CONTRACT TEMPLATE
MS&NCD Form 0009A Grant Cover Sheet
Eff. 9/2005
Revised 5/06, 7/07
Page 1 of 16
General Instructions: This contract template is intended for use by state agencies disbursing grant funds to ensure that all
requirements from GS 143C-6-23 are included in the grantee contract. The template package includes: grant cover
sheet, Attachment A General Terms and Conditions (1 version for private sector contracts, 1 version for local government
contracts), Attachment D Notice of Certain Reporting and Audit Requirements, and Attachment E State Grant
Certification—No Overdue Tax Debts. Other attachments listed below would be specific to each grant and developed by
the agency.
Grant Cover Sheet Instructions: Use for all grants as a general contract cover page and then attach appropriate contract
documents, as referenced in Section 1. Agencies will need to complete sections of this document and remember to
delete all instructions.
GRANT COVER SHEET
Contract # _________
This Contract is hereby entered into by and between the _________________________________ (the "Agency") and
________________________________ (the "Grantee") (referred to collectively as the “Parties”). The Grantee’s federal tax
identification number is _________________.
1. Contract Documents: This Contract consists of the following documents: (Delete attachments that do not apply and
label attachments according to order of precedence as applicable. Attachment letters will change if all attachments are not
applicable to your contract documents.)
(1) This Contract
(2) The General Terms and Conditions (Attachment A)
(3) The Scope of Work, description of services, or Grantee’s proposal (Attachment B)
(4) The line item budget and budget narrative (Attachment C) and if applicable, indirect cost documentation
(5) Notice of Certain Reporting and Audit Requirements (Attachment D)
(6) Certification of No Overdue Tax Debts (Attachment E)
(7) If applicable, Federal Certification Regarding Environmental Toba