Subaward Agreement
Institution/Organization ("UNIVERSITY")
Name:
Address:
Institution/Organization ("SUBRECIPIENT")
Middle Tennessee State University
1301 East Main Street
Murfreesboro, TN 37132-0001
Name:
Address:
Prime Award No.
EIN No.:
Subaward No.
Awarding Agency
CFDA No.
Subaward Period of Performance
Amount Funded this Action
Est. Total (if incrementally funded)
Project Title
Reporting Requirements [Check here if applicable:
See Attachment 2] :
FFATA (Attachment 3B) :
ARRA funds (Attachment 2)
Terms and Conditions
1) University hereby awards a cost reimbursable subaward, as described above, to Subrecipient. The statement of work and budget for this
subaward are (check one):
as specified in Subrecipient’s proposal dated
; or X as shown in Attachment 4 . In its performance of
subaward work, Subrecipient shall be an independent entity and not an employee or agent of University.
2) University shall reimburse Subaward not more often than quarterly for allowable costs. All invoices shall be submitted using Subrecipient’s
standard invoice or MTSU’s standard invoice (attachment 5) and at a minimum shall include current and cumulative costs (including cost sharing),
subaward number, and certification as to truth and accuracy of invoice. Invoices that do not reference University’s subaward number shall be
returned to Subrecipient. Invoices and questions concerning invoice receipt or payments should be directed to the appropriate party’s Financial
Contact, as shown in Attachment 3.
3) A final statement of cumulative costs incurred, including cost sharing, marked “FINAL,” must be submitted to University’s Financial Contact NOT
LATER THAN sixty (60) days after subaward end date. The final statement of costs shall constitute Subrecipient’s final financial report.
4) All payments shall be considered provisional and subject to adjustment within the total estimated cost in the event such adjustment is necessary
as a result of an adverse audit finding against the Subrecipient.
5) Matters concerning the technical performance of this subaward should be directed to the appropriate party’s Project Director, as shown in
Attachment 3. Technical reports are required as shown above, “Reporting Requirements.”
6) Matters concerning the request or negotiation of any changes in the terms, conditions, or amounts cited in this subaward agreement, and any
changes requiring prior approval, should be directed to the appropriate party's Administrative Contact, as shown in Attachment 3. Any such
changes made to this subaward agreement require the written approval of each party's Authorized Official, as shown in Attachment 3.
7) Each party shall be responsible for its negligent acts or omissions and the negligent acts or omissions of its employees, officers, or directors, to
the extent allowed by law.
8) Either party may terminate this agreement with thirty days written notice to the appropriate party’s Administrative Contact, as shown in
Attachment 3. University shall pay Subrecipient for termination costs as allowable under OMB Circular A-21or A-122 or 45 CFR Part 74 Appendix
E, “Principles for Determining Costs applicable to Research and Development under Grants and Contracts with Hospitals”, as applicable.
9) No-cost extensions require the approval of the University. Any requests for a no-cost extension should be addressed to and received by the
Administrative Contact, as shown in Attachment 3, not less than thirty days prior to the desired effective date of the requested change.
10) The Subaward is subject to the terms and conditions of the Prime Award and other special terms and conditions, as identified in Attachments 1
and 2.
11) By signing below Subrecipient makes the certifications and assurances shown in Attachments 1 and 2.
By an Authorized Official of UNIVERSITY:
___________________________________
By an Authorized Official of SUBRECIPIENT:
_______________
Date
______________________________________
_______________
Date
November 2010
Attachment 1
Subaward Agreement
By signing the Subaward Agreement, the authorized official of the SUBRECIPIENT certifies, to the best of his/her knowledge and belief,
that:
Certification Regarding Lobbying
1) No Federally appropriated funds have been paid or will be paid, by or on behalf of the Subrecepient to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee
of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making
of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
2) If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or
intending to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
Subrecipient shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," to the University.
3) The Subrecipeint shall require that the language of this certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section
1352, title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less
that $10,000 and not more than $100,000 for each such failure.
Debarment, Suspension, and Other Responsibility Matters
Subrecipeint certifies by signing this Subaward Agreement that neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any
federal department or agency.
OMB Circular A-133 Assurance
Subrecipeint assures University that it complies with A-133 and that it will notify UNIVERSITY of completion of required
audits and of any adverse findings, which impact this subaward.
Special Terms and Conditions
1) The Subrecipient warrants that no part of the total contract amount provided herein shall be paid directly or indirectly to
any officer or employee of the state of Tennessee as wages, compensation, or gifts in exchange for acting as officer, agent,
employee, sub-contractor, or consultant to the Subrecipient in connection with any work contemplated or performed relative
to this Subaward. If the Subrecipient is an individual, the Subrecipient warrants that within the past six months he/she has
not been and during the term of this contract will not become an employee of the State of Tennessee.
2) This Subaward may be terminated by either party by giving written notice to the other, at least _30__ days before the
effective date of termination.
3) This Subaward may be modified only by written amendment executed by all parties hereto.
4) The books, records, and documents of the Subrecipient, insofar as they relate to work performed or money received
under this Subaward, shall be maintained for a period of three full years from the date of the final payment, and shall be
subject to audit, at any reasonable time and upon notice, by the University or the Comptroller of the Treasury, or their duly
appointed representatives.
5) The Subrecipient shall not assign this Subaward or enter into sub-contracts for any of the work described herein without
obtaining the prior written approval of the University.
6) By acceptance of this Subaward the Subrecipient is attesting that the Subrecipient will not knowingly utilize the services
of illegal immigrants and will not knowingly utilize the services of any subcontractor that does so in delivery of the services
under this agreement. If the Subrecipient is discovered to have breached this attestation, the Subrecipient shall be
prohibited from supplying services to any TBR institution/state for a period of one (1) year from the date of discovery of the
breach. Subrecipient may appeal the (1) year by utilizing an appeals process in the “Rules of Finance and Administration,
0602.”
November 2010
ATTACHMENT 2
SUBAWARD AGREEMENT
Reporting Requirements
November 2010
Attachment 3
Subaward Agreement
University Contacts
Subrecipient Contacts
Administrative Contact
Administrative Contact
Name:
Address:
Name:
Telephone:
Fax:
Email:
Dr. Myra Norman
1301 East Main Street, Box 124
Murfreesboro, TN 37132-0001
615-898-5010
615-898-5028
mnorman@mtsu.edu
Address:
Telephone:
Fax:
Email:
Principal Investigator
Project Director
Name:
Address:
Name:
Address:
Telephone:
Fax:
Email:
130 East Main Street, Box
Murfreesboro, TN 37132-0001
615615@mtsu.edu
Telephone:
Fax:
Email:
Financial Contact
Financial Contact
Name:
Address:
Name:
Telephone:
Fax:
Email:
Tammy Wiseman
1301 East Main Street, CAB 105
Murfreesboro, TN 37132-0001
615-494-7675
615-8985799
twiseman@mtsu.edu
Address:
Telephone:
Fax:
Email:
Authorized Official
Authorized Official
Name:
Address:
Name:
Telephone:
Fax:
Email:
John Cothern
1301 East Main Street
Murfreesboro, TN 37132-0001
Address:
615-898-2852
jcothern@mtsu.edu
Telephone:
Fax:
Email:
November 2010
ATTACHMENT 4
SUBAWARD AGREEMENT
Statement/Scope of Work (SOW) & Budget
November 2010
ATTACHMENT 5
SUBAWARD AGREEMENT
MTSU Standard Financial Invoice
INVOICE FOR REIMBURSEMENT
NAME AND ADDRESS OF CONTRACTOR:
INVOICE NUMBER:
INVOICE ENDING DATE:
CONTRACTING AGENCY:
CONTRACT PERIOD
BANNER FUND:
COST
CONTRACT
CATEGORIES
BUDGET
CUMMULATIVE
QUARTERLY
EXPENDITURES
EXPENDITURES
A.
SALARIES
$
$
$
B.
FRINGE
$
$
$
C.
EQUIPMENT
$
$
$
D.
TRAVEL
$
$
$
E.
PARTICIPANT SUPPORT
$
$
$
F.
OTHER DIRECT COSTS
$
$
$
G.
INDIRECT COSTS
$
$
$
$
$
$
TOTALS
1.
Total Cumulative Accrued Expenditures
$
2.
Estimated Disbursement for the Next Quarter (Advance Only)
$
3.
Total Estimated Cash Needs (Line 1 + 2)
$
4.
Less Payment Received to Date
$
5.
Amount Receivable/REFUNDABLE with this Invoice
$
I certify to the best of my knowledge and belief that the data above is
Allotment
Code:
correct and that all expenditures were made in accordance with the
Cost Center:
contract conditions and that payment is due and has not been previously
requested.
CONTRACTOR'S AUTHORIZED SIGNATURE
Signature
TITLE
_______________________________
DATE
Signature
TITLE
_______________________________
DATE
November 2010
Attachment 6
Audit Certification and Financial Questionnaire
Middle Tennessee State University – Office of Research Services
Organization/Company Name: _______________________________________________________
Sub-award # _______________________________
Title of Project: __________________________________________________________________________
This is an audit certification for your organization's/company's most recently completed fiscal year
(Respond to A or B, below, as applicable):
A. My organization is subject to the requirements of OMB Circular A-133 and an external
independent audit of my organization/company has been completed for Fiscal Year 20______ .
____No material instances of non-compliance, material weakness and/or reportable conditions were
found related to any sub-award(s) from MTSU. A true, complete and correct copy of the audit
report is attached or available at the following website
____________________________________________.
____Material instances of non-compliance, material weakness and/or reportable conditions were
found related to sub-awards (s) from MTSU and enclosed is a copy of the audit report with
corrective action responses or it can be found at the following website:
_________________________________________________________________.
OR
_________B. My organization/company is not subject to the requirements of OMB Circular A-133 because
(_____we are a for-profit organization, ____we are a foreign (non-US) entity, _____we expend
less than $500,000 a year in federal funds, or _____ other
(_________________________________________). We _____ have/ ____ have not been
audited by a U.S. Government audit agency or by an independent CPA firm for the most recently
completed Fiscal Year : from MM/DD/YYYY:______________ to
MM/DD/YYYY:______________).
*If you have had a recent annual audit conducted, please, provide a copy of the audited financial
statement for the most current fiscal year or a link to the website:
_________________________________________.
Signature of Authorized Official:
Signature
_______________Date
Name (printed)
__ Title
Organization/Company EIN #
_______
Address
Phone
______ ______
_________
___
__ DUNS #__________________________
___________________
_
Fax
________
___Email
November 2010