Federal Funding Accountability and Transparency Act Form

FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT FORM

This Agreement and accompanying disclosures are submitted to ensure compliance with the Federal Funding Accountability and Transparency Act (FFATA) reporting requirements and to document the associated contractual relationship.

Grantor/Agency Name:    Recipient/Contractor Name:    Agreement Date:

WHEREAS

Whereas Grantor/Agency is obligated to report information concerning federal awards, subawards and executive compensation under applicable federal transparency statutes and regulations; and the parties desire to identify and disclose required information so that the Grantor/Agency may satisfy its reporting obligations.

Whereas Recipient/Contractor shall perform the work described below and provide accurate disclosures of subawards and executive compensation as necessary for FFATA compliance.

Whereas the parties agree that the representations and certifications contained in this Form are material to the Grantor/Agency's continued funding and reporting obligations.

SCOPE OF WORK

PAYMENT TERMS

Late Payment Fee: If any payment owed hereunder is not received within days of the due date, interest shall accrue at per month on the outstanding balance, or the maximum rate permitted by law, whichever is less.

TERM AND TERMINATION

Term Commencement Date:    Term Expiration Date:

Either party may terminate this Agreement for convenience upon days' prior written notice to the other party. Termination for cause may be effected immediately upon written notice if a material breach is not cured within days after receipt of notice of such breach.

FFATA DISCLOSURE REQUIREMENTS

Federal Award Title:

Federal Award Identification Number (FAIN or other ID):    Federal Award Amount:    Award Date:

Does this award include subawards that must be reported under FFATA?    Yes    No

EXECUTIVE COMPENSATION DISCLOSURE

With respect to the award cited above, does the Recipient/Contractor have any senior executives (as defined for reporting purposes) who received total compensation of $250,000 or more in the preceding fiscal year?    Yes    No

CONFIDENTIALITY

The parties acknowledge that the disclosures made pursuant to FFATA are subject to federal reporting requirements and accordingly certain information may be publicly disclosed. Except as required by law, the parties shall maintain the confidentiality of proprietary business information provided in connection with this Agreement. Confidential information does not include information that is or becomes publicly available through no fault of the receiving party, independently developed without use of the disclosing party's confidential information, or rightfully obtained from a third party.

GOVERNING LAW

This Form and any dispute arising under or related to its implementation shall be governed by the laws of the State of without regard to its conflict of law principles.

ENTIRE AGREEMENT

This Form, together with any referenced attachments and the controlling grant or prime award terms, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes any prior oral or written agreements, representations, or understandings. Any modification to this Form must be made in writing and signed by authorized representatives of both parties.

CERTIFICATIONS AND ACKNOWLEDGEMENTS

By signing below, the undersigned certifies, to the best of his or her knowledge and belief, that the information provided in this Form is true, complete, and accurate, and that the Recipient/Contractor will promptly notify the Grantor/Agency of any changes material to FFATA reporting. The undersigned understands that false statements may be subject to penalties applicable under federal law.

Authorized Representative Title (Grantor/Agency):

Authorized Representative Title (Recipient/Contractor):

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