![](media/image1.png)

***General Information: In order to ensure a timely response as to
bridge funding availability and comply with funds control policy,
requests should be submitted to the Sponsored Projects Office 60 days
prior to the accounting period to which the funding will be needed.
Requests must be submitted and approved prior to starting or continuing
work.***

+-----------------------------------+---+-----------------+---+---+-----------+
| **PART I -- DIVISION SECTION**    |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Division:**                     |   | **Date:**       |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| Type of Bridge Funding Request    |   |                 |   |   |           |
| (check one or more):              |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| New Additional Funding Time       |   |                 |   |   |           |
| Extension                         |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Sponsor Name:**                 |   | **Principal     |   |   |           |
|                                   |   | Investigator:** |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| LBNL Award Number:                |   | **Primary       |   |   |           |
|                                   |   | Project ID:**   |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Total Estimated Bridge Funding  |   |                 |   |   |           |
| Amount Required:**                |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| (If this request if for           |   |                 |   |   |           |
| additional funding, include total |   |                 |   |   |           |
| amount requested, i.e., sum or    |   |                 |   |   |           |
| previous requests plus this       |   |                 |   |   |           |
| request)                          |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| **\$**                            |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Bridge Funding Start Date**:    | * |                 |   |   |           |
|                                   | * |                 |   |   |           |
|                                   | B |                 |   |   |           |
|                                   | r |                 |   |   |           |
|                                   | i |                 |   |   |           |
|                                   | d |                 |   |   |           |
|                                   | g |                 |   |   |           |
|                                   | e |                 |   |   |           |
|                                   | F |                 |   |   |           |
|                                   | u |                 |   |   |           |
|                                   | n |                 |   |   |           |
|                                   | d |                 |   |   |           |
|                                   | i |                 |   |   |           |
|                                   | n |                 |   |   |           |
|                                   | g |                 |   |   |           |
|                                   | E |                 |   |   |           |
|                                   | n |                 |   |   |           |
|                                   | d |                 |   |   |           |
|                                   | D |                 |   |   |           |
|                                   | a |                 |   |   |           |
|                                   | t |                 |   |   |           |
|                                   | e |                 |   |   |           |
|                                   | ( |                 |   |   |           |
|                                   | E |                 |   |   |           |
|                                   | x |                 |   |   |           |
|                                   | p |                 |   |   |           |
|                                   | i |                 |   |   |           |
|                                   | r |                 |   |   |           |
|                                   | a |                 |   |   |           |
|                                   | t |                 |   |   |           |
|                                   | i |                 |   |   |           |
|                                   | o |                 |   |   |           |
|                                   | n |                 |   |   |           |
|                                   | ) |                 |   |   |           |
|                                   | * |                 |   |   |           |
|                                   | * |                 |   |   |           |
|                                   | : |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Reason for Anticipated Delay in |   |                 |   |   |           |
| Receipt of Funding** (please      |   |                 |   |   |           |
| include actions to date and path  |   |                 |   |   |           |
| forward):                         |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Personnel and Scientific        |   |                 |   |   |           |
| Strategy if Bridge Funding is not |   |                 |   |   |           |
| Provided:**                       |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **PI Signature**                  |   |                 |   |   | **Date:** |
|                                   |   |                 |   |   |           |
| (No other method to deal with     |   |                 |   |   |           |
| funding interruption and agrees   |   |                 |   |   |           |
| to comply with all bridge funding |   |                 |   |   |           |
| control requirements)             |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Division Director Signature**   |   |                 |   |   | **Date:** |
| (Please print & sign)             |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| (Recognizes risk that any         |   |                 |   |   |           |
| unallowable or uncollected costs  |   |                 |   |   |           |
| from default will be funded out   |   |                 |   |   |           |
| of appropriate alternative        |   |                 |   |   |           |
| divisional funds or LBNL CRD      |   |                 |   |   |           |
| funds, but it is in the best      |   |                 |   |   |           |
| interest of LBNL to assume the    |   |                 |   |   |           |
| risk.)                            |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **PART II - SPO SECTION**         |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| For a new non-federal project, is |   |                 |   |   |           |
| the signed contract on file? Yes  |   |                 |   |   |           |
| No Not Applicable                 |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| **Is this a WN initiative?**      |   |                 |   |   |           |
| **Yes** **No**                    |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| **Is the request Bridge Funding   |   |                 |   |   |           |
| policy compliant?** **Yes**       |   |                 |   |   |           |
| **No**                            |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| **Is the use of Bridge Funds      |   |                 |   |   |           |
| recommended?** **Yes** **No**     |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| Reason for Anticipated Delay in   |   |                 |   |   |           |
| Receipt of Funding (please        |   |                 |   |   |           |
| include actions to date, path     |   |                 |   |   |           |
| forward and expected resolution   |   |                 |   |   |           |
| date):                            |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| Sponsor's Intent to Continue      |   |                 |   |   |           |
| Funding (written confirmation     |   |                 |   |   |           |
| must be attached to this          |   |                 |   |   |           |
| request):                         |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| Name of Authorized Official:      |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| Title:                            |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| Date:                             |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| **Comments** (if unable to obtain |   |                 |   |   |           |
| written confirmation):            |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **SPO Contracts Officer           |   |                 | * |   |           |
| Signature**                       |   |                 | * |   |           |
|                                   |   |                 | D |   |           |
| (Certifies compliance with bridge |   |                 | a |   |           |
| funding and SPO policies)         |   |                 | t |   |           |
|                                   |   |                 | e |   |           |
|                                   |   |                 | : |   |           |
|                                   |   |                 | * |   |           |
|                                   |   |                 | * |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **SPO Manager Signature (policy   |   |                 | * |   |           |
| exceptions only)**                |   |                 | * |   |           |
|                                   |   |                 | D |   |           |
| **Risk Assessment:**              |   |                 | a |   |           |
|                                   |   |                 | t |   |           |
| (Reviews requests over \$250,000, |   |                 | e |   |           |
| 90 days, or policy exceptions and |   |                 | : |   |           |
| provides contractual risk         |   |                 | * |   |           |
| assessment)                       |   |                 | * |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| PART III -- BUDGET OFFICE SECTION |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| Are Bridge Funds available as of  |   |                 |   |   |           |
| the previous month's financial    |   |                 |   |   |           |
| close? Yes No                     |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
| Is there adequate documentation   |   |                 |   |   |           |
| to justify the release of bridge  |   |                 |   |   |           |
| funds? Yes No                     |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Budge Office Analyst Signature  |   |                 |   | * |           |
| (or mgmt chain)**                 |   |                 |   | * |           |
|                                   |   |                 |   | D |           |
| (Reviews that supporting          |   |                 |   | a |           |
| documentation is appropriate. In  |   |                 |   | t |           |
| consultation with A/R, reviews    |   |                 |   | e |           |
| sponsor's payment history and     |   |                 |   | : |           |
| verifies that sponsor has not     |   |                 |   | * |           |
| defaulted payment resulting in    |   |                 |   | * |           |
| collection by the US Treasury.)   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **PART IV -- CFO FINAL APPROVAL** |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+
| **Chief Financial Officer         |   |                 |   | * |           |
| Signature (or designate)**        |   |                 |   | * |           |
|                                   |   |                 |   | D |           |
| (Approves release of bridge       |   |                 |   | a |           |
| funding)                          |   |                 |   | t |           |
|                                   |   |                 |   | e |           |
|                                   |   |                 |   | : |           |
|                                   |   |                 |   | * |           |
|                                   |   |                 |   | * |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
|                                   |   |                 |   |   |           |
+-----------------------------------+---+-----------------+---+---+-----------+