Applicare a Grant EFSA

APPLICATION FORM

Call reference: GP/EFSA/BIOCONTAM/2015/02

Call title: In vivo toxicity and genotoxicity of beauvericin and enniatins

Restricted to the list of competent organisations adopted by EFSA Management Board

according to Article 36 of European Parliament and Council Regulation (EC) No 178/2002

Francesca Maranghi - Dipartimento SPVSA francesca.maranghi@iss.it

CHECKLIST THIS CHECKLIST, completed.

APPLICATION FORM, completed and signed

LEGAL ENTITY FORM to be provided for the applicant (and for each partner in case of consortium)

FINANCIAL IDENTIFICATION FORM to be provided for the applicant and in case of a consortium only by the consortium leader

THE DECLARATION OF HONOUR ON EXCLUSION CRITERIA - to be provided for the applicant (nd for each partner in case of consortium

THE DECLARATION OF HONOUR ON SELECTION CRITERIA - to be provided for the applicant and in case of a consortium only by the consortium leader

THE CURRICULUM VITAE of the experts and other staff involved in the project or, if the individual members not yet assigned for the proposed project, at least staff profiles necessary for the project, including for each member a brief description of the expertise and a list of publications relevant to the project.

APPLICABLE ONLY IN CASE OF CONSORTIUM: PARTNERSHIP STATEMENT - signed by applicant and each partner

SIMPLIFIED FINANCIAL STATEMENT This is applicable only if an applicant or in case of consortium a member of consortium is a private body. In addition, if the grant requested from EFSA is </= 60.000 € this document doesn’t have to be submitted at all.

LETTER OF COMMITMENT signed by other contributing public sector body. This is applicable only when the project involves sources of funding other than EFSA grant and contributions from applicant and partner.

ESTIMATED BUDGET OF THE PROJECT

1. INFORMATION ON THE APPLICANT AND IN CASE OF CONSORTIUM OF THE

LEADER AND PARTNER/S

1.1 APPLICANT / (in case of consortium: LEADER)

Official name in full: XX

Short name or acronym: XX

Legal form: XX

Address:

Street: XX

Number: XX

Post code: XX

City: XX

Country: XX

Organisation`s contact details:

Telephone: XX

Fax: XX

E-mail address: XX

Internet site: XX

Legal representative of the applicant (he/she will sign the grant agreement in case of

award): XX

----------------------------------

Administrative contact point for project implementation in the case of grant

award: XX

Position: XX

Telephone: XX

Fax: XX

E-mail address: XX

Contact person responsible for this application (if different from the above):

Position: XX

Telephone: XX

Fax: XX

E-mail address: XX

1. Partners

Partner 1:

Official name in full: XX

Short name or acronym: XX

Legal form: XX

Address:

Street: XX

Number: XX

Post code: XX

City: XX

Country: XX

Organisation`s contact details:

Telephone: XX

Fax: XX

E-mail address: XX

Internet site: XX

Legal representative of the partner (he/she will sign the Mandate (Power of Attorney) to the applicant to sign the grant agreement on behalf of this partner): XX

Repeat this section as many times as there are the partners

TECHNICAL DESCRIPTION OF THE PROJECT

Project title: XX

Project objectives/output: XXX

The extent to which the project is described in detail, achieves the objectives of this call and is likely to deliver output that will be useful, as well as the proposed methodology is well described and of high quality with particular reference to the following:

A detailed description of the experiment approach including:

Justification of the choice of animals (species, strain and group size), enniatin chosen, dose regime, controls;

Tests to be undertaken to examine the toxicity, reproductive and developmental functions and genotoxity endpoints;

Experience of performing the proposed tests;

Proposed approach to statistical analysis;

Approach for reporting the results.

The reply will be evaluated under award criteria 1, max. 60 points. Project description: XXX

Project description clarity including phases, clear timelines for the project tasks completion, detailed milestones per task (e.g. via a project Gantt chart), expected outcomes and deliverables, measures to be put in place to guarantee that the deadlines for providing deliverables are met and a contingency plan in case of deviations from the project. The reply will be evaluated under award criteria 2, max. 10 points.

Task distribution: XXX

Task distribution among consortium partners (if applicable) and individual team members, internal communication (i.e. within the consortium/team) and external communication (i.e. with EFSA).

The reply will be evaluated under award criteria 3, max. 10 points.

Quality assurance: XXX

Description of specific quality assurance measures proposed for the project to guarantee high quality of deliverables.

The reply will be evaluated under award criteria 4, max. 10 points.

Cost effectiveness: XXX

It is optional to write; feel free to extend the box as necessary The award criteria 5 will be evaluated by EFSA comparing the expected project added value as perceived by EFSA from the above information provided by the applicant and the costs of the project. Nevertheless, feel free to add your arguments in this section.

Technical and financial consistency of the proposal: XXX

It is optional to write text; feel free to extend the box as necessary. The award criteria 6 will be evaluated by EFSA assessing how consistent the proposed budget is with the technical description of the project and the EFSA rules on the eligibility of the costs. Nevertheless, feel free to add your arguments in this section.

FINANCIAL INFORMATION ON THE PROJECT

Costs of the proposed project: C1 Total eligible costs: XX euro C2 Total ineligible project costs: XX euro C3 Total project costs = C1+C2: XX euro

Attention: More details on costs, including their justification, must be

provided in the Estimated Budget.

Incomes of the proposed project: Mandatory incomes:

I1 Grant requested from EFSA: XX euro I2 Contributions from the applicant: XX euro I3 Contributions from the partner 1: XX euro (If applicable)

Optional incomes: I4 Financial contributions from public bodies: XX euro, from: XX

- requested and already confirmed: XX euro, from: XX - requested and not yet confirmed: XX euro, from: XX

I5 Income generated by the project: XX euro Attention: C3 MUST EQUAL TO I1+I2+I3+I4+I5 Repeat this line as many times as there are partners. Please remember to attach to this Application a Letter of commitment which is mandatory if a public body financially contributes to the project (body other than EFSA, applicant or partners). This letter is to be signed by the contributing public body and it

serves to confirm its commitment to financially contribute to the project.

The estimated budget must be presented in Euro.

The items presented in the estimated budget shall be justified in the application form. There shall be no doubt left on the neccessity of the cost item.

When establishing the estimated budget follow the Rules on eligibility of costs annexed to the Call for proposals.

The indirect costs incurred in carrying out the project are eligible up to 10% of the total eligible direct costs.

Item Cost category Applicant Partner 1 Partner 2 * Totals****

X Ineligible costs 0,00 € 0,00 € 0,00 € 0,00 €

A.1 Costs of personnel 0,00 € 0,00 € 0,00 € 0,00 €

A.2 Travel costs and subsistance allowances 0,00 € 0,00 € 0,00 € 0,00 €

A.3 Depreciation costs of equipment or other assets 0,00 € 0,00 € 0,00 € 0,00 €

A.4 Consumables & supplies 0,00 € 0,00 € 0,00 € 0,00 €

A.5 Workshops, seminars, conferences 0,00 € 0,00 € 0,00 € 0,00 €

A.6 Subcontracting 0,00 € 0,00 € 5.000,00 € 0,00 €

A.7 Miscellaneous costs 0,00 € 0,00 € 0,00 € 0,00 €

A Eligible direct costs 0,00 € 0,00 € 0,00 € 0,00 €

B Eligible indirect costs 0,00 € 0,00 € 0,00 € 0,00 €

C=A+B Total eligible costs 0,00 € 0,00 € 0,00 € 0,00 €

D=X+A+B Total project costs (eligible + ineligible) 0,00 € 0,00 € 0,00 € 0,00 €

Item Income Applicant Partner 1 Partner 2 * Totals

E.1 Contribution from aplicant and partners 0,00 € 0,00 € 0,00 € 0,00 €

E.2 Grant requested from EFSA** 0,00€ 0,00 €

E.3 Contribution from other public bodies*** 0,00 € 0,00 €

E.4 Any revenue generated by the project 0,00 € 0,00 €

E Total income 0,00 €

* Add more columns if necessary.

** Grant requested from EFSA can not be higher than the maximum possible grant stipulated in the Call for proposals.

*** Add more rows if necessary.

**** Make sure the totals in this column correspond to totals in sheets per category

THE ESTIMATED BUDGET IS IN BALANCE

Estimated budget - Item A.1 - Costs of personnel

No. Name of staff member Organisation/ Employed

by Position/Function

Yearly salary

(a)

Amount per

day

(b)=(a)/190*

Number of days

on project

(c)

Eligible costs

(d)=(b)x(c)

1 Francesca MARANGHI ISS Researcher 54.000,00 € 284,21 € 120 34.105,26 €

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21 To be recruited

Estimated budget - Item A.2 - Travel costs and subsistance allowances

No. Organisation/

Employed by From Destination Justification for mission

Mode of

transport

Number

of

persons

(a)

Subsistence

allowance per

person per day

(b)

Number of

days on

mission

(c)

Estimated cost

per person

per journey,

inluding VAT, if

eligible (d)

Eligible costs

(e)=(a)x(b)x(c)+

(a)x(d)

1 ISS Rome Parma (Italy) Kick-off meeting Train 4 230,00 € 2 150,00 € 2.440,00 €

2 ISS Rome Parma (Italy) Final meeting Train 4 230,00 € 2 150,00 € 2.440,00 €

3 ENEA Rome Parma (Italy) Kick-off meeting Train 2 230,00 € 2 150,00 € 1.220,00 €

4 ENEA Rome Parma (Italy) Final meeting Train 2 230,00 € 2 150,00 € 1.220,00 €

5 ANSES Fougeres Parme (Italy) Kick-off meeting Train + Flight 3 230,00 € 2 1.000,00 € 4.380,00 €

6 ANSES Fougeres Parme (Italy) Final meeting Train + Flight 2 230,00 € 2 1.000,00 € 2.920,00 €

7 ANSES Fougeres Rome (Italy) In vivo experiment Train + Flight 3 230,00 € 5 1.000,00 € 6.450,00 €

8 0 0,00 € 0 0,00 € 0,00 €

9 0 0,00 € 0 0,00 € 0,00 €

10 0 0,00 € 0 0,00 € 0,00 €

11 0 0,00 € 0 0,00 € 0,00 €

12 0 0,00 € 0 0,00 € 0,00 €

13 0 0,00 € 0 0,00 € 0,00 €

14 0 0,00 € 0 0,00 € 0,00 €

15 0 0,00 € 0 0,00 € 0,00 €

Total 16.190,00 €

Estimated budget - Item A.4 - Consumables and supplies

No. Title of item Purpose of consumables and supplies for the project Planned day

of purchase Quantity (a)

Cost per item,

including VAT, if

eligible (b)

Eligible costs

(c) = (a)x(b)

ISS

1 Animals 230 mice 24 g male and female adults

2 Animal diet Specific animal diet

3

Histopathological analysis and laboratory

consumables Dyes, reagents, alcohol, paraffin.

4 Kit for hormones T3, TSH, Estrogen and Testosterone Assays

5 Nervous system biomarkers ROS and GSH Assays

6 comet assay Slides, agarose, solvent, Triton, coverslips,

7 Mycotoxin for sub-chronic study ENNB

8 Mycotoxin for sub-chronic study BEA

9 Blood counts Blood counting facility

10 Serum isotype evaluation ELISA kits (three isotypes), plates

11 FACS analysis Antibodies, plates, tubes, reagents, FACS facility

12 Histopathological analysis Fixation, embedding, sectionning, staining (thymus, spleen, MLN)

13 In vitro cultures Polyclonal stimuli, media and complements, plates, disposable plastics (spleen)

14 Cytokine evaluation (culture supernatants) ELISA kits (two cytokines), plates

15 Tissue homogenates Facility for preparation of tissue homogenates (spleen)

16 NO evaluation Reagents, plates, facility for spectrofotometric reading

ENEA

17 Pig-a assay

MutaFlow kit (LITRON), Lympholyte solution, LS column and Microbeads (Miltenyi), 0.2 um

filters, consumables, countBright abolute counting beads (Invitrogen)

18 MN assay MicroFlow kit (LITRON), fixative, 0.2 um filters, consumables

19 Comet assay Slides, agarose, chemicals, coverslips, mercury lamp for fluorescence microscopy

ANSES

21 Animals Males swiss mice

22 Comet assay Slides, agarose, solvent, Triton, coverslips,

Medicon/Filcon for medimachine For Medimachine to homogenize animal tissues for comet assay

23 Mycotoxin for acute in vivo genotoxicity Beauvericin

24 Mycotoxin for acute in vivo genotoxicity Enniatin

25 Histology tissue processing Fixation, embedding, sectionning, staining

Estimated budget - Item A.6 - Subcontracting of tasks (attention: Core tasks cannot be

subcontracted. Only ancillary and assistance tasks can be subcontracted)

No. Task to be

subcontracted

Proposed

subcontractor

name, if

known

Justification for

using sub-

contracting

For external

consultants contracted

- amount per day,

including VAT, if

eligible

(a)

For external

consultants contracted

- number of days on

project (b)

Other costs

(c)

Eligible costs

(d)=(a)x(b)+(c)

use this table to

record

subcontracting where

the unit prices (man

days) are agreed

1 Histopathological

plate-forme

H2P2 - Biosit /

Biogenouest 5.000,00 € 1 0,00 € 5.000,00 €

2 0,00 € 0 0,00 € 0,00 €

3 0,00 € 0 0,00 € 0,00 €

4 0,00 € 0 0,00 € 0,00 €

5 0,00 € 0 0,00 € 0,00 €

6 0,00 € 0 0,00 € 0,00 €

7 0,00 € 0 0,00 € 0,00 €

subtotal 1 5.000,00 €