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COST OR PRICE SUMMARY FORMAT FOR SUBAGREEMENTS UNDER U.S. EPA ASSISTANCE PART I - GENERAL 1. RECIPIENT 2. ASSISTANCE IDENTIFICATION NO. 3. NAME OF CONTRACTOR OR SUBCONTRACTOR 4. DATE OF PROPOSAL 5. ADDRESS OF CONTRACTOR OR SUBCONTRACTOR 6. TYPE OF SERVICE TO BE FURNISHED PART II - COST SUMMARY 7. DIRECT LABOR (Specify labor categories) ESTIMATED HOURLY HOURS RATE $ ESTIMATED COST $ DIRECT LABOR TOTAL: 8. INDIRECT COSTS (Specify indirect cost pools) TOTALS $ X BASE = RATE $ ESTIMATED COST $ INDIRECT COSTS TOTAL: $ 9. OTHER DIRECT COSTS a. TRAVEL ESTIMATED COST (1) TRANSPORTATION $ (2) PER DIEM $ TRAVEL SUBTOTAL: b. EQUIPMENT, MATERIALS, SUPPLIES $ QTY COST ESTIMATED COST (Specify categories) $ $ EQUIPMENT SUBTOTAL: c. SUBCONTRACTS ESTIMATED COST $ SUBCONTRACTS SUBTOTAL: $ d. OTHER (Specify categories) ESTIMATED COST $ OTHER SUBTOTAL: $ OTHER DIRECT COSTS TOTAL: $ 10. TOTAL ESTIMATED COST $ 11. PROFIT $ 12. TOTAL PRICE $ PART III - CERTIFICATIONS 13. CONTRACTOR OR SUBCONTRACTOR EPA Form 5700-41 This proposal is submitted for use in connection with and in response to (1) ____________________________________________ _______________________________________________________ . This is to certify to the best of my knowledge and belief that the cost and pricing data summarized herein are complete, current, and accurate as of (2) ________________________________ and that a financial management capability exists to fully and accurately account for the financial transactions under this project. I further certify that I understand that the subagreement price may be subject to downward renegotiation and/or recoupment where the above cost and pricing data have been determined, as a result of audit, not to have been complete, current and accurate as of the date above. (3) DATE OF EXECUTION SIGNATURE OF COMPOSER TITLE OF COMPOSER 14. LOAN RECIPIENT I certify that I have reviewed the cost/price summary set forth herein and the proposed costs/price appear acceptable for subagreement award. _________________ DATE OF EXECUTION SIGNATURE OF REVIEWER TITLE OF REVIEWER EPA Form 5700-41