1
CONFIDENTIAL TREATMENT REQUESTED: Certain portions of this
document have been omitted and are marked with the
notation, "*Confidential Treatment Requested." A complete
copy has been filed with the Securities and Exchange Commission.
EXHIBIT 10.21
LICENSE AGREEMENT
THIS AGREEMENT is made and entered into this 30th day of June, 1997, by and
between:
ALLOS THERAPEUTICS, INC., 0000 Xxxxx Xxxxxxxx, Xxxxx 000, Xxxxxx, Xxxxxxxx
00000 (hereinafter referred to as the "LICENSEE"), and
VIRGINIA COMMONWEALTH UNIVERSITY INTELLECTUAL PROPERTY FOUNDATION,
Virginia Commonwealth University-Medical College of Xxxxxxxx Xxxxxx, Xxxxxx
Xxxx, Xxxxxxxx, Xxxxxxxx 00000 (hereinafter referred to as the "LICENSOR").
WHEREAS, LICENSOR is the owner of all right, title, and interest in and to
intellectual property made by employees and students of Virginia Commonwealth
University or made using the facilities of Virginia Commonwealth University,
and will be an owner of any and all intellectual property made under the
Sponsored Research Agreement between Virginia Commonwealth University and
LICENSEE, and any and all of its attachments, attached hereto as Exhibit A;
WHEREAS LICENSEE is desirous of acquiring from LICENSOR certain rights set
forth below in and to the intellectual property made by employees and students
of Virginia Commonwealth University under the Sponsored Research Agreement
between Virginia Commonwealth University and LICENSEE;
NOW, THEREFORE, in consideration of the promises and the covenants set
forth herein, LICENSOR and LICENSEE agree as follows:
1. DEFINITIONS
The following definitions shall apply in the interpretation of this
Agreement.
1.1 "Affiliate" of any company means any corporation which, directly or
indirectly, controls or is controlled by, or is under direct or indirect common
control with, such company; and for the purposes of this definition "control"
(including "control by" and "under common control with") as used with respect to
any corporation or company, shall mean the possession, directly or indirectly,
of the power to direct or cause the direction of the management and policies of
such corporation or company, through the ownership of more than 50% of the
voting shares.
1.2 "Calendar Quarter" means the three-month period ending March 31, June 30,
September 30, or December 31 in any year.
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1.3 "Technology" shall mean all intellectual property including copyrights,
patents and patent applications, both foreign and domestic, as well as
continuations, continuations-in-part, divisionals, reexaminations, reissues and
extensions thereof, owned or to be owned by LICENSOR which pertain to
discoveries and inventions or other developments made during and under the
Sponsored Research Agreement between Virginia Commonwealth University and
LICENSEE, and any improvements to intellectual property developed during and
under the Sponsored Research Agreement which occur within two years after the
termination of any Research Project set forth in the Sponsored Research
Agreement. Technology does not include any intellectual property which is made
outside the scope of the Sponsored Research Agreement.
1.4 "Licensed Technology" shall mean all Technology for which LICENSEE has
executed its option to acquire a license and for which the license has not been
terminated.
1.5 "Licensed Product" shall mean any product or part thereof which embodies in
whole or in part the Licensed Technology.
1.6 "Net Sales" for purposes of computing the royalty payment contemplated under
the provisions below, means either LICENSEE's or its sub-licensees [*] for
Licensed Product after [*].
1.7 "Net Revenues" shall mean all [*] derived by LICENSEE from the Licensed
Technology, other than [*], including but not limited to [*].
1.8 "Effective Date" shall mean the date of the Agreement set forth above.
1.9 "Licensed Territory" shall mean world wide.
2. OPTION
2.1 LICENSOR hereby grants to LICENSEE an exclusive Option to acquire a license
to any and all parts of the Technology. The Option period on any part of the
Technology will be for six (6) months from the date it is disclosed to LICENSEE.
2.2 The Option will be deemed exercised by the LICENSEE when LICENSEE notifies
the LICENSOR in writing that it wishes to exercise its Option on a particular
portion of the Technology, and when the LICENSEE authorizes the filing of
patent applications and/or copyrights on that portion of the Technology. All
Technology for which LICENSEE exercises its Option, and for which rights are
not earlier terminated, will be considered Licensed Technology.
2.3 The LICENSEE shall retain no rights in or options on Technology which
LICENSEE does not exercise its Option.
*CONFIDENTIAL TREATMENT
REQUESTED
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3. LICENSE
3.1 If LICENSEE exercises its Option under Section 2.2 of this Agreement,
LICENSOR to the extent not prohibited by law or other patents, and subject to
any rights of the U.S. Government under 37 C.F.R. 401, grants LICENSEE and
exclusive license to make, have made, use, lease, sell, import, and export
LICENSED PRODUCT in the LICENSED TERRITORY.
3.2 If LICENSEE exercises its Option under Section 2.2 of this Agreement,
LICENSOR hereby grants LICENSEE the exclusive right to sublicense Licensed
Technology to third parties and Affiliates subject to the terms and conditions
of this Agreement. LICENSEE will attach and incorporate by reference the
provisions of this Agreement pertaining to payment obligations, patent
applications, warranties, reporting requirements, and confidentiality, to any
sub-license agreements entered into by LICENSEE.
3.3 LICENSEE will provide LICENSOR with copies of appropriate sections of all
sub-license agreements evidencing a third party or Affiliate sublicensee's
commitment to be bound by the terms and conditions of this Agreement and with
sections pertaining to Net Revenues within one month of their being executed by
the LICENSEE with the third party or Affiliate sublicensee.
3.4 In order to establish a period of exclusivity for LICENSEE once LICENSEE
exercises its Option under Section 2.2 of this Agreement, LICENSOR hereby
agrees that it shall not grant any other license to make, have made, use,
lease, sell, export or import, or sub-license Licensed Product during the
period of time commencing with the Effective Date of this Agreement and
terminating with the last to occur of:
a. the expiration of the last to expire patent on the Licensed
Technology; or
b. January 1, 2017.
3.5 Nothing in this Agreement shall be construed to confer rights upon
LICENSEE by implication, estoppel, or otherwise to any technology or
intellectual property other than the Licensed Technology.
3.6 This License shall be subject to a royalty-free right of LICENSOR and the
inventors or authors of any Licensed Technology to make, have made, or use the
Licensed Technology and Licensed Products for educational, research and
scientific study and not for commercial purposes.
4. DILIGENCE AND PATENT PROSECUTION
4.1 LICENSEE shall use reasonable efforts to bring one or more Licensed
Products to market through vigorous and diligent efforts and to continue
active, commercially reasonable marketing efforts for one or more Licensed
Products.
4.2 LICENSEE, at its sole expense, shall apply for, seek issuance
or registration of, and maintain patents and copyrights during the term of this
Agreement on the Licensed Technology for subject
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matter protectable by patent or copyright using counsel which is mutually
acceptable to both LICENSEE and LICENSOR. The management of the various tasks
and procedures involved shall be the primary responsibility of LICENSEE.
LICENSOR, at the sole expense of LICENSEE, shall assist LICENSEE in all such
tasks and procedures.
4.3 All patents, patent applications, and copyrights on the Licensed Technology
shall be assigned to LICENSOR, and LICENSOR's interest therein shall be recorded
in the U.S. Patent and Trademark Office, U.S. Copyright Office, and
corresponding foreign patent and copyright offices at the sole expense of
LICENSEE.
4.4 LICENSEE shall provide LICENSOR with copies of all papers received from and
to be filed in the U.S. Patent and Trademark Office, U.S. Copyright Office, and
corresponding foreign patent and copyright offices.
4.5 LICENSEE shall be entitled, in its discretion, to abandon any application
or granted patent or copyright if it considers that the ongoing costs of the
same are not justified, provided that LICENSEE notifies LICENSOR prior to such
abandonment and allows LICENSOR reasonable opportunity to avoid such
abandonment. In no event shall such reasonable opportunity be less than one (1)
month prior to abandonment. If LICENSEE chooses to abandon an application or
granted patent or copyright under this provision and LICENSOR, at its sole
expense, continues pursuing the application, granted patent or copyright,
LICENSEE shall retain no right to exclusively use or exclusively exploit the
technology claimed in a granted patent or copyright on the technology which
LICENSOR later obtains in the country, territory or jurisdiction which granted
the patent or copyright.
5. PAYMENT PROVISIONS AND REPORTING OBLIGATIONS
5.1 LICENSEE shall satisfy all requirements of the Sponsored Research Agreement
attached hereto as Exhibit A.
5.2 LICENSEE shall pay all fees and costs relating to filing, prosecution, and
maintenance of patents and copyrights on the Licensed Technology.
5.3 LICENSEE, in its discretion and using counsel mutually acceptable to
LICENSEE and LICENSOR, can assert patent or copyright rights under the Licensed
Technology against third parties. Any recovery from lawsuits asserting such
patent and copyright rights shall be first used to satisfy the legal expenses
and costs of such lawsuits, and then be split equally between LICENSEE and
LICENSOR.
5.4 LICENSEE shall pay all fees and costs, including reasonable attorney's fees
of the LICENSOR, in connection with any lawsuit involving defense of the
validity of patents and copyrights on the Licensed Technology, and infringement
of patents and copyrights on the Licensed Technology by a third party. LICENSOR
agrees to cooperate with LICENSEE in all such lawsuits; however, in no event
will LICENSOR be required to bring or defend such lawsuits
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for the benefit of LICENSEE, and in no event will the failure of LICENSOR to
bring or defend such lawsuits relieve LICENSEE of royalty obligations set forth
below in this Agreement.
5.5 LICENSEE shall pay LICENSOR royalties of [*] Net Revenues and [*] of Net
Sales of Licensed Product derived by Licensee under this Agreement.
5.6 LICENSEE, within sixty (60) days after each calendar quarter of each year,
shall deliver to LICENSOR true and accurate reports, pertaining to [*]
5.7) [*]
5.8) LICENSEE shall keep full, true and accurate books of account containing
all particulars that may be necessary for the purpose of showing the amounts
payable to LICENSOR hereunder. Said books of account shall be kept at
LICENSEE'S principle place of business. [*]
5.9) [*]
* CONFIDENTIAL TREATMENT
REQUESTED
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6. TERMINATION
6.1 The provisions of this Agreement, having come into force on the Effective
Date, shall, unless terminated earlier for any reason, continue in force in
accordance with their respective terms (if any) and otherwise without limit of
time.
6.2 LICENSEE may terminate this Agreement at any time by giving LICENSOR ninety
(90) days written notice. In the event of termination of this Agreement by
LICENSEE, LICENSEE shall have no further rights under this Agreement; however,
LICENSEE will have remain obligated for any royalties due or other expenses
incurred up until the date of termination.
6.3 LICENSOR may terminate this Agreement if LICENSEE
a. fails to pay on the due date any sum due under Section 5 of this
Agreement;
b. fails to provide reports on the due date specified under Section 5 of
this Agreement; or
c. fails to provide funding as specified in the Sponsored Research
Agreement attached as Exhibit A,
provided that LICENSOR provides LICENSEE with written notice of any of the
above, and that LICENSEE is allowed ninety (90) days to cure after receiving
the written notice from LICENSOR.
6.4 Either party may forthwith terminate this Agreement by written notice to
the other
a. if the other commits any breach of its obligations under this
Agreement, other than in the cases specified in Section 6.3 of this Agreement,
and, if the breach is capable of remedy, has failed to remedy the same within a
period of ninety (90) days after receipt of written notice specifying the
nature of the breach and requiring it to be remedied; or
b. if the other party makes any arrangement or composition with its
creditors, or goes into liquidation (except for the purposes of amalgamation or
reconstruction and in such manner that the company resulting therefrom
effectively agrees to be bound by or assume the obligations imposed on that
party under this Agreement); or
c. if an encumbrance takes possession, or a receiver is appointed, of any
of the property or assets of the other party; or
d. anything analogous to any of the foregoing under the law of any
jurisdiction occurs in relation to that other party; or
e. if the other party ceases, or threatens to cease, to carry on business.
6.5 No relaxation, forbearance, delay or indulgence by either party in
enforcing any of the terms of this Agreement or the granting of time by either
party to the other shall prejudice, affect or restrict the rights and powers of
the former hereunder nor shall any waiver by either party of a breach of this
Agreement be considered as a waiver of any subsequent breach of the same or any
other provision hereof.
* CONFIDENTIAL TREATMENT
REQUESTED
6
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6.6 The rights to terminate this Agreement given by this clause shall not
prejudice any other right or remedy of either party in respect of the breach
concerned (if any) or any other breach.
7. MISCELLANEOUS
7.1 Nothing in this Agreement shall create, or be deemed to create, a
partnership, or the relationship of principal and agent, between the parties.
7.2 LICENSEE shall be entitled to assign this Agreement to any of its
Affiliates taking over substantially all the business of LICENSEE relating to
this Agreement or, with the consent of LICENSOR, which shall not be
unreasonably be withheld, to any other company taking over substantially all
the business of LICENSEE relating to this Agreement and all or a major part of
the voting shares in which are, or are to be floated on, a recognized exchange
or otherwise publicly owned.
7.3 Subject to Section 7.2 of this Agreement, the clauses are personal to the
parties and neither party may assign, mortgage, charge or license any of its
rights hereunder, nor may either party sub-contract or otherwise delegate any
of its obligations hereunder, except with the prior written consent of the
other party.
7.4 LICENSEE shall (i) to the extent reasonably practical, place in a
conspicuous location on all patented products made pursuant to this Agreement a
patent notice in accordance with 35 U.S.C. Section 282 consisting of the word
"Patent" or "Patents" and the number or numbers of the United States patent or
patents licensed hereunder, and (ii) comply in all respects with the laws of the
country of manufacture, and/or sale of the Technology with respect to marking
such products so as to ensure LICENSOR of full protection and rights under such
laws. LICENSEE shall include the provisions of this clause in all sub-licenses
with third parties and Affiliates.
7.5 LICENSEE shall at all times during the term of this Agreement and thereafter
indemnify, defend and hold LICENSOR, its trustees, directors, officers,
employees and affiliates harmless against all claims, proceedings, demands and
liabilities, including legal expenses and reasonable attorney's fees, arising
out of the death of or injury to any person or persons or out of any damages to
property resulting from the research, development, production, manufacture,
sale, modification, use, import or advertisement of LICENSED PRODUCT or arising
from any obligation of LICENSEE hereunder.
7.6 LICENSEE shall at all times during the term of this Agreement and
thereafter indemnify, defend, and hold LICENSOR, its trustees, directors,
officers, employees, and affiliates, harmless against all claims, proceedings,
demands and liabilities of any kind whatsoever, including legal expenses and
reasonable attorney's fees, arising out of patent infringement action by a third
party.
7.7 LICENSEE shall obtain and carry in full force and effect commercial,
general liability insurance which shall protect LICENSEE and LICENSOR with
respect to events set forth above. Such insurance shall be written by a
reputable company authorized to due business in the
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Commonwealth of Virginia, shall list LICENSOR as an additional named insured
thereunder, shall be endorsed to include product liability coverage and shall
require reasonable written notice to be given to LICENSOR prior to any
cancellation or material change thereof. The limits of such insurance shall not
be less than one million dollars ($1,000,000) per occurrence with an aggregate
of five million ($5,000,000) for personal injury or death, and one million
dollars ($1,000,000) per occurrence with aggregate of three million dollars
($3,000,000) for property damage. LICENSEE shall provide LICENSOR with
Certificates of Insurance evidencing same.
7.8 EXCEPT AS OTHERWISE EXPRESSLY SET FORTH IN THIS AGREEMENT, LICENSOR, ITS
TRUSTEES, DIRECTORS, OFFICERS, EMPLOYEES, AND AFFILIATES MAKE NO REPRESENTATIONS
AND EXTEND NO WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT
NOT LIMITED TO WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE,
AND VALIDITY OF THE CLAIMS OF ANY PATENTS ON THE TECHNOLOGY ISSUED OR PENDING,
OR FREEDOM OF A PRODUCT THAT EMBODIES THE TECHNOLOGY FROM INFRINGEMENT OF THE
INTELLECTUAL PROPERTY RIGHTS OF OTHERS, THE ABSENCE OF LATENT OR OTHER DEFECTS,
WHETHER OR NOT DISCOVERABLE. IN NO EVENT SHALL LICENSOR, ITS TRUSTEES,
DIRECTORS, OFFICERS, EMPLOYEES, AND AFFILIATES BE LIABLE FOR INCIDENTAL OR
CONSEQUENTIAL DAMAGES OF ANY KIND, INCLUDING BUT NOT LIMITED TO ECONOMIC DAMAGE
OR INJURY TO PROPERTY AND LOST PROFITS, WHETHER LICENSOR SHALL BE ADVISED, SHALL
HAVE OTHER REASON TO KNOW, OR IN FACT SHALL KNOW OF THE POSSIBILITY OF THE
FOREGOING.
7.9 For the purposes of this Agreement "Force Majeure" means any circumstances
beyond the reasonable control of either party including, without limitation, any
strike, lock-out, or other form of industrial action. If either party is
affected by Force Majeure, it shall forthwith notify the other party of the
nature and extent thereof. Neither party shall be deemed to be in breach of this
Agreement, or otherwise be liable to the other, by reason of any delay in
performance, or the nonperformance, of any of its obligations under this
Agreement, to the extent that such delay or nonperformance is due to any Force
Majeure of which it has notified the other party, and the time for performance
of that obligation shall be extended accordingly. If the Force Majeure in
question prevails for a continuous period in excess of six (6) months, the
parties shall enter into bona fide discussions with a view to alleviating its
effects, or to agreeing upon such alternative arrangements as may be fair and
reasonable.
7.10 LICENSEE shall not use the names or trademarks of LICENSOR, nor any
adaptation thereof, nor the names of any of its employees, in any advertising,
promotional or sales literature without prior written consent obtained from
LICENSOR, or said employee, in each case, except that the LICENSEE may state
that it is a licensee of LICENSOR with respect to the Technology.
7.11 All Notices shall be made in writing to the individuals noted below at the
addresses noted above, and shall be sent by certified mail, returned receipt
requested. If the individual to whom notices are to be given, or address where
notices are to be sent changes for any party, that party
*CONFIDENTIAL TREATMENT
REQUESTED
8
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shall promptly notify the other party accordingly.
7.12 LICENSEE recognizes the proprietary rights of LICENSOR in and to the
confidential nature of information provided to LICENSEE under the Sponsored
Research Agreement attached hereto as Exhibit A, and agrees to take every
necessary precaution to safe-guard and treat the information as confidential and
to take appropriate action by instruction, agreement or notice with LICENSEE's
directors, officers, agents and employees to protect the confidential and
proprietary nature of the Information. LICENSEE agrees that it will not make use
of, either directly or indirectly, any of the information which it receives from
LICENSOR, other than for the purpose for which the information is disclosed
except with the specific prior written authorization of LICENSOR. LICENSEE
agrees not to disclose, publish or otherwise reveal any of the information to
any other party, except with the specific prior written authorization of
LICENSOR. However, nothing contained in this provision of the Agreement shall be
construed, by implication or otherwise, to apply to information which:
a) is or becomes part of the public domain through no fault of LICENSEE:
b) was in the possession of LICENSEE, as evidenced by written records,
prior to the time of disclosure by LICENSOR;
c) lawfully becomes known or available to the LICENSEE from third parties
who are not under a similar agreement directly and indirectly with LICENSOR
regarding disclosure; or
d) LICENSEE is required by law to disclose.
7.13 This Agreement contains the entire and only agreement and understanding
between the parties and supersedes all preexisting agreements between them
respecting its subject matter. Any representation, promises, or condition in
connection with such subject matter which is not incorporated in this Agreement
shall not be binding on either party. No modification, renewal, extension,
waiver, and no termination of this Agreement or any of its provisions shall be
binding upon the party against whom enforcement of such modification, renewal,
extension, waiver or termination is sough, unless made in writing and signed on
behalf of such party by one of its duly authorized officers. As used herein, the
word "termination" includes any and all means of bringing an end prior to its
expiration by its own terms this Agreement, or any provisions thereof, whether
by release, discharge, abandonment or otherwise.
7.14 This Agreement shall be construed, governed, interpreted and applied in
accordance with the laws of the Commonwealth of Virginia, U.S.A, except that
questions affecting the construction and effect of any patent shall be
determined by the law of the country in which the patent was granted. Any legal
action or proceeding relating to this Agreement or any document or instrument
related hereto shall be brought only in the courts of the Commonwealth of
Virginia in Richmond, Virginia, and by its execution and delivery of this
Agreement, LICENSEE hereby accepts for itself and in respect to its property,
generally and unconditionally, the jurisdiction of the aforesaid courts.
7.15 This Agreement may be executed in one or more counterparts and any party
hereto may execute any such counterparts each of which shall be deemed an
original and all of which, taken together, shall constitute but one and the
same document. It shall not be necessary in making
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proof of this document or any counterpart hereof to produce or account for any
of the other counterparts.
7.16 The provisions of this Agreement are severable, and in the event that any
provisions of this Agreement shall be determined to be invalid or unenforceable
under any controlling body of the law, such invalidity and unenforceability
shall not in any way affect the validity or unenforceability of the remaining
provisions hereof. In the event the validity or unenforceability of any
provision of this Agreement is brought into question because of the decision
of a court of competent jurisdiction, LICENSOR, by written notice to LICENSEE
may revise the provision in question or may delete it entirely so as to comply
with the decision of said court.
7.17 The failure of either party to assert a right hereunder or to insist upon
compliance with any term or condition of this Agreement shall not constitute a
waiver of that right or excuse a similar failure to perform any such term or
condition by the other party.
7.18 It is understood that LICENSOR is subject to United States laws and
regulations controlling the export of technical data, computer software,
laboratory prototypes and other commodities (including the Arms Export Control
Act, as amended and the United States Department of Commerce Export
Administration Act of 1979). The transfer of such items may require a license
from the cognizant agency of the United States Government and/or written
assurances by LICENSEE that LICENSEE shall not export data or commodities to
certain foreign countries without prior approval of such agency. LICENSOR
neither represents that license shall not be required not that, if required, it
shall be issued.
7.19 All reports and documents to be forwarded to LICENSOR shall be in the
English Language.
7.20 All payments required under this Agreement shall be made in U.S. Dollars.
[*]
IN WITNESS WHEREOF, the parties have caused this Agreement to be executed
in duplicate as first above written.
ALLOS THERAPEUTICS INC. VIRGINIA COMMONWEALTH
UNIVERSITY INTELLECTUAL
PROPERTY FOUNDATION
By: /s/ XXXXXXX XXXXXXX
----------------------------- -----------------------------
Name: Xxxxxxx Xxxxxxx Xxxxx Xxxxxxxxx
Title: President Acting Director of Technology Transfer
Date: 6/30/97 Date:
--------------------------- ------------------------
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VIRGINIA COMMONWEALTH UNIVERSITY SPA#__________________________
SPONSORED PROGRAMS INTERNAL APPROVAL Copy Received ___ yes ___ no
(INSTRUCTIONS PROVIDED ON REVERSE SIDE; PLEASE PRINT OR TYPE) Award Received ___ yes ___ no
SPA Reviewer _________________
(for SPA purposes only)
I. PRINCIPAL INVESTIGATOR
Principal Investigator(s) Xxxxxxx Xxxxxx J.
------------------------------------------------
Last Name First name M.I. (Please provide complete name)
Office Phone Extension: 8-8483 Office Fax#: 8-7625 Box#: 980540 Department Med Chem
------------- ----------- -------- ---------------------------------
Contact Individual for Proposal Pickup & Phone: Xxxxxxxx Fiscal Administrator: Dpt#
------------------- ----------------- --------
II. SPONSOR AND PROPOSAL INFORMATION
Name of Sponsor (Agency): Allos Therapeutics, Inc.
---------------------------------------------------------------------------------------------------
Proposal Identification Number:
--------------------------------------------------------------------------------------------
Title: Non-Heme Allosteric Proteins
----------------------------------------------------------------------------------------------------------------------
Type of Proposal: Research(R) X Clinical Trial(R) Training/Fellowship(T) Other(O)
--- --- --- ---
Status of Proposal: New(N) X Non-competing Continuation(C) Competing Continuation(R) Supplement(S) Revision
--- --- --- --- ---
Other:
---------------------------------------------------------------------------------------------
*****************************************************************************************************************************
YES NO
Will the project include use of human subjects? CCHR Approval# 9410-4D Date: Feb. 97 Pending? [X] [ ]
---------- --------- ---
Will the project include use of vertebrate animals? IACUC Approval# Date: Pending? [ ] [X]
---------- --------- ---
Does the project involve research on infectious substances? (i.e. HIV, etc.) Blood, Hb [X] [ ]
----------------------------------
Does the research involve recombinant DNA/hazardous substances (subject to appropriate regulations)? [ ] [X]
Does the project involve rented off-campus facilities? Location: VBRP [X] [ ]
--------------------------------------------
If YES is rent included in budget? yes no X
--- ---
Does the proposal involve one or more other institutions or organizations? [ ] [X]
If YES list participants:
----------------------------------------------------------------------------
Will program income be generated? Estimated Amount $ Alternative: [ ] [X]
-------- ---------
Does any investigator have a significant financial interest in this project? [ ] [X]
20% What percent of your total effort will be devoted to the project?
---
20% What portion of your salary will be requested by the grant/contract?
---
*****************************************************************************************************************************
III. BUDGET
Fill in Dates Below Direct Costs Indirect Costs* Total Costs Indirect Costs***
------------------- ------------ --------------- -----------
THIS BUDGET PERIOD: [ * ]
From: To: -----------------------
7/1/97 6/30/98 [ * ] [ * ] [ * ]
--------------------------- -------------------- -------------------- -------------------- Base: MTDC TDC
TOTAL PROJECT PERIOD:** ---- ------
From: To: Type: CR FUC TFC
7/1/97 6/30/98 [ * ] [ * ] [ * ] --- --- ----
--------------------------- -------------------- -------------------- --------------------
* IF NO INDIRECT COSTS ARE ALLOWED OR IF IDC ARE LIMITED BY SPONSORING AGENCY, ATTACH DOCUMENTATION
** NOT APPLICABLE FOR NON-COMPETITIVE RENEWALS
*** IF A VOLUNTARY REDUCTION OF INDIRECT COSTS IS DESIRED, ATTACH THE REQUEST AND JUSTIFICATION AND OBTAIN THESE ENDORSEMENTS:
CHAIRPERSON'S APPROVAL: XXXX'X APPROVAL: (INITIALS)
--------- ----------
IV. CERTIFYING SIGNATURES
We, the undersigned, do certify to the best of our knowledge and believe that 1) the designated facility will be released for the
effort indicated; 2) personnel costs are correctly estimated; 3) adequate and suitable space is/will be provided for completion
of the above noted project; 4) we comply with the Debarment Statement and the Conflict of Interests Statement as defined on the
reverse side of this document; and 5) this project is consistent with the educational and research objectives of the University.
Principal Investigator(s)/Project Director(s) /s/ XXXXXX X. XXXXXXX Date: April 30, 97
------------------------------------------------------------------- ------------
Department Chairperson(s) /s/ XXXXXX X. XXXXXXX Date: April 30, 97
--------------------------------------------------------------------------------------- ------------
School Xxxx(s) or Designee(s) Date:
----------------------------------------------------------------------------------- ------------
Authorized University Official Date:
---------------------------------------------------------------------------------- ------------
NOTE: THIS FORM IS FOR INTERNAL USE ONLY: DO NOT FORWARD WITH PROPOSAL
Sponsored Programs Administration o X.X. Xxx 000000 x Xxxxxxxx, XX 00000
VCU OSDA (000-0000) Fax 000-0000
*CONFIDENTIAL TREATMENT
REQUESTED
12
Principal Investigator/Program Director (Last, first, middle):
Xxxxxxx, Xxxxxx X.
---------------------------------------------------------------------------------------------
FROM THROUGH
DETAILED BUDGET FOR INITIAL BUDGET PERIOD
DIRECT COSTS ONLY 07/01/97 06/30/98
---------------------------------------------------------------------------------------------
PERSONNEL (Applicant organization only) DOLLAR AMOUNT REQUESTED (omit cents)
--------------------------------------- % -------------------------------------
TYPE EFFORT INST.
ROLE ON APPT. ON BASE SALARY FRINGE
NAME PROJECT (months) PROJ. SALARY REQUESTED BENEFITS TOTALS
---- ------- -------- ------ ------- --------- -------- --------
X. Xxxxxxx Principal 12 20 [ * ] [ * ] [ * ] [ * ]
Investigator
X. Xxxxx Xxxxxxx Xxxx-xxx 00 00 [ * ] [ * ] [ * ] [ * ]
Xxxx Xxxxx Research 12 50 [ * ] [ * ] [ * ] [ * ]
Technician II
Xxxxxx Xxxx Post-doc 12 50 [ * ] [ * ] [ * ] [ * ]
X. Xxxxxx Post-doc 12 100 [ * ] [ * ] [ * ] [ * ]
X. Xxxx Protein 12 100 [ * ] [ * ] [ * ] [ * ]
Chemist
Xxxxx Xxxxxxx Graduate 12 100 [ * ] [ * ] [ * ] [ * ]
Student ---- ---- ------- -------- ------- --------
SUBTOTALS--------------------------------> [ * ] [ * ] [ * ]
======== ======= ========
---------------------------------------------------------------------------------------------
CONSULTANT COSTS
0.
None 0. 0.
---------------------------------------------------------------------------------------------
EQUIPMENT (Itemize)
0.
---------------------------------------------------------------------------------------------
SUPPLIES (Itemize by category)
Chemicals, solvents, analysis, buffer, Reage 20,000.
20,000.
---------------------------------------------------------------------------------------------
TRAVEL
0. 0.
---------------------------------------------------------------------------------------------
PATIENT CARE COSTS INPATIENT None 0. 0.
OUTPATIENT None 0. 0.
---------------------------------------------------------------------------------------------
ALTERATIONS AND RENOVATIONS (Itemize by category)
None 0. 0.
---------------------------------------------------------------------------------------------
OTHER EXPENSES (Itemize by category)
Instrument repairs [ * ]
0.
0.
0. [ * ]
---------------------------------------------------------------------------------------------
SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD $ [ * ]
186,516.
---------------------------------------------------------------------------------------------
CONSORTIUM/CONTRACTUAL COSTS DIRECT COSTS 0.
---------------------------------------------------------------
INDIRECT COSTS 0.
---------------------------------------------------------------
TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 7a. Face Page) -----------> $ [ * ]
---------------------------------------------------------------------------------------------
PHS 398 (Rev. 5/95) (Form Page 4) Page 4
Number pages consecutively at the bottom throughout the application. Do not use
suffixes such as 3a, 3b,.
*CONFIDENTIAL TREATMENT
REQUESTED
