UNIVERSITY OF NORTH DAKOTA School of Medicine and Health Sciences Center for Rural Health

NORTH DAKOTA Department of Health

NORTH DAKOTA Healthcare Association

REQUEST FOR PROPOSAL for The North Dakota Rural Hospital Flexibility (FLEX) Program ‘03 “EMS Network Grant” RFP # 52-2003

RELEASE DATE: October 11, 2002 APPLICATION DUE DATE: Application due November 27, 2002 AWARD DATE: December 20, 2002

Prepared by the University of North Dakota Purchasing Department

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PURPOSE This Request for Proposal is released by the University of North Dakota Purchasing Department on behalf of the University of North Dakota Center for Rural Health, School of Medicine and Health Sciences, the North Dakota Department of Health, and the North Dakota Healthcare Association. Under the North Dakota Rural Hospital Flexibility (FLEX) program, you are eligible to apply to the University of North Dakota Center for Rural Health, School of Medicine and Health Sciences for the EMS Network Grant. The purpose of this grant is to establish an EMS network and collaborative relationships with Critical Access Hospitals (CAHs) while enhancing local EMS services. Projects will be funded up to $15,000 each. The funds for this effort originate from the federal Office of Rural Health (ORHP), Department of Health and Human Services. In North Dakota, a formal partnership exists between the North Dakota Healthcare Association, the North Dakota Department of Health, and the UND Center for Rural Health-School of Medicine and Health Sciences. The three partners co-administer the program as a steering committee setting policy, developing guideline, and reviewing and determining the EMS Network Grant awards. ORHP created a special federal grant program for the states to implement and continue the Medicare Rural Hospital Flexibility Program.

DEFINITIONS Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Response to the RFP CAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Critical Access Hospital Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospital of contract award FLEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rural Hospital Flexibility Program ORHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Office of Rural Health Policy Proposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Response to the RFP RFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Request for Proposal Respondent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospital responding to RFP, Applicant FLEX Steering Committee . . . . . . . . . . . . . . . University of North Dakota, Center for Rural Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . North Dakota Department of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . North Dakota Healthcare Association UND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . University of North Dakota

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SECTION 1. STANDARD TERMS AND CONDITIONS 1.1

Contract term: upon award through August 31, 2003.

1.2

Parties to the contract: the contract shall be between the University of North Dakota and the awarded Respondent(s).

1.3

The successful Contractor(s) will agree to indemnify, save, and hold harmless UND, and its officers and employees, from any and all claims of any nature, including all costs, expenses, and attorneys’ fees, which may in any manner result from or arise out of the performance of the agreement, except for claims resulting from or arising out of UND’s sole negligence. Contractor will also agree to indemnify, save, and hold UND harmless for all costs, expenses, and attorneys’ fees incurred in litigating the indemnifications coverage provided herein.

1.4

Remedy for default: in the event any Contractor(s) shall be judged as bankrupt, making a general assignment for the benefit of its creditors, or if a receiver shall be appointed on account of Contractor(s) insolvency, or in the event the Contractor(s) does not correct or, if immediate correction is not possible, commence and diligently continue action to correct, any default of Contractor(s) to comply with any of the provisions or requirements of the contract within 10 days after receipt in writing of notice of such default by UND. UND may, by written notice to Contractor(s), without prejudice to any other rights or remedies which UND may have at law or in equity, terminate further performance by Contractor(s) of the Contract. In the event of such termination, UND may complete the performance of the Contract by such means as UND reasonably selects and Contractor(s) shall be responsible for any additional costs incurred by UND in so doing. Any amounts due Contractor(s) or services performed by Contractor(s) in compliance with the terms of the contract prior to such termination for default, shall be subject to offset of any additional costs of completing the Contract and other damages incurred by UND as a result of Contractor(s) default.

1.5

Assignment: the Contract may not be assigned by Contractor(s) without the prior written consent of UND. Any assignment of the contract by Contractor(s) in whole or in part, by operation of law or otherwise without the prior written consent of UND, shall be void.

1.6

Licenses: the successful Contractor(s) shall have and maintain a valid and appropriate business license (if applicable), meet all local, state, and federal codes, and have current all required local, state, and federal licenses.

1.7

Governing law: the Contract shall be subject to and governed in all respects, including issues of validity, interpretation, performance and enforcement, by the laws of the State of North Dakota.

1.8

Supervision and inspection: UND will reserve the right to request the removal of any Contractor(s) employee from the performance of the contract if in the judgment of UND, such removal shall be necessary in order to protect the interests of UND.

1.9

Insurance: (1) Contractor(s) shall secure and keep in force during the term of the Agreement, from insurance companies, government self-insurance pools, or government self-retention funds authorized to do business in North Dakota: (1) commercial general liability; (2) automobile liability; and (3) workers’ compensation coverage. Contractor(s) shall include in the RFP response a certificate of insurance as evidence these policies are in effect. The minimum coverage for commercial general liability and automobile insurance shall be limits of $250,000 per person and $1,000,000 per occurrence. Proof of coverage for workers’ compensation shall be by providing a certificate of workers’ compensation coverage from the North Dakota State Workers’ Compensation Bureau as part of the RFP response.

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(2)

UND, including its officers and employees, shall be endorsed on the commercial general liability policy as additional insureds. Contractor(s) shall furnish a certificate of insurance and a copy of the additional insured endorsement to the undersigned UND representative within the RFP response. Said endorsement shall contain a "Waiver of Subrogation" waiving any right of recovery the insurance company may have against the UND as well as provisions that the policy and/or endorsement may not be canceled or modified without thirty (30) days' prior written notice to the undersigned UND representative, and that any attorney who represents UND under this policy must first qualify as and be appointed by the North Dakota Attorney General as a Special Assistant Attorney General as required under N.D.C.C. Section 54-12-08.

(3)

Contractor's insurance coverage shall be primary (i.e., pay first) in respect to any insurance, self-insurance, or self-retention maintained by UND. Any insurance, self-insurance, or self-retention maintained by the UND shall be in excess of Contractor's insurance and shall not contribute with it.

(4)

Any deductible amount or other obligations under the policy(ies) shall be the sole responsibility of Contractor(s).

(5)

This insurance may be in policy or policies of insurance, primary and excess, including the so-called umbrella or catastrophe form and can be placed with the insurers rated "A" or better by A.M. Best Company, Inc.

(6)

UND will be indemnified, saved, and held harmless to the full extent of any coverage actually secured by Contractor(s) in excess of the minimum requirements set forth above.

1.10

Non-collusion: by signing the RFP response the Respondent certifies that the response submitted has been arrived at independently and has been submitted without collusion with, and without any agreement, understanding, or planned common course of actions with, any other vendor of services described in the RFP scope of work, designed to limit independent bidding or competition.

1.11

Attorney’s fees: In the event a lawsuit is instituted on behalf of UND to obtain performance due of any kind under the contract, and ND is the prevailing party, Contractor(s) shall, except when prohibited by N.D.C.C. Section 28-26-04, pay ND’s reasonable attorney's fees and costs in connection with the lawsuit.

1.12

Nondiscrimination and compliance with laws: Contractor(s) agree to comply with all applicable laws, rules, regulations, and policies, including but not limited to those relating to nondiscrimination, accessibility, and civil rights.

1.13

Force Majeure: Contractor(s) shall not be held responsible for delay or default caused by fire, riot, acts of God, or war if the event is beyond Contractor's reasonable control and Contractor gives notice to UND immediately upon occurrence of the event causing the delay or default or which is reasonably expected to cause a delay or default.

1.14

Severability: If any term or provision of the contract is declared by a court having jurisdiction to be illegal or unenforceable, the validity of the remaining terms and provisions shall not be affected, and the rights and obligations of the parties are to be construed and enforced as if the contract did not contain that term or provision.

1.15

Execution of contract: UND Purchasing will issue an official contract to the successful Contractor(s). At time of award, the appropriate contact/invoice addresses will be given. The final contract will be binding to Contractor(s) and UND upon completion of contract signing by UND and Contractor(s).

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Documents: the RFP, its attachments, its appendices, its amendments, and the awarded Contractor(s) RFP response and any attachments hereto shall be used in the writing of the contract entered into between the successful Contractor(s) and UND. 1.16

Termination: UND may terminate this contract under any of the following conditions: (1)

If funding from federal, state, or other sources is not obtained or continued at levels sufficient to allow for the purchase of the services or supplies under this contract. The contract may be modified by agreement of the parties in writing to accommodate a reduction in funds.

(2)

If federal or state laws, rules, or regulations are modified or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this contract, or are no longer eligible for the funding proposed for payments authorized by this contract.

(3)

If any license, permit, or certificate required by law, rule, regulation, or the terms of this contract, is for any reason denied, revoked, suspended, or not renewed.

Any such termination of this contract shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination. 1.17

Termination by Default: UND, by written notice of default (including breach of contract) to Contractor(s) may terminate the whole or any part of this contract: 1.

If Contractor(s) fails to provided services called for by this contract within the time specified or any extension agreed to by UND, to include non-competitive or agreed upon discount pricing, product quality, product compatibility with already and future networks, product consistency, and timely deliveries of product.

2.

If Contractor(s) fails to perform any of the other provisions of this contract, or so fails to pursue the work as to endanger performance of this contract in accordance with its terms, and after receipt of written notice from UND, fails to correct such failures within ten days or such longer period as UND may authorize.

The rights and remedies of UND provided in the above clause related to defaults (including breach of contract) by Contractor(s) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. 1.18

Authority to Contract: Contractor(s) shall not have the authority to contract for or incur obligations on behalf of UND.

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SECTION 2. SCOPE OF WORK Requirements/Eligibility Under this grant, a network/collaborative agreement between a minimum of two certified ambulance services and one certified Critical Access Hospital (CAH) must be demonstrated. CAHs are encouraged to develop a broad-based network which may be inclusive of a tertiary partner, other acute care hospitals, other CAHs, or other partners. The CAH will act as the lead agency and will assume fiscal responsibility for the awarded grant funds. Applicants must demonstrate the following in the proposal. 1.

How the proposed project will benefit the community or the service area.

2.

How the proposed project will help to ensure the future of emergency medical service delivery in the service area.

3.

How the proposed project addresses and facilitates access to emergency medical services.

4.

Identify needs and how the proposal address those needs.

5.

What current resources, skills, and staffing exist that will be used in conjunction with the proposal and how those existing resources will be used with the grant.

6.

How the proposed budget relates to the identified need and proposed action.

7.

What the time line is and that it is reasonable. Note the grant completion date is August 31, 2003.

8.

How the proposal facilitates a collaborative relationship between the partners.

9.

Include a plan for continuation (including possible funding sources) after the end of the grant period.

10.

Include the name of the primary contact person for the proposed project.

11.

Include a budget narrative.

12.

Memorandum of Agreement (MOA), describing the role and responsibility of each network member and if equipment is purchased under the grant, that the MOA establishes the ownership of the property following termination of federal funds.

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SECTION 3 RULES FOR APPLICATION 3.1

It is the sole responsibility to the Respondent to be certain that it has received a full set of the Proposal Documents when preparing to respond. Upon submission of its Application, the Respondent shall be deemed conclusively to have been in possession of a full set of proposal documents. Respondents are expected to examine the entire RFP, including all specifications, requirements, and instructions. Failure to do so will be at the Respondent’s risk.

3.2

UND will not be responsible for any costs incurred by Respondents which may result from preparation or submission of application to this RFP.

3.3

Proposal Application Respondents are required to use the attached application titled “EMS Network Grant Program, Application Form”. Additional sheets may be used as needed and must be identified with its application number and hospital name. Please refer to Section 2, Scope of Work, for additional application information. Faxed applications will not be accepted. The original and one copy of the application and supplemental materials and attachments, must be mailed or hand carried to the following. Physical Address UND Center for Rural Health School of Medicine and Health Sciences Attn: Brad Gibbens or Kristine Sande 501 North Columbia Rd. Grand Forks ND 58202-9037

Mailing Address Brad Gibbens, Associate Director or Kristine Sande, Project Coordinator UND Center for Rural Health School of Medicine and Health Sciences P.O. Box 9037 Grand Forks ND 58202-9037

Clearly marked on the outside of the package must be the proposal description, “RFP - 522003.”, as well as the Respondent’s organization name, and full address. UND accepts no responsibility for non-receipt and delays in receipt caused by mail carrier. Applications postmarked by November 27, 2002 will be accepted. Acceptance or Rejection of Application: The Steering Committee reserves the right to accept or reject any or all Applications or parts of the Application, and to waive informalities. The time line for this grant is as follows. RFP release date: Application due date: Award date: Work completion:

October 11, 2002 November 27, 2002 December 20, 2002 August 31, 2003

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APPLICATION GUIDELINES Instructions: The application form is to be completed by hospitals seeking support from the FLEX Grant Program. For information on the grant or its application please contact Kristine Sande or Brad Gibbens at the UND Center for Rural Health, School of Medicine and Health Sciences at the following: UND Center for Rural Health School of Medicine and Health Sciences P.O. Box 9037 Grand Forks, ND 58202-9037 701-777-3848 (P) 701-777-6779 (F)

[email protected] [email protected]

World Wide Web Address: http://medicine.nodak.edu/crh In completing this application, be as specific as you can be in stating your needs, describing your situation, and identifying your actions. Maximum application length is ten pages. If you include appendices, those are not counted against the ten page limit, but please, only provide pertinent information.

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SECTION 4 AWARD 4.1

Applications will be reviewed by the FLEX Steering Committee consisting of the following. University of North Dakota, Center for Rural Health North Dakota Department of Health North Dakota Healthcare Association

4.2

The criteria for application evaluation is the meeting of requirements as outlined in the Scope of Work, Section 2, items 1 through 12.

4.3

A contract will be provided as the award document. For your information, pages 11, 12, and 13 comprise a sample of the contract. You do not need to complete the subcontract or return it with your proposal. It is simply meant to serve as an example of what a hospital/UND subcontract will include. Please note that any expenditures made prior to the formal contract signing by both parties are the responsibility of the hospital. These prior expenses cannot be submitted as grant expenses or reimbursements. Funded projects are required to submit a final report to the Center for Rural Health at the end of the contract period. At a minimum, reports should detail: 1. 2. 3. 4.

The results of project including what was accomplished during the grant period and how the project has benefitted the hospital and the community. Items which were approved for funding but were not accomplished during the contract period. Barriers encountered and unanticipated events/experiences (positive or negative) that occurred during the implementation of the project. A brief summary of results from any analysis performed by consultants and paid for with grant funds.

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EMS NETWORK GRANT PROGRAM APPLICATION FORM Funded projects are required to submit a report at the end of the contract period. 1.

Hospital Name Federal Tax ID number

2.

Hospital Address:

Phone:

Fax:

E-mail: 3.

Name of Contact Person:

4.

Name of Acute Care Network Partner: (If one has been identified, it is not necessary to have a network partner to participate in the community assistance program) Location:

5.

Are your presently involved with any other federal, state, or private community development activity? (e.g. Department of Economic Development and Finance) ____Yes ____No If yes, please provide the name, address, and contact person. Working with another agency does not preclude you from this effort. We ask this only to limit duplication of effort and to facilitate collaboration with other groups. Name: Address: Contact Person:

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Please describe your proposal. (On attached paper.) With the application evaluation criteria in mind please address such subjects as:

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 7.

How the proposed project will benefit the community or the service area. How the proposed project will help to ensure the future of emergency medical service delivery in the service area. How the proposed project addresses and facilitates access to emergency medical services. Identify needs and how the proposal address those needs. What current resources, skills, and staffing exist that will be used in conjunction with the proposal and how those existing resources will be used with the grant. How the proposed budget relates to the identified need and proposed action. What the time line is and that it is reasonable. Note the grant completion date is August 31, 2003. How the proposal facilitates a collaborative relationship between the partners. Include a plan for continuation (including possible funding sources) after the end of the grant period. Include the name of the primary contact person for the proposed project. Include a budget narrative. MOA, establishing ownership of any property procured from grant funds. Please provide a budget narrative that shows how your plan to target the grant dollars. This information is required. (On attached paper. Estimates are acceptable.) How does the budget relate to need and proposed actions?

8.

Please include a time line to cover proposed activities with the completion date to be August 31, 2003. (You may use attached paper.)

9.

Signature and Title of Application Preparer: ________________________________________ Signature ________________________________________ Title

10.

Date:______________

Signature and title of hospital official authorized to enter into contract: ________________________________________ Date:______________ Signature ________________________________________ Title

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SAMPLE “SUBCONTRACT #100" UND Fund 4125-1290 This agreement is between the University of North Dakota, hereinafter called the CONTRACTOR , and , hereinafter referred to as the RECIPIENT. Whereas the CON TRACT OR has entered into Grant Agreement 5 H54 RH 00036-03 (CFD A #93.241) with the Departm ent of Hea lth and Hu man Serv ices, Health R esources & Services A dministration . Whereas the RECIP IENT has propo sed to assist the CONTRACT OR in the accomplishment of said work, Now therefore, the pa rties hereto do covenan t and agree as follows: 1. SCOPE OF WORK. The RECIPIENT agrees to perform the scope of work set forth below. The scope of work shall not be changed except by d uly executed amendm ents to this agree ment. 2. PERIOD OF PERFORM ANCE. The period of performance for this agreem ent shall commence o n September 1 , 2002, and shall terminate o n August 31, 2003, unless extended by mutual agreement in writing between the parties, or unless terminated by the CON TRA CTO R as prov ided in Artic le 8. 3. PAYMENTS As consideration and compensation for the work cited in ATTACHM ENT A, the CO NTRAC TOR agrees to pay the RECIP IENT o n a cost reimbursemen t basis, specifying payment terms as follows: The RECIPIENT may incur costs up to $ object ca tegories as sho wn in Attachm ent A

. The parties agree to the subcontract budget, specifying major

The CONTRACTO R shall not be obligated to pay the RECIPIENT for any costs incurred above the total funds allocated o f $ or any subse quent written a mendm ents to said fund ing allocation . Invoices for expenses in curred sha ll be submitted in duplicate n ot more freq uently than mo nthly, in amoun ts determine d to be allo wable by the CON TRA CTO R and in ac cordanc e with the app licable circula rs identified in Article 4. Fun ds from this ag reement ar e included under Ex panded Authority. Paymen t of said invoice s shall be con tingent upon approv al by the Co ntractors T echnical Re presentative . Said invoice shall b e in accord ance with the R ECIP IENT S standard billing format. The RECIPIENT shall submit a Final Bill, designated as such, promptly upon completion of work, but no later than October 15, 2003. The reports listed above along with all matters affecting the terms of this agreement or the administration thereof shall be referred to: Sally Horner Grants & Contracts Administration University of N orth Dak ota P.O. Box 7306 Grand Forks, ND 58202 PH:(701) 777-4151 Fax (701) 777-2504 Prior written approval shall be required for any changes or amendments to the agreement , including but not limited to, changes in scope of w ork, perio d of perfor mance, co st, subcontra cting and rep ort requirem ents. Any chan ges in or amendments to this agreement will be executed by an authorized official of the CONTRACTOR.

SAMPLE CONTRACT ONLY

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4. INCORPORATING PROVISIONS OF PRIME AWARD The subcontracted effort being performed under this agreement is part of the award received from the prime sponsor Department or Health and Human Services. Consequently, the terms and conditions specified by the prime sponsor becom e a part of this ag reement. Treatment of all costs must be consistent with acceptable accounting procedures outlined in OMB Circular A-110. Allowable costs shall be determined by the application of the cost principals found in OMB Circular A-21. 5. TECHNICAL DIRECTION. The RECIPIENT S performance of the work shall be under the direction of the CONTRACTOR'S Technical Represe ntative, Brad Gibben s, who will be ch arged with m onitoring the p roject. T he Tech nical Repr esentative is authorized to exercise the technical direction of the project within the general scope of work and the administration thereof. The Technical Representative will comment on technical reports and approve all reports and other deliverables including payme nt request vouchers. 6. INDEPENDENT CONTRACTOR. RECIPIENT herein is an Independent Contractor, not a partner or joint venturer, and shall not act as an agent for CONT RACT OR or shall RE CIPIEN T be deem ed to be an emp loyee of CON TRAC TOR for a ny purpose whatsoever. RECIPIENT shall not have any authority, either express or implied, to enter any agreement, incur any obligations on CONTRA CTOR'S behalf, or commit CON TRACT OR in any manner whatsoever without CON TRA CTO R'S express prior written co nsent. 7. LIABILITY. Each party shall be responsible for claims, losses, damages, and expenses which are proximately caused by the negligence or wrongful acts or omissions of that party or its employees, agents or representatives, acting within the scope of their employment. Nothing herein shall preclude either party from asserting against third parties any defenses to lia bility it may have un der the law o r be constru ed to crea te a basis for a c laim or suit whe n one wou ld otherwise ex it. This prov ision shall survive the termination of this Agreem ent. 8. TERMINATION. In the event of default by RECIPIENT of the obligations under this agreement, or in the event that the prime sponsor, DHHS, terminates work by CONTRACT OR on this subject matter, then performance by RECIPIENT may be terminated by CONTR ACTOR at any time by giving written notice. Such notice shall be effective upon the receipt of written notice by RECIPIENT. The RECIPIENT shall take all reasonable steps to minimize termination costs. CONT RACTO R shall, in the event of termination of the contract, in whole or part, make payment to the RECIPIEN T for such portion of the agreement which has been performed according to the terms of the agreement prior to termination. CONTRACT OR may withhold from such payments due RECIPIEN T such sums as the CON TRA CTO R determ ine to be nec essary to pro tect the CO NTR ACT OR aga inst loss of nature. 9. G O V ER N IN G L AW . All interpretation of the agreement shall be governed by the laws of the State of North Dakota, United States of America. T he only app ropriate ve nue for reso lution of dispu tes to the agree ment shall be in the State of N orth Dakota, United States of America. 10. SUBCONTRACTING. The RECIPIENT shall not subcontract any portion of the Services assigned to it without advance written authorization from the CONTRACTOR and DHHS. 11. AUDIT AND AC CESS TO RECIPIENTS REC ORDS. The REC IPIENT will comply with OMB CIRCU LAR A-13 3, for examination of record s and audit purposes. 12. MISCELLANE OUS PROV ISIONS. This document, with its ATTACHM ENTS, constitutes the entire agreement between the parties relative to the subject ma tter, and may b e modified or amend ed only by w ritten agreem ent signed b y both parties . If one or mo re of the pro visions of the ag reement sha ll be held to b e invalid, illegal o r unenforce able in any resp ect, the validity legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

SAMPLE CONTRACT ONLY

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Failure of either party to insist upon strict performance of any covenant or condition of the agreement in any one or more instan ces shall not b e construed as a waiver for the future of any su ch coven ant or cond ition, but the sam e shall be and re main in full force a nd effect. In the event of any inconsistency between the conditions of this agreement and those of the aforementioned ATTACH MENT S, the inconsistency shall be resolved by giving precedence in the following order: 1) Subcontract Agreement, and 2) the ATTACHM ENTS. If any inconsistency exists within the aforementioned order of precedence of definition o f terms, REC IPIEN T shall be r esponsib le for notifying the C ONT RACT OR’S B udget and Grants Office for determination by the CONTRACTOR.

In witness whereof, the parties hereto have executed this agreement on the day and year last specified below. UNIVERSITY OF NORTH DAK OTA BY

BY

NAME

NAME William G osnold, Jr.

TITLE

TITLE Interim Director, Res. & Program Dev

DATE

DATE

Taxpa yer ID N o.

SAMPLE CONTRACT ONLY