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NOTE: Accounting documentation to support stated contribution(s) must be retained for audit purposes. ** This information is formatted to print on legal (8.5x14) paper. 1.91tvӰԺ Project Number:2.Project Title:3.#Benefit of Contribution to Project:4.Contributor's Name: Address:5.`Type of Contribution (*** See instructions for determining basis for valuation or donations ***)a)SERVICE:Dates of Service fromtoService Performed: Unit Type: (e.g. hrs,days,etc.)Total Units Donated:b)SPACE:Dates of Use fromPurpose/Location of Space:c) EQUIPMENT:Type of Equipment:d)!MATERIAL, SUPPLIES, TRAVEL, ETC.: DESCRIPTION6. CertificationDonor CertificationI certify, to the best of my knowledge and belief, that the donated contributions data above are complete and correct and that these "costs" were not borne directly or indirectly by the Federal government. Signature:Date: Print Name:Phone:%Principal Investigator Certification:7.Submitting FormForward the signed original to:** For 91tvӰԺ Internal use only**Valuation Method Unit Rate:Total Value of Service:** VALUATION METHOD:Total Value of Space:Total Value of Equipment:Value** VALUATION METHOD Total Value!Mail Point: 30338 91tvӰԺ Holly DriveDOMB Circulars (see A110 for Federal Awards issued prior to 12/26/14))Uniform Guidance 200.306 Cost sharing 0Sponsored Research Grant Financial AdministratorxI certify that the contributions listed above were necessary for the proper and efficient accomplishment of program activities and that the value was established in accordance with the procedures set forth in OMB Circular A110 for Federal awards issued prior to 12/26/14 or the Uniform Guidance 200.306 Cost sharing for Federal awards issued after 12/26/14 (see links below).Revised July 2018BF7 99{:A:E< <=cc PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VѠԯٴ++2a,/$nECA6٥D-ʵ? dXiJF8,nx (MKoP(\HbWϿ})zg'8yV#x'˯?oOz3?^?O?~B,z_=yǿ~xPiL$M>7Ck9I#L nꎊ)f><|HL|3.ŅzI2O.&e>Ƈ8qBۙ5toG1sD1IB? }J^wi(#SKID ݠ1eBp{8yC]$f94^c>Y[XE>#{Sq c8 >;-&~ ..R(zy s^Fvԇ$*cߓqrB3' }'g7t4Kf"߇ފAV_] 2H7Hk;hIf;ZX_Fڲe}NM;SIvưõ[H5Dt(?]oQ|fNL{d׀O&kNa4%d8?L_H-Ak1h fx-jWBxlB -6j>},khxd׺rXg([x?eޓϲكkS1'|^=aѱnRvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0ktheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  T8 RNT0\`  dMbP?_*+%&?'?(?)?"??&U} @} @} @}  @}  @} @}  @R    @ @ h@ @ @                   ||||||||||| ||||||||||| sssssssssss B @ggggggg B @{{{{{{{ B @{{{{{{{ B @ ggggggg @  qqqqqqq B @ @ C @ ii D ii @jjjjjjj @E FEGyy HHGIHHJzz @ C @ ii D ii @gggggg @ C @ ii D ii @ggggggg @ C K tuuuuuuvL Mwqqqqqqx Mwqqqqqqx M wqqqqqqx  N B O 6:,,,4444&T&8T$T&6(((  @! 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Value assessed to donated supplies included in the cost sharing or matching share shall be reasonable and shall n%'A110 Cost Sharing Instructions'!B25 yK (g) The method used for determining cost sharing or matching for donated equipment, buildings and land for which title passes to the recipient may differ according to the purpose of the award, if (1) or (2) apply. %'A110 Cost Sharing Instructions'!B26yK K(4) The value of loaned equipment shall not exceed its fair rental value. %'A110 Cost Sharing Instructions'!C33r88yK (d) Volunteer services furnished by professional and technical personnel, consultants, and other skilled and unskilled labor may be counted as cost sharing or matching if the service is an integral and necessary part of an approved project or program. Rat%'A110 Cost Sharing Instructions'!B23rHHyK (f) Donated supplies may include such items as expendable equipment, office supplies, laboratory supplies or workshop and classroom supplies. Value assessed to donated supplies included in the cost sharing or matching share shall be reasonable and shall n%'A110 Cost Sharing Instructions'!B25 >>yK (g) The method used for determining cost sharing or matching for donated equipment, buildings and land for which title passes to the recipient may differ according to the purpose of the award, if (1) or (2) apply. %'A110 Cost Sharing Instructions'!B26CCyK K(4) The value of loaned equipment shall not exceed its fair rental value. %'A110 Cost Sharing Instructions'!C33.))yK EOMB Circulars (see A110 for Federal Awards issued prior to 12/26/14)yK lhttps://www.whitehouse.gov/omb/circulars/yX;H,]ą'c|))yK *Uniform Guidance 200.306 Cost sharing yK https://www.ecfr.gov/cgi-bin/text-idx?SID=c16296aecfef71d582e0634cf6658cf1&node=2:1.1.2.2.1.4.29.7&rgn=div8yX;H,]ą'cggD@ Oh+'0@H\t  Hal DunnAdministratorMicrosoft Macintosh Excel@8I@0*( ՜.+,D՜.+, PXd lt| 91tvӰԺ Form  Worksheets 8@ _PID_HLINKSA<-: lhttps://www.ecfr.gov/cgi-bin/text-idx?SID=c16296aecfef71d582e0634cf6658cf1&node=2:1.1.2.2.1.4.29.7&rgn=div8F*https://www.whitehouse.gov/omb/circulars/W %'A110 Cost Sharing Instructions'!C33V%'A110 Cost Sharing Instructions'!B26V %'A110 Cost Sharing Instructions'!B25V %'A110 Cost Sharing Instructions'!B23W %'A110 Cost Sharing Instructions'!C33V%'A110 Cost Sharing Instructions'!B26V %'A110 Cost Sharing Instructions'!B25V %'A110 Cost Sharing Instructions'!B23  !"#$%&'()*+,-./0123456789:<=>?@ABDEFGHIJRoot Entry FWorkbookDuSummaryInformation(;DocumentSummaryInformation8C