Fillable Subrecipient Certification Form (University of Denver)

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Subrecipient Certification Form (University of Denver)

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Subrecipient Certification Form
Page 1 of 3
All subrecipients are required to complete this form when contracting with the University of Denver (Colorado Seminary). It provides for certain
documents and certifications required by sponsors. This form should be signed by the authorized official at the institution or Organization.
Subrecipient Legal Name: ___________________________________________________________________
Subrecipient PI Name: ______________________________________________________________________
Subaward Number: _________________________________________________________________________
SECTION A - Certifications
1. Small Business Concern
Subrecipient represents that it is a small business concern as defined in 13 CFR 124.1002. Yes No
If "Yes"
: Subrecipient represents that it is a:
Small disadvantaged business as certified by the Small Business Administration
Women-owned small business concern
Veteran-owned small business concern
Service-disabled veteran-owned small business concern
HUBZone small business concern
2. Human Subjects
Yes No
Pending
Exemption or IRB Approval Date: ___________________ IRB Number
: _______________________
If "Yes": Have all key personnel involved completed Human Subjects Training?
Yes No
3. Animal Subjects
Yes No
Approval Date: ______________________________ IACUC Number: ________________
Pending
4. Conflict of Interest
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 though 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 any resultant agreement.
Subrecipient does not have an active and/or enforced conflict of interest policy and agrees to abide by DU’s
policy, located here.
Subrecipient Certification Form
Page 2 of 3
5. Responsible Conduct of Research (RCR) Training (applicable to NSF funding)
Not applicable because this project is not being funded by NSF, or other sponsor that has adopted the RCR
training requirement.
Subrecipient Organization/Institution certifies that it, in accordance with NSF Proposal & Awards Policies &
Procedures Guide, Part II, Award & Administration Guide (AAG) Chapter IV.B., the organization/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.
Subrecipient does not have an RCR training program in accordance with the above and agrees to abide by DU’s
policy and program, located here.
SECTION B - Audit Status
6. Audit Status
Subrecipient receives an annual audit in accordance with OMB Circular A-133.
Most recent fiscal year completed: FY: ______________________
Were any audit findings reported? (If "Yes," explain in the Comments section below.)
Yes No
Please attach a complete copy of your most recent A-133 audit report or provide the URL link to a
complete copy.
Subrecipient DOES NOT receive an annual audit in accordance with OMB Circular A-133.
Subrecipient is a:
Non-profit entity under federal funding threshold of $500,000 in annual federal awards
Foreign entity
For profit entity
Government entity
Approved for Subrecipient
The information, certifications and representations above have been read, signed and made by an authorized official
of the Subrecipient named herein. The appropriate programmatic and administrative personnel involved in this
application are award of agency policy in regard to subawards and are prepared to establish the necessary inter-
institutional agreements consistent with those policies. Any work begun and/or expenses incurred prior to
execution of a subaward agreement are at the Subrecipient’s own risk.
__________________________________________________________________________________________
Signature of Subrecipient’s Authorized Official
__________________________________________________________________________________________
Name and Title of Authorized Official
___________________________
Date
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Subrecipient Certification Form
Page 3 of 3
Comments: Audit report is attached
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Subrecipient Certification Form (University of Denver)

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Completed 29 August 2020

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