loi-form-for-nih-consortium--mdacc-prime-013111 by lanyuehua


									                                                                    Office of Sponsored Programs
                                                                  Main (713-792-3220) Fax (713-794-4535)

                                   Letter of Intent to Establish an NIH Consortium

       Title of Application:

       Applicant/Prime Institution:                     M. D. Anderson Cancer Center

       Principal Investigator:

       Cooperating/Subrecipient Organization:



                      Proposed Effective Date:

                 First Budget Year                                                         Project Period

       Direct Costs:                                                       Direct Costs:

       F & A Costs:                                                        F & A Costs:

       Total:                                                              Total:

The appropriate program and administrative personnel of each institution involved in this grant application are aware
of the consortium agreement policy of the National Institutes of Health (“NIH”), as set forth in the NIH Grants Policy
Statement, October 2010, and are prepared to establish the necessary inter-institutional agreement consistent with
that policy and the NIH Grants Policy Statement. Cooperating/Subrecipient Institution hereby certifies that neither it
nor its principals nor those performing services under this Agreement: (a) are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from
participation in this transaction; (b) are presently indicted for, or criminally or civilly charged by a governmental entity
(Federal, State, or local) with commission of any of the offenses listed in 2 CFR part 180.800(a), nor have been
convicted of, or had a civil judgment rendered against them for any such offense within the three (3) year period
preceding this application; nor (c) had any public transaction (Federal State or local) terminated for cause or default
within the three (3) year period preceding this application. The amounts shown above appear in the application; the
actual amount awarded to the Cooperating/Subrecipient Institution will be determined after an award is made.


M. D. Anderson Cancer Center
Name of Institution                                                 Name of Institution

Signature of Authorized Official                                    Signature of Authorized Official

Name & Title of Authorized Official                                 Name & Title of Authorized Official

Date                                                                Date

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