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Pre Clinical Trial Agreement

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Pre Clinical Trial Agreement Powered By Docstoc
					                                             Pre-Clinical Trial Cost Agreement

The University of Mississippi Medical Center, a state supported educational institution with a place of business at 2500
North State Street, Jackson, MS 39216-4505, hereinafter referred to as “Institution” and ______________ with a place
of business at ________________________ , hereinafter referred to as “Sponsor” agree that Institution anticipates
entering into an agreement with Sponsor to perform a clinical study entitled __________________________________
Protocol# ____________. Based on this anticipated performance, Sponsor agrees to pay Institution non-refundable pre-
clinical trial costs, regardless of whether a clinical trial agreement is executed, upon receipt of invoice, as follows:

        Pre-Clinical Trial Costs = $9,500.

    1. Costs ($7000) which include, but are not limited to:

             Protocol Review                                    Study team IRB Preparation and submission time
             Staff Training                                     Study team preparation of IRB requested revisions and
                                                                  communications/negotiations between IRB and sponsor
             Budget Preparation                                 Qualification (Site Selection) visit
             Contract preparation and negotiation time          Study specific SOP development
             Investigator Meetings                              Source document development
             Administration


    2. IRB Initial Review Fee = $2500

Upon contract execution, the Sponsor agrees to pay Institution the following costs:

        Pharmacy Fee = $500
        Record Storage/Maintenance Fees = $500
        Laboratory Fees = $500

Payments:
All payments required hereunder shall be made payable to University of Mississippi Medical Center,
Tax I.D. No. 64-6008520, and mailed to:

                                      University of Mississippi Medical Center
                                               2500 North State Street
                                              Jackson, MS 39216-4505
                                             Attn: Comptroller’s Office
                        Checks will reference the Investigator’s name and the study number.

Nothing contained in this agreement shall be deemed to grant any authorization to begin the study. This agreement is
only for the purpose of the sponsor providing Pre-Clinical Trial Costs to the Institution.

The parties signing below have authority to enter into Agreement for their respective entities.

University of Mississippi Medical Center                  Sponsor

________________________________                          ______________________________
Name: Pamela P. Tazik                                     Name
Title: Director of Sponsored Projects                     Title
Date                                                      Date
________________________________
Name:
Title: Principal Investigator
Date:

				
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