HTML Preview Transmittal Letter For Proposal page number 1.
LETTER OF TRANSMITTAL FOR REQUEST FOR GRANT PROPOSAL
RFGP #34360-62417 (Page 1 of 2)
I, ____________________________, am legally authorized to bind _________________________ regarding
Name and Title Grantee Name
compliance with the following assurances and submission requirements. (If you are not the president or chair of the
agency board of directors, you must attach written evidence showing authority to bind the Grantee.)
By indication of the authorized signature below, I hereby make certification and assurance of my organization’s
compliance with the following:
We assure that the proposal submitted by ____________________________ meets all requirements in each section
Grantee Name
of this RFGP and shall remain valid for (six) 6 months after the proposal due date.
We assure that the proposal submitted by ____________________________ was arrived at independently, without
Grantee Name
collusion with any other proposer, competitor, or employee of the Department of Health.
We assure that no amount shall be paid directly or indirectly to an employee of the State of Tennessee as wages,
compensation, or gifts in exchange for acting as an officer, agent, employee, subcontractor, or consultant to my
organization in connection with this Request for Grant Proposal process.
Please provide the following information:
Complete legal entity as it appears on your corporate charter:
Agency tax identification number:
The person to be contacted regarding this proposal:
Name and Title:
Address:
Telephone Number:
Fax Number:
E-Mail Address:
Please circle Option 1 or Option 2 related to subcontracting:
OPTION 1
We are proposing to use the following subcontractor(s). Attached is a complete mailing address for each
subcontractor and the scope and portions of work the subcontractors will perform.
OPTION 2
We assure that we will not assign the Grant Contract awarded through this RFGP process or subcontract for any
services performed under the Grant Contract awarded through this RFGP process.
CONFLICT OF INTEREST
We assure that neither our agency nor any individual who will perform services under this grant has a possible conflict of
interest (e.g. employment by the State of Tennessee) other than those listed below.
We understand the State reserves the right to cancel an award if any interest disclosed from any source could either give
the appearance of a conflict of interest or cause speculation as to the objectivity of the Grantee. Such determination
regarding any questions of conflict of interest shall be solely within the discretion of the State.
Possible Conflicts of Interest:____________________________________________________________
____________________________________________________________________________________
Authorized Signature Date