AGREEMENT TO TRANSFER EXTRAMURAL FUNDS BETWEEN UW INSTITUTIONS
Agreement Number
#15- _________
This Agreement is entered into in order to specify the terms and conditions under which UW-Extension
(hereinafter referred to as “Recipient”) and ____________ (hereinafter referred to as “Subrecipient”) will
participate in the conduct of a project funded by ______________ (hereinafter referred to as “Sponsor”)
under award number ___________, CFDA No. __________ (UWEX No. ________), titled
_________________________________________.
Technical Direction: The Recipient Project Director, __________, will retain technical direction of the
project. The Key Person of the Subrecipient, ____________ is considered essential to the work.
Scope of Work: The Subrecipient shall supply all of the necessary personnel, equipment, and materials to
accomplish the tasks set forth in Section A.
Period of Performance: The effective period shall be from __________ to __________.
Limitation on Costs: Reimbursable cost, both direct & indirect, will not exceed $_________ as detailed in
Section B. All Subrecipient cost sharing requirements (if any) are also identified in Section B.
Invoices and Reports: The Subrecipient will submit invoices to the Recipient no more than monthly and no
less frequently than quarterly within _____ days of the end of each quarter, and a final invoice due within
_____ days of the end of the award. Invoices shall reference the agreement number and reflect costs
incurred by major budget category. The invoice should also identify any program income generated and cost
sharing provided by the Subrecipient during the invoice period. An original invoice with certification (see
detail below in the Special Provisions section), shall be submitted to:
UW-Extension, Office of Extramural Support
432 N. Lake St., Rm 104
Madison, WI 53706
The Recipient will reimburse the Subrecipient within 30 days of receiving an invoice from the Subrecipient.
The Subrecipient is responsible for submitting technical reports as required by the Recipient’s Principal
Investigator.
Project Accounting and Transfer of Funds: The Subrecipient will establish a federal fund 144 project/grant
number for processing of project related expenditures. The Subrecipient should deposit invoice payments
received from the recipient using revenue account code 9910. Recipient will process invoice payments using
expenditure account code 3910.
Program Income and match costs: The subrecipient must segregate any program income earned on grant
activities from other program income. The revenue and expenditure of program income and any costs claimed
as match must also be segregated from other income and expenditures. Documented match costs must equal
or exceed costs set forth in Section A.
Institutional Representatives: Liaison with the Recipient will be through ____________, telephone (___)
___ -_____, email ________________. Liaison with the Subrecipient will be through ______________,
telephone (___) ___ -____, email _______________.
Special Provisions – Recipient will include in the terms of this agreement (or attach) the Sponsor’s
“Notification of Award” including Sponsor’s terms and conditions.
Uniform Guidance invoice certification is required for this project. ☐ Yes
☐ No
If yes, the following Uniform Guidance invoice certification language must be included on the invoice:
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete,
and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives
set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or
fraudulent information, or the omission of any material fact, may subject me to criminal, civil or
administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section
1001 and Title 31, Sections 3729-3730 and 3801-3812).
If no, the following invoice certification language must be included on the invoice:
The undersigned certifies that the information set forth herein is true and correct and may be used as a
basis for payment for effort performed and that payment thereon has not been received.
Agreement becomes valid upon the signature of the Institutional Representative of each institution:
RECIPIENT
SUBRECIPIENT
_________________________________
____________________________________
Signature
Signature
Jordon Ott, Director - OES _________
____________________________________
Name & Title
Name & Title
_________________________________
____________________________________
Date
Date
A. DESCRIPTION OF SERVICES
B. BUDGET