U.S. Department of
Transportation
Office of the Secretary
of Transportation
Small Business Innovation Research
2001 Program Solicitation
DTRS57-01-R-SBIR
Proposal Cover Sheet (Appendix A)
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This form is a SAMPLE ONLY. For a working copy of the Proposal Cover Sheet, please download the solicitation.
Project Title _____________________________________________________
Research Topic No. ________ Research Topic Title _____________________
______________________________________________________________
Submitted by:
Name ______________________________________________________
Address ___________________________________________________
City ___________________ State ________________ Zip + ___________
Amount Requested (Phase I) $ _____________ Proposed Duration ___________
(May be up to $100,000 unless otherwise indicated) (in months)(Not to exceed six months)
The above concern certifies it is a small business firm
and meets the definition stated in Section II.B; and that it
meets the eligibility requirement in Section I.C.
Yes_______ No_______
The above concern certifies it _____does_____does not
qualify as a minority and disadvantaged small business as
defined in Section II.C. (For statistical purposes only.)
The above concern certifies it_____does_____does not
qualify as a women-owned small business as defined in Section II D.
(For statistical purposes only.)
This firm and/or Principal Investigator has submitted
proposals containing a significant amount of essentially
equivalent work under other federal program solicitations,
or has received other federal awards containing a significant
amount of essentially equivalent work. (If yes, identify
proposals in the Section III. D. 10. "Similar Proposals
or Awards".)
Yes_______ No_______
Will you permit the Government to disclose the title and
technical abstract of your proposed project, plus the name,
address, and telephone number of the Corporate Official
and Principal Investigator of your firm, if your proposal
does not result in an award, to any party that may be
interested in contacting you for further information?
Yes_______ No_______
Principal Investigator Corporate/Business Official
Name____________________________ Name____________________________
Title______________________________ Title______________________________
Signature_________________Date_____ Signature_________________Date_____
Telephone No.______________________ Telephone No.______________________
PROPRIETARY NOTICE (IF APPLICABLE, SEE SECTION V. D.1
