RCUH Policies and Procedures
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Open in new tab Direct Project Request
Applicant Information Date: _________________________
Organization name: ______________________________________________________________
Address: ______________________________________________________________________
City: ________________________________ _ State: ____________ Zip code: ______________
Name of primary contact: ____________________________ Title: _______________________
Email: ___________________________________________ Phone: _______________________
Entity type: ___________________________________________ Federal ID#: ______________
(Type of legal entity & domicile. E.g. non-profit organization incorporated in the State of Hawaii)
Nature of Business Activity: _______________________________________________________
(E.g. astronomical research, training activities)
______________________________________________________________________________
1. The purpose of RCUH includes, but is not limited to, the promotion of all educational, scientific, and literary pursuits. Please explain how any of the below, or all, apply to the project(s) requesting RCUH services and also how these project(s) serve a public purpose/benefit the State of Hawaii:
• Encourages, initiates, aids, develops, and conducts training, research, and study in the physical, biological, social sciences, humanities, and all other branches of learning;
• Encourages and aids in the education and training of persons for the conduct of training, investigations, research, and study;
• Furnishes the means, methods, and agencies by which the training, investigation, research, and study may be conducted;
• Assists in the dissemination of knowledge by establishing, aiding and maintaining professorships or other staff positions, fellowships, scholarships, publications, and lectures;
• Engages in other means of making the benefits of training, investigations, research and study available to the public;
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Rev July 2020
• Takes any and all other actions reasonably designed to promote these purposes in the interest of promoting the general welfare of the people of the State.
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Explain why RCUH administrative service is needed:
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. The following minimum insurance coverage is required in the Master Agreement with RCUH. In addition, RCUH must be named as an additional insured, if the project is accepted:
Commercial General Liability Insurance
Each occurrence limit $1,000,000
General aggregate limit $2,000,000
Automobile Liability Insurance (owned/hired/non-owned)
Bodily injury (each person/accident) $1,000,000
Property damage (each accident) $1,000,000
Umbrella/Excess Liability
Each occurrence limit $5,000,000
General aggregate limit $5,000,000
Workers’ Compensation and Employers’ Liability Insurance (applicable if Client has employees other than RCUH employees)
Workers’ Compensation Hawaii Statutory Limits
Employers’ Liability $1,000,000
4. Attach the entity’s latest audited financial statements (must be within the last 2 years).
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5. Provide one (1) bank and two (2) business references:
Bank Reference #1 Reference #2
Name _____________________ ____________________ ______________________
Title _____________________ ____________________ ______________________
Company _____________________ ____________________ ______________________
Email _____________________ _____________________ _____________________
Phone _____________________ _____________________ _____________________
6. Proposed Project Task Order(s) – Exhibit A attached.
Direct Projects accepted by RCUH must comply with RCUH policies and procedures. Please refer to www.RCUH.com
Certification
I certify that I am an authorized officer of the organization named above, and that the information provided on this request is true and correct.
Signature: ________________________________________________ Date: ________________
Print name: ____________________________________ Title: ___________________________
**********************************RCUH USE ONLY******************************
Direct Project request has been reviewed and recommended as follows:
Initials Date Comments
Director of HR Approve/Disapprove ______ ____________ ______________________
Director of Finance Approve/Disapprove ______ ____________ ______________________
Approve/Disapprove Direct Project request:
______________________________________________________________________________
Executive Director Date
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EXHIBIT A
Task Order No. _____
RCUH Project No. ________
PROJECT TASK ORDER FORM
__________________________________________ (Client)/
THE RESEARCH CORPORATION OF THE UNIVERSITY OF HAWAII (RCUH)
In accordance with the terms and conditions of the Master Agreement between Client and RCUH, Client hereby requests that RCUH establish a direct project account and provide administrative services for the following:
Project Title: __________________________________________________________________
Principal Investigator: ____________________________________________________________
Email: ________________________________________ Phone: __________________________
Project Period: _________________________________________________________________
Amount of Task Order: ___________________________________________________________
Brief description of project: ______________________________________________________________________________
______________________________________________________________________________
Project scope of work and deliverables:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Source of funding. Please list the agency/sponsor and attach a copy of sponsored agreement, if applicable.
Agency/Sponsor Amount
Federal agency _________________________________ $_________________
State agency _________________________________ $_________________
Other _________________________________ $_________________
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Does your project have cost share or matching requirements? Yes ___ No ___. If yes, please provide details:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Will this project involve any of the following? Check all that apply and explain:
___Construction ________________________________________________
___Exporting of Tech Equip/Data ________________________________________________
___Firearms ________________________________________________
___Foreign Operations ________________________________________________
___Hazardous Materials ________________________________________________
___Helicopter/Aircrafts ________________________________________________
___HIPAA (Protected Health Info) ________________________________________________
___Human Subjects ________________________________________________
___Live Animals ________________________________________________
___Marine/Diving Activities ________________________________________________
___Subcontracts ________________________________________________
Budget:
Salaries ________________*
Fringe ________________
Supplies ________________
Travel ________________
Equipment ________________
Other ________________
__________ ________________
__________ ________________
__________ ________________
__________ ________________
__________ ________________
Total Direct Costs ________________
RCUH Indirect Costs (___ %) ________________ Indirect costs rate is subject to change with a 60-day notice from RCUH
Total ________________
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*Personnel requirements/brief job description:
Position Description
_____________________ ________________________________________________
_____________________ ________________________________________________
_____________________ ________________________________________________
_____________________ ________________________________________________
_____________________ ________________________________________________
Does this project have existing employees? Yes ___ No ___. If yes, is the intent for them to become RCUH employees? Yes ___ No ___.
Note: RCUH reserves the right to evaluate incumbent employees and determine appropriateness of conversion to RCUH.
Is there intellectual property associated with your project(s)? Yes ___ No ___. If yes, who is the owner of the intellectual property?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
An advance of $_____________ (equivalent to 2 months of estimated expenditures) will be provided to RCUH upon execution of this task order and receipt of the RCUH invoice. Payment of each subsequent monthly invoice is due within 30 days of receipt of invoice.
Email RCUH invoices to:
Name: ____________________________________
Email address: ______________________________
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_____________________________________________________
Requested by: _____________________________
Name: _____________________________
Title: _____________________________
Date: _____________________________
Reviewed and approved by: _____________________________
Name: _____________________________
Its: Financial Officer
Date: _____________________________
_____________________________
Name: _____________________________
Its: President/Executive Director
Date: _____________________________
Research Corporation of the University of Hawaii
Accepted by: _____________________________
Name: Leonard R. Gouveia, Jr.
Its: Executive Director
Date: _____________________________
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