HomeMy WebLinkAboutKittitas Subrecipient Project Certification FormWOFFICE OF SPONSORED PROGRAMS
UNIVERSITY of WASHINGTON SUBRECIPIENT PROJECT CERTIFICATION FORM
SUBRECIPIENT ORGANIZATION LEGAL NAME: County of Kittitas
SUBRECIPIENT PI: Chelsey Loeffers UW PI: Sara Glick
PRIME AWARDING AGENCY: CDC SUBAWARD No.: UWSC11930
PROJECT TITLE: National Harm Reduction Technical Assistance and Syringe Services Program Monitoring and Evaluation
SUBAWARD AMOUNT: $ $81,021 PROJECT PERIOD START DATE: 9/29/2021 END DATE: 09/29/2022
PROJECT CERTIFICATIONS
1. Human Subjects: Will the project involve interaction with Human Subjects, or identifiable data or specimen
from human subjects? ❑D YES El NO Approval Date: 6/9/2020
If "YES," provide a copy of IRB approval with this form prior to execution of the subaward agreement. In
addition, if NIH funding is involved, all key personnel engaged in human subjects research must take the
required NIH human subjects training.
2. Animal Subjects: Will the project involve the use of vertebrate animals?
OYES ® NO Approval Date:
If "YES," provide a copy of IACUC approval with this form prior to execution of the subaward agreement.
3. Stem Cells: Will this project involve the use and/or creation of human embryonic stem cells?
OYES ®NO Approval Date:
If "YES," provide a copy of Stem Cell approval with this form prior to execution of the subaward agreement.
4. Cost Sharing/Matching/In-Kind: Will the subaward involve Cost Sharing, Matching, and/or In -Kind as part of
Subrecipient involvement in the project? OYES 8 NO Amount: $0
If "YES," provide specific amount and justification in subrecipient's budget.
5. Equipment: Will this project involve purchase or use of equipment? BYES ONO
If "YES," select applicable: 8 Purchase of Equipment ❑ Use of Sponsor/Government Furnished Equipment
6. Ethics in Research Training (applicable to projects funded by NSF):
8 This project is not being funded by NSF.
❑ Subrecipient Organization hereby certifies that it will ensure all undergraduates, graduate students, and
postdoctoral researchers who will be supported by NSF funding will be trained on the oversight in the
responsible and ethical conduct of research as required under the "America COMPETES Act."
The information and certifications above have been read, signed, and made by an authorized official of the Subrecipient named
herein. The appropriate programmatic and administrative personnel involved in this application are aware of prime sponsor's
policy concerning subawards and are prepared to establish the necessary inter -institutional agreements consistent with those
pg ' d]pr expenses incurred prior to execution of a subaward agreement are at the Subrecipient's own risk.
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'Signature of Sub re ent's Auttiarrsad Official Date
Tristen Lam irector tristen.lamb@co.kittitas.wa.us, 509-962-7003
Name and Title
Email and Phone
UW OSP Version 6.2020