Small Business Innovation Research (Sbir) Program Proposal Cover Sheet printable pdf download

APPENDIX A

U.S. DEPARTMENT OF DEFENSE

SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM

PROPOSAL COVER SHEET

Failure to fill in all appropriate

spaces may cause your proposal to be disqualified

TOPIC NUMBER: _______________________________

PROPOSAL TITLE: __________________________________________________________________________

__________________________________________________________________________

FIRM NAME: _______________________________________________________________________________

MAIL ADDRESS: ____________________________________________________________________________

____________________________________________________________________________

CITY: _______________________________________________

STATE: ___________ ZIP: _____________

PROPOSED COST: __________________________ PHASE I OR II:______ PROPOSED DURATION: _____

PROPOSAL

IN MONTHS

BUSINESS CERTIFICATION:

YES

Are you a small business as described in paragraph 2.2?

Are you a socially and economically disadvantaged business as defined in paragraph 2.3?

(Collected for statistical purposes only)

Are you a woman-owned small business as described in paragraph 2.4?

(Collected for statistical purposes only)

Have you submitted proposals or received awards containing a significant amount of essentially

equivalent work under other DoD or federal program solicitations? If yes, list the name(s) of

the agency or DoD component, submission date, and Topic Number in the spaces below.

______________________________________________

____________________________________________________

______________________________________________

____________________________________________________

________________________________

Number of employees including all affiliates (average for preceding 12 months):

PROJECT MANAGER/PRINCIPAL INVESTIGATOR

CORPORATE OFFICIAL (BUSINESS)

NAME:______________________________________

TITLE:_____________________________________

TITLE:_______________________________________

TELEPHONE:_________________________________

For any purpose other than to evaluate the proposal, this data except Appendix A and B shall not be disclosed outside the Government

and shall not be duplicated, used or disclosed in whole or in part, provided that if a contract is awarded to this proposer as a result of

or in connection with the submission of this data, the Government shall have the right to duplicate, use or disclose the data to the

extent provided in the funding agreement. This restriction does not limit the Government's right to use information contained in the

data if it is obtained from another source without restriction. The data subject to this restriction is contained on the pages of the

proposal listed on the line below.

PROPRIETARY

INFORMATION:________________________________________________________________________________________________

Before signing below, please read the cautionary note at Section 3.7

________________________________________

__________

______________________________________________

_________

SIGNATURE OF PRINCIPAL INVESTIGATOR

DATE

SIGNATURE OF CORPORATE BUSINESS OFFICIAL

DATE

Nothing on this page is classified or proprietary information/data

Proposal page No. 1

Small Business Innovation Research (Sbir) Program Proposal Cover Sheet

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