he subre
cipient’s own
risk.
MBL PI Dept:
Prime Sponsor:
Project Summary Information
MBL PI Name:
Proposal #:
Proposal Title:
Subrecipient Information
Legal Name (as registered in DUNS):
Address: State/Province:
Country:
Institution Type:
Registered in CCR? Yes No
DUNS Number:
Subrecipient Project Information
Subrecipient PI Name:
Title:
Phone:
Email:
Performance/Work
Site Address:
Subrecipient’s Proposal Title (if different than above):
Performance Period
Start thru End Dates
Project Direct Costs
Requested
Project Indirect Costs
Requested
Cost Sharing
(if applicable)
Project Total Costs
Requested
Email:
Subrecipient Contact
Information
Phone: Email:
Address:
Single Audit
Contact
Name/Title:
Phone:
Address:
Office of
Sponsored
Programs
City:
Zip+4:
Congressional District :
EIN Number:
Parent DUNS (if necessary):
Year Established (Institution):
1
Embryonic Stem Cells:
Work covered by ITAR/EAR?:
Research Exempt:
I
f Exempt,
Exempti
on
Number:
Human Subjects Research:
Vertebrate
Ani
mal
s
Research:
Animal
Welfare Assurance
#
:
Federalwide Assurance (FWA)#:
Subrecipient Classification
Requirements and responsibilities for a subrecipient are different than those of a vendor
Subrecipient
-significant programmatic decision making
-adheres to applicable sponsor program compliance requirements
-uses sponsor funds to carry out a Scope of Work for MBL
-Statement of Work may result in intellectual property or publishable results
Vendor
-provides goods and services within normal business operations
-provides similar goods or services to other customers
-provides goods or services that are ancillary to MBL's sponsored project
-is not subject to compliance requirements of MBL's sponsor
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Our organization is properly categorized as a subrecipient based on our scope of work
Administrative/Contractual Contact
Name/Title:
Compliance
v10.7.19lh
eRA Commons Username (if NIH Submission):
NSF ID# (if NSF submission):
CLEAR FORM
SAVE FORM
PRINT FORM
SELECT ONE
$ 0.00
Fringe Benefit Rates
The rates included in the proposal are calculated based on:
Rates consistent with or lower than our federally-negotiated rates. A copy of your FB rate agreement or a URL link to the
agreement must be furnished with this form
URL Link for Fringe Benefits or other rates (Please specify the basis on which the rate has been calculated in comments line below)
Single Audit Status
Does the subrecipient receive an annual single audit in accordance with OMB Uniform Guidance, 2 CRF 200?
Yes No
Were any audit findings reported in your most recent A-133 audit? Fiscal year of most recent single audit
Yes No
If “YES,” provide a description of the finding in the comments below
Subrecipients receiving an annual audit are required to provide a copy of the most recent single audit report or the URL link before a subaward will be
issued
If subrecipient does not receive an annual audit in accordance with OMB Uniform Guidance, 2CFR 200, please sel
ect the appropriate box indicating why the
subrecipient would not be subject to compliance with single audit certi
fication: (check all that apply)
Subrecipient receives overall federal funding less than $750,000 per year For-Profit Entity
Non-Profit Entity (under federal funding threshold) Foreign Entity
Federal Agency
FFATA (Federal Funding Accountability and Transparency Act) Information
Is subaward entity exempt from reporting executive compensation? Yes No
Responsible Conduct in Research Education (applies to NSF)
The Authorized Organizational Representative of the applicant institution is certifying that, in accordance with the NSF Proposal & Award Policies
& Procedures Guide, Part II, Award & Administration Guides (AAG) Chapter IV.B., the institution has a plan in place to provide appropriate training
and oversight in the responsible and ethical conduct of research to undergraduates, graduate students, and postdoctoral researchers who will be
supported by NSF to conduct research
Office of
Sponsored
Programs
Facilities and Administrative Rates
The rates included in the proposal are calculated based on:
Our United States federally negotiated F&A rates for this type of work, or a reduced F&A rate that we hereby agree to accept
(A copy of your U.S. F&A agreement or URL link to the agreement must be furnished with this form)
No Negotiated Rate (requesting de minimis rate of 10%)
Not Applicable (no indirect requested)
URL Link for F&A agreement or other rates (Please specify the basis on which the rate has been calculated in comments line below)
Email:
Financial Contact
Name/Title:
Phone:
Address:
Email:
Authorized Official
Name/Title:
Phone:
Address:
Government Entity
2
Not Applicable
Debarment, Suspension, Proposed Debarment
Is the Principal Investigator or any other employee or student participating in this project debarred, suspended, or otherwise excluded from or ineligible for
participation in Federal Assistance Programs or activities? (If “YES” please explain in comments section below)
Yes No
Subrecipient Organization/Institution hereby certifies that they:
Are not presently debarred, suspended, proposed for debarment, or declared ineligible for award of Federal Contracts
Are not presently indicted for, or otherwise criminally or civilly charged by a government agency
Have not within three (3) years been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State, or Local) contract or subcontract violation of Federal or
State antitrust statues, relating to the submission of offers or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of
records making false statements or receiving stolen property
Subrecipient Proposal Documents
Statement of Work (required)
Budget and Budget Justification (required)
Small/Disadvantaged Business Subcontracting Plan – in agency required format (required for subcontracts over $650,000)
Biosketches and Other Support for all Key Personnel – in agency required format
Other:
Other:
Official Signing for Subrecipient
Name:
Title:
Email:
Signature of Signing Official Date
The information contained on and attached to this Subaward Commitment Form has been read and certified before the authorized official of the subrecipient named above. The
appropriate programmatic and administrative personnel involved in this application are aware of agency policy and any pertinent regulations relevant to this proposal and are
prepared to establish the necessary inter-institutional agreements consistent with those policies.
Office of
Sponsored
Programs
Subrecipient FCOI Policy Statement (applicable to PHS funded sponsors or those that have adopted the federal financial disclosure requirements)
Subrecipient Organization/Institution 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 expenditure of any funds under any resultant
agreement
(The information below is necessary to provide access to MBL's C
OI Disclosure system. Please attach additional pages if necessary)
Name E-mail
Subrecipient PI
Key Personnel
Key Personnel
Key Personnel
3
Not applicable because this project is not being funded by PHS or sponsor that has adopted the federal financial disclosure standards
Subrecipient does not have an active and/or enforced conflict of interest policy and agrees to abide by MBL's policy, located
at: http://www.mbl.edu/policies/conflict-of-interest/
The names of individuals working on this project who are responsible for design, conduct, or reporting of the research are included below:
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Subaward Commitment Form (Marine Biological Laboratory)

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Completed 16 August 2020

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