HomeMy WebLinkAbout07/16/2019 06F Federal Aviation Administration Grant; Yakima Air Terminal-McAllister Field Capital Improvements ti i..asxntntj kd
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BUSINESS OF THE CITY COUNCIL
YAKIMA, WASHINGTON
AGENDA STATEM ENT
Item No. 6.F.
For Meeting of: July 16, 2019
ITEM TITLE: Resolution authorizing a grant application to the Federal Aviation
Administration (FAA)for Capital Improvement Projects at the
Yakima Air Terminal-McAllister Field
SUBMITTED BY: Robert K. Peterson,Airport Director, 509-575-6149
SUMMARY EXPLANATION:
The Airport Improvement Program (AIP) provides grants to public agencies for planning and
development of public-use airports that are included in the National Plan of Integrated Airport
Systems. The Yakima Air Terminal-McAllister Field is one of many airports that is eligible to receive
federal grants under this program to replace aging infrastructure and equipment.
These grant funds will assist in design, engineering, and acquisition to replace an Aircraft Rescue and
Fire Fighting apparatus. Currently, the airport deploys a 2005 Oshkosh Striker in order to meet
stringent Federal Aviation Administration (FAA) safety standards. Within these standards the FAA
recommends airports replace their fire apparatus every fifteen years to ensure reliability and adequate
response to aircraft accidents. The 2005 Oshkosh Striker continues to witness increased
maintenance attention and lack of available replacement parts as the apparatus continues to age.
Additionally, the grant funds will assist the airport in design and engineering costs for the replacement
of the High Intensity Runway Edge (HIRL) lighting system. This lighting system is required in order to
facilitate aircraft operations during hours of darkness and during times of inclement weather.
Furthermore, the project will crack seal and sealcoat asphalt surfaces which will extend the overall life
expectancy of the airport's primary runway.
It is estimated both grant applications will request approximately One Million Two Hundred Fifty-Eight
Thousand Two Hundred Fifty-One ($1,258,251) dollars, of which 90% of the total costs will be funded
by the FAA and the remaining 10% by the airport's Passenger Facility Charges.
Notes:
• Projects are funded by FAA grants which will not impact the city's 2019-20 general fund
budget.
• Grant application for the fire apparatus, Runway HIRL, and crack seal will be submitted in
August 2019 when equipment bids are received.
2
ITEM BUDGETED: Yes
STRATEGIC PRIORITY: Public Safety
APPROVED FOR
SUBMITTAL: City Manager
STAFF RECOMMENDATION:
Adopt Resolution
BOARD/COMMITTEE RECOMMENDATION:
N/A
ATTACHMENTS:
Description Upload Date Type
E. RESDi ut 617817019 Resolution
D ARFF Grant Application 6/24/2019 Backup Material
D Runway 9127 HIRL Grant Aupheddhun 612di2019 Backup Material
3
RESOLUTION NO. R-2019-
A RESOLUTION authorizing a grant application to the Federal Aviation Administration (FAA)for
Capital Improvement Projects at the Yakima Air Terminal-McAllister Field.
WHEREAS, the City owns and operates the Yakima Air Terminal-McAllister Field in accordance with
applicable Federal, State, and Local regulations; and
WHEREAS,the Federal Aviation Administration makes federal grants available to airports to maintain
and improve airport facilities; and
WHEREAS, the Yakima Air Terminal-McAllister Field has been notified that grant funds may be
available to maintain and/or improve the airport upon submission of completed grant applications and
satisfaction of certain conditions; and
WHEREAS, the Yakima Air Terminal-McAllister Field has recently completed an Airport Master Plan
Update, which details a variety of Federal Aviation Administration required capital improvement projects,
including 1)the design,engineering,and replacement of the airport's primary Aircraft Rescue and Fire Fighting
apparatus to ensure the airport meets current and future safety standards while adequately providing
emergency services on airport property; and 2) to develop engineering plans and specifications necessary to
rehabilitate the airport's primary Runway High Intensity Runway Lighting system and associated electrical
components, together with conducting the necessary pavement maintenance to include crack, fog seal and
update the airfield pavement markings which will extend the useful life of the asphalt surface; and
WHEREAS, the two grant applications will request a total of approximately One Million Two Hundred
Fifty-Eight Thousand Two Hundred Fifty-One ($1,258,251) dollars in grant funding from the Federal Aviation
Administration, of which the Federal Aviation Administration will provide up to 90% of the funds needed for
capital improvements and the airport will match the remaining 10% through its Passenger Facility Charge
program for said projects; and
WHEREAS,the City Council deems it to be in the best interest of the City and its residents to authorize
submission of two grant applications to the Federal Aviation Administration for grant funds needed to
accomplish the identified capital improvements and, if grant funds are awarded, to accept the funds for the
purposes identified in the grant application, Now, Therefore,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF YAKIMA:
1. The City Manager is hereby authorized and directed to submit two completed grant applications
to the Federal Aviation Administration to 1) request grant funds to design, engineer and replace
the airport's primary Aircraft Rescue and Fire Fighting apparatus, and 2) to develop engineering
plans and specifications in order to rehabilitate the airport's primary Runway High Intensity
Runway Light system and conduct necessary pavement maintenance in order to extend the useful
life of the Runway at the Yakima Air Terminal-McAllister Field.
2. If grant funds are awarded,the City Manager is further authorized and directed to accept said grant
funds to be applied to the purposes specified above.
ADOPTED BY THE CITY COUNCIL this 16th day of July, 2019.
ATTEST: Kathy Coffey, Mayor
Sonya Claar Tee, City Clerk
4
OMB Number:4040-0004
Expiration Date:12/31/2019
Application for Federal Assistance SF-424
*1.Type of Submission: *2.Type of Application: 'If Revision,select appropriate letter(s):
Preapplication ®New
®Application ❑Continuation *Other(Specify):
ChangedlCorrected Application [ Revision •
"3.Date Received: 4.Applicant Identifier:
5a.Federal Entity Identifier: 5b.Federal Award Identifier:
:3-53-0089-011-2019
State Use Only:
6.Date Received by State: 7.State Application Identifier:
8.APPLICANT INFORMATION:
'a.Legal Name: City of Yakima
*b.Employer/Taxpayer Identification Number(EIN/TIN): •c.Organizational DUNS:
91-6001293 0792126510000
.... .... ........ .
d.Address:
*Streetl:
129 2nd St.
Street2: •
...........
*City: Yakima
.... ................ ...
County/Parish:
*State: WA: Washington
Province:
*Country: USA: UNITED STATES
...........
*Zip/Postal Code:
.... ................................
e.Organizational Unit:
Department Name: Division Name:
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: *First Name: Robert
Middle Name:
*Last Name: .Peterson
Suffix:
Title: .Airport Uirectcr
Organizational Affiliation:
*Telephone Number: 50 9-52 5-614 9 Fax Number:
*Email: Rob.Pot erson@yekimaeit l:ermirial.com
5
Application for Federal Assistance SF424
*9.Type of Applicant 1:Select Applicant Type:
C: City or Township Government
Type of Applicant 2:Select Applicant Type:
Type of Applicant 3:Select Applicant Type:
*Other(specify):
*10.Name of Federal Agency:
DOT-FAA
11.Catalog of Federal Domestic Assistance Number:
20.106
CFDA Title:
Airport Improvement Program
*12.Funding Opportunity Number:
L .
*Title:
13.Competition Identification Number:
Title:
14.Areas Affected by Project(Cities,Counties,States,etc.):
Add Aftachment i menj- - Ait40.11m'
. . . .
*15.Descriptive Title of Applicant's Project:
.Acquire ARFF Vehicle
Attach supporting documents as specified in agency instructions.
Add Attachmetds :
6
Application for Federal Assistance SF-424
16.Congressional Districts Of:
*a.Applicant wA-004 "b.Program/Project rrwA-004
Attach an additional list of Program/Project Congressional Districts if needed.
::1)Aigi # n t : ( tttLitit ... :Aittli. mi: ..
17.Proposed Project:
*a.Start Date: 0 4/01/2 019 *b.End Date: 12/31/2 0 2 0 ~
18.Estimated Funding($):
*a.Federal 1,000,000.00
*b.Applicant 111,111.00
.. ..... .... ..................................
*c,State
*d Local
*e.Other
*f. Program Income
*g.TOTAL 1,111,11:1.00
*19.Is Application Subject to Review By State Under Executive Order 12372 Process?
C a.This application was made available to the State under the Executive Order 12372 Process for review on ,
® b.Program is subject to E.O.12372 but has not been selected by the State for review.
-1 c.Program is not covered by E.O.12372.
............
*20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.)
LYes ®No
If"Yes",provide explanation and attach
.A#d 4 i l l # :tt A((tj j01i 1I ..V10. €". t( h rt(
21.*By signing this application,I certify(1)to the statements contained in the list of certifications**and(2)that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may
subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001)
Z **I AGREE
**The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
................................
Authorized Representative:
Prefix: *First Name: C:1 if f
Middle Name:
*Last Name: Moore
Suffix:
*Title: City Manager
*Telephone Number: ti -b75-t149 Fax Number:
*Email'. C1iif.Moore@yakimawa.gov
.... .... .... ....
*Signature of Authorized Representative: f *Date Signed: : 1
7
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100.100, Application for Federal Assistance
������U�������� ��� ���'�k���� Projects)
' ' ' '
Paperwork Reduction Act Burden Statement ,
Afedera|agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
] valid OMB Control Number. The OMB Control Number for this information collection ie3120-OS6Q. Public
reporting for this collection of information is estimated to be approximately 28 hours per response,
including the time for reviewing inat,ucdono, searching existing data sources, gathering and maintaining ^
the data needed, completing and reviewing the collection of information. All responses to this collection of
� information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting �
requirements of 2 CFR 200; no assurance of confidentiality is provided. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to the FAA at 800 Independence Ave. SW,Washington, DC 2O501 ���n� Information
. . � �
CoUectionC|eanoncaO��oer ASP'11U '
U ' �
INSTRUCTIONS FOR FORM 5100-100
PART U — Application for Federal Assistance
Part | nf the Application for Federal Assistance consists ofacompleted Standard Form (SF)424. The
remaining parts of Form 5100-100 (Parts 11, 1111 and IV) represent continuation pages that the Sponsor
| must attach to the associated SF-424 form.The signature of the Sponsor's authorized representative on
the SF-424 form represents acceptance of the representations and certifications made within the
corresponding FAA 51OO'1OUform.
PART UU — Project Approval Information
This information is necessary for the Federal Aviation Administration to evaluate this request for Federal
assistance. Responses do not require an explanation unless explicitly requested by the question.
SECTION A. STATUTORY CONDITIONS
Item 1 —Indicate whether the Sponsor maintains an active registration in the Federal System for Award
K8anagement (SA[N). Pursuant to2CFR§25.2UO(b). a Sponsor must maintain an active registration in
the Central Contractor Registration repository(housed within SAM) with current information at the time of
the application and during the active period of the Federal award.
Item 2— Indicate whether the Sponsor can commence the project within the same fiscal year the grant is
made or within 6 months of when the grant is made, whichever is later. Attach explanation for negative
responses. This information is considered when allocating discretionary funds. (49 U.S.C. §47115(d)(2))
8
'
Item 3—Indicate whether the Sponsor can complete the project without unreasonable delays. If
applicable, provide listing of foreseeable events (winter shutdown, land acquisition issues, non-
aeronautical swento. etcjthothavepob»rtia|tuda|ayuomp|sdionofthepnojent. (4QUSC §471OG(a))
Item 4—Indicate whether the environmental review(i.e. environmental assessment, mitigated FONSI,
etc.) identified impacts or effects on the environment that require mitigating measures that lessen the
impact or effect on the environment. If yes, provide a summary listing of mitigating measures.
(49U.3.C. §471D6(c))
Item 6—Indicate whether the project covered by this request io also covered byon approved Passenger
Facility Charge (PFC) application or other Federal assistance program by selecting all applicable check
boxes (40U.S.C. §4O117(d) and 2CFR§ 2OO.403). |f the approved PFC application only addresses the
Sponuur'oA|P matching share, select the appropriate check box.
If the project, or portions thereof, is covered by another Federal assistance program, identify the Federal
assistance program by name and the Catalog of Federal Domestic Assistance (CFDA) number.
Item 6—Indicate whether the Sponsor intends to seek reimbursement of Sponsor indirect costs as
defined by2CFR §300.414 and 2CFR Appendix V||toPart 200. This information request does not
include the indirect costs claimed bya for-profit entity(e.g. consultant).
° The de minimis rate may only be used if the Sponsor has not previously received a negotiated
Indirect Cost Rata (ICR) and does not exceed the limitations prescribed in Appendix VII to Part
200.
� A Sponsor with an existing approved negotiated ICR must identify the ICR value, the name of the
cognizant agency that approved the |CR and the date ofapproval.
Limitations of use:Per policy, Sponsor's may only apply an approved ICR to allowable direct salary
expenses that are reasonable and necessary ho carry-out the project.
SECTION B' C2RTIF|CAT|QN REGARDING LOBBYING
( This section addresses the Sponsor's declaration regarding lobbying activities. The declaration made in
�
the section are under signature of the authorized representative as identified in box 21 of form QF-424. to
which this form ioattached.
Tide3l U.S.C. § 1352 establishes that no appropriated funds may be expended by a recipient of a
Federal grant to pay any person for influencing or attempting to influence an officer or employee of any
agency, Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this covered Federal assistance action. Pursuant to40CFRpart 20. thio
certification attests that the Sponsor has not made, and will not make, any payment prohibited payment
by31 U.S.C. § 1362.
FAA Fonno/oo'1oo 6
y
SECTION C. REPRESENTATIONS AND CERTIFICATION
1. Compatible Land Use (40U.S.C. §471U7(o)(1O))—Identify actions the Sponsor has taken 0u
assure land uses in close proximity to the airport are compatible with normal airport operations.
2. Defaults—Confirm that Sponsor is not in default on any obligation to the United States or any
agency of the United States government.
3. Possible Disabilities—Confirm that Sponsor has no facts or circumstances (i.e. legal, financial
or otherwise)that might adversely affect the Sponsor in completing the project and carrying out
the provisions of the associated Grant Assurances.
4. Consistency with Local P|ane (4Q U.G.C. §47100(a))—Confirm project io consistent with plans
(existing at the time the project is approved) of public agencies authorized by the State in which
the airport io located tnplan.
5. Consideration mf Local Interests (4QU.S.C. §471OG(b))—Confirm the Sponsor has given fair
consideration to the community in and near the project.
G. Consultation with Users (4OU.S.C. §471O5(a))'Confirm the Sponsor has consulted with
airport users that will be affected by the project.
7. Public Hearings (4QU.S.C. §471OG(u))—For projects involving the location ofanairport,
runway or major runway extension, confirm the Sponsor:
a. Provided an opportunity for a public hearing to consider economic, social and
environmental effects of the project.
b. Has voting representation from the communities in which the project is located; or has
advised the communities that they have the right to petition the Secretary about the
proposed project.
B. Air and Water Quality Standardo' Confirm Sponsor will comply with applicable air and water
quality standards.
9' Exclusive Rights (4QU.S.C. §471O7(o)—Identify all instances of exclusive rights toconduct
aeronautical services ot the airport. '
10. Land (49 U.S.C. §4T10G(b))—
a. Identify property interests specific to the development project and/or land acquisition. The
declaration of property interest is to be based upon a title opinion submitted by an
attorney. When identifying the property interest, use the same parcel numbers as used to
identify the property on the associated Exhibit A property map.
� Example: "Sponsor maintains property interest as depicted within the property table on
the Exhibit A property map daU*d__/ / originally @edwith A0rPxojeot##V^
b. Complete this subpart if the Sponsor proposes a project for which they have not yet
obtained appropriate property interests. Note that the work may not commence until
Sponsor obtains acceptable property interests. Identify such property by parcel number
that corresponds to the associated Exhibit A property map.
o. Complete this subpart when acquiring property interests under the grant. Identify such
property by parcel number that corresponds to the associated Exhibit A property map.
FAA Form 5100'100 m
lO
PARTUAU — GBudgetUmfonmmaMon
SECTION A. GENERAL
1. Federal Domestic Assistance Catalog Number' Show the Federal Domestic Assistance Catalog
Number from which the assistance iorequested.
2. Functional or Other Breakout: Indicate"Airport Improvement Prngnam^ Prepare a separate set of
Port ||| forms for other Federal program categories.
SECTION B. CALCULATION OF FEDERAL GRANT
When applying for new grant, use the Total Amount Column only. Use all columns when requesting
revisions of previously awarded amounts.
Line I - Enter amounts needed for administration expenses, which may include such items as: legal fees,
mailing/shipping expenses, audit fees and documented Sponsor employee time that is necessary to
administer the grant.
Line 2' Enter amounts pertaining tu allowable preliminary expenses. These include such expenses ou
independent fee estimate preparation, advertising expenses and permits.
Line 3- Enter amounts directly associated with the acquisition of land, existing structures, and related
right-of-way.
Line 4' Enter fees for architectural engineering basic services.
Line 8' Enter amounts for architectural engineering special services (e.g. mumeyn, tests and borings).
Line 6- Enter fees for inspection, testing and monitoring of construction and related programs.
Line 7- Enter amounts associated with the development of land where the primary purpose of the grant
is land improvement. Site work normally associated with major construction should be excluded from this
category and shown on line 11.
Line 8- Enter the dollar amounts needed to provide relocation advisory assistance, and the net amounts
for replacement(last resort) housing. Do not include vn|onmUun administration expenses on this Line;
include them on Line 1.
Line 9- Enter the estimated amount of relocation payments to be made to displaced persons, business
concerns, and non-profit organizations for moving expenses and replacement housing.
Line 10- Enter the cost of demolition or removal of improvements on developed land. Reduce the costs
on this line by the amount of expected proceeds from the sale of salvage, if so instructed by the Federal
grantor agency. Otherwise, show the proceeds on Line 15.
Line 11 - Enter amounts for the actual construction of, addition to or restoration of a facility. Include in this
( category the amounts of project improvements such as grading, drainage, paving. marking. lighting,
bui|dingo, seed ing/nodding. etc.
Line 12' Enter amounts for equipment. Emymp|oa inc|udeARFF vahideo. SRE equipment. AWOS
equipment. interactive training, NA\AA|Oequipment. etc.)
Line 13' Enter miscellaneous amounts for items not specifically covered by previous categories.
FAA Form mn*/oo w
ll
Line 14' Enter the sum of Lines 1'12i
Line 15- Enter the estimated amount of program income that will be earned during the grant period and
applied to the program. Examples include vehicle trade-in va|ue, sale ofmillings resulting from pnojeoL,
credits passed onfrom contractor, etc.This line may be used bu indicate applied liquidated damages.
Line 16' Enter the difference between Line 14 and Line 15,
Line 17- Enter the aggregate amount for those items,which are a part of the project but not subject to
Federal participation. Refer to Section C. exclusions.
Line 18—Enter the subtotal sum of Lines 18and 17. (This ia the amount to which the matching share
ratio prescribed in program legislation is applied.)
Line 19' Indicate the total amount of the Federal aoeietonuo requested. This value io determined by
multiplying the grant participation rate by the amount indicated in line 18.
Line 20—Indicate the amount nf the Grantee's share (from Section O).
Line 21 —Indicate the amount of other shares (from Section D)
Line 22—Indicate sum of Lines 19. 20 and 21.
SECTION C' EXCLUSIONS
Line 23 a'0 'Identify and list those costs which are part of the project cost but are not subject to Federal
participation because of program legislation or Federal grantor agency instructions. The total amount on
K Line g should agree with the amount shown on Line 17 of Section B.
n
�
n
SECTION CL PROPOSED METHOD OFFINANCING NON-FEDERAL SHARE
|
Line 24 m'Q �ho�U�o source c�d�o grantee's share. |f cash is not immediately available, specify the
i - � '
; auduno completed to data and those actions remaining to make nnah available under Section E'
! Remarks. Indicate also the period of time that will be required after execution of the grant agreement to
! obtain the funds. If there is a non-cash oontribution, explain what this contribution will consist of.
! Uma 34h ' Indicate total of Lines 24 m-g. This amount must equal the amount in Section B. Lina2O.
! Line 25a-Show the amount that will be contributed by a GtuUa or state aganuy, only if the applicant is not
a State nr state agency. If there isu non-cash or other contribution, explain what the contribution will
consist of under Section E' Remarks.
Line 25b' Show the amount that will be contributed from other sources. If there is e nun'ooah
cunthbudnn, explain what the contribution will ounnioL of under Section E' Remarks.
Line 25c-Show the total of Lines 28e and 28b. This amount must be the name as the amount shown in
� Section B. Line 21.
�
Line 2G' Enter the totals of Lines 24h and 25o.
� SECTION E'OTHER REMARKS
Make any remarks pertinent to the project and provide any other information required by these
instructions or the grantor agency. Attach additional sheets, if necessary.
12
PART IV— Program Narrative
Prepare the program narrative statement in accordance with the following instructions for all new grant
programs. Requests for supplemental assistance should be responsive to |b»m 5b only. Requests for
continuation or refunding or other changes of an approved project should be responsive to Item 5n only.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE
Provide a short and concise description of the proposed improvement. Include a narrative on why this
improvement imneeded.
2. RESULTS OR BENEFITS EXPECTED
Identify results and benefits to be derived. For example, include a description of who will occupy the
facility and show how the facility will be used. For land acquisition or development pnojauto, explain how
the project will benefit the public.
3. APPROACH
a. Outline a plan of action pertaining to the scope and detail of how the Sponsor proposes to
accomplish the work.
b. Cite factors, which might accelerate or decelerate the work, and your reason for taking this
approach as opposed to others. Describe any unusual features of the project such as
construction approach, reductions in cost or time or extraordinary social and community
involvements.
o. Provide projections uf project milestone dates. As o minimum, identify target dates for defining
pro/eotnuato (i.o. bidopeningornomp|etionofnegoUaUona). anduipatediomuanneofnotice-to'
proceedendonUuipatedprcjectnnmp|aUondate.
d. Identify monitoring and oversight mechanisms the Sponsor proposes to implement.
e. Lint key individuals and entities such as conou|tont. Sponsor personnel and contractor who will
work on the project. Provide a short description of the nature of their effort or contribution.
4. GEOGRAPHIC LOCATION
Identify location of the project. This will typically be the name of the airport.
S. IF APPLICABLE, PROVIDE THE FOLLOWING INFORMATION:
o. Describe the relationship between this project and other work planned, anticipated or underway
under the Federal Assistance listed under Pert||. Section A. Item 6.
b. Explain the reason for all requests for supplemental assistance and justify the need for additional
funding.
u. If there have been significant changes in the project objectives, location, approach or time delays,
explain and justify. For other requests for changes or amendmento, explain the reason for the
ohango(o). If the eonpe, budgat, or objectives have changed or an extension of time in necessary,
explain the circumstances and justify.
6. SP0NSOR'S REPRESENTATIVE
Identify contact information ofSpononr'erepresentative.
FAA Form 5100'100 m
13
U.S. OMB CONTROL
.~ �
~~ po�om//wmuonuummistrauvn EXPIRATION DATE:ao1/2o1e
Application for Federal Assistance (Development and Equipment Projects)
PART UU — PROJECT APPROVAL INFORMATION
Part III 'SECTION A
.The term ''8ponmu['' reharototh�app|ioantnameprovidedinbox8oftheae000iatodSF'424form.
] Item 1. — -- -- �
� Does Sponsor maintain an active registration in the System for Award Management
`�* �lNo �
( vwmv.SAyN.gm0? ��
Item 2'
� Can Sponsor commence the work identified in the application in the fiuoayear the
'grant is made or within six months after the grant is made, whichever is later? �5�� Yes ��1 No ���� N/A
� Item 3.
Are there any foreseeable events that would delay completion of the project? If yes, �lyao �� Nu El N/A �
provide attachment to this form that lists the events.
^~ �~ ��
Item 4.
Will the pnojeoi(n) covered by this request have impacts or effects onthe
' environment that require mitigating measures? |f yes, attach n summary listing of El Yes 0No El N/A |
� mitigating measures to this application and identify the name and date nfthe �
_environmental docun]e
� Item 5.
Is the project covered by this request included in an approved Passenger Facility
Charge (PFC) application or other Federal assistance program? If yes, please 0Yeo [I No El N/A
identify other funding sources by checking all applicable boxes.
�
� QQ The project in included inan approved PFCapplication. �
�
If included inan approved PFCapplication,
does the application only address/\|P matching share? �B Yes El "
—_ __ �
Fl '
The project is included in another Federal Assistance program. Its CFDA number is below. �
! Item G' �
� �Will the requested Federal assistance include Sponsor indirect costs ao described in �lyen ��No �lN64
�2 CFR Appendix V1| hoPod300. S�tee and Local Government and Indian Thbe �� �� �� �
�Indirect Cost Pnopuea|oY :
�If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate
�the Sponsor proposes toapply: �
FlDeyNhnhnio rate of1U% oo permitted by2CFR§ 2OO.414. �
�. .
� Negotiated Rate equal ho % am approved by (the Cognizant Agency)
� on U]aba (2CFR part 20l appendix t4|).
' Note: Refer bnthe instructions for limitations of application associated with claiming Sponsor indirect 000��
i
FAA Form s1on'1oo(m16)SUPERSEDES PREVIOUS EDITION Page 1m7
14
OMB CONTROL NUMBER:oun-0uun
mma�x���Tomo�Ts�om1oo10
� PARTUU -SGCTIONB
Certification Regarding|Lobbying
The declarations made on this page are under the signature of the authorized representative as identified in box 21 of
| form SF-424, to which this form is attached. The term "Sponsor" refers to the applicant name provided in box 8 of the
associated 8F'424form.
The Authorized Representative certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor, to any person
for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative ogreement, and the exianaion, nonUnuaUon, renowo|, omondment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
�
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
�
/ influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer ,
or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract,
grant. |oan, or cooperative agreement. the Authorized Representative ahoU complete and submit Standard
� Furm-LLL. ''Oino|nnureFormtoReportLobbying.'' ineocnrdmnoexvithitoinotruntiono.
(3)The Authorized Representative shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans,
and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was '
� made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code.Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
FAA Form o1m0-1oopnm SUPERSEDES PREVIOUS EDITION Page umr
15
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE:8/31/2019
PART II—SECTION C
The Sponsor hereby represents and certifies as follows:
1. Compatible Land Use—The Sponsor has taken the following actions to assure compatible usage of land adjacent
to or in the vicinity of the airport:
Airport Overlay Ordinance protects land uses that are incompatible with airports. Yakima Municipal Code Chapter
15.30 and 15.04 discusses zoning and incompatible land uses in relation to the airport.
2. Defaults—The Sponsor is not in default on any obligation to the United States or any agency of the United States
Government relative to the development, operation, or maintenance of any airport, except as stated herewith:
Correct
3. Possible Disabilities—There are no facts or circumstances (including the existence of effective or proposed leases,
use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other
legal proceedings) which in reasonable probability might make it impossible for the Sponsor to carry out and complete
the Project or carry out the provisions of the Grant Assurances, either by limiting its legal or financial ability or
otherwise, except as follows:
N/A
4. Consistency with Local Plans—The project is reasonably consistent with plans existing at the time of submission
of this application) of public agencies that are authorized by the State in which the project is located to plan for the
development of the area surrounding the airport.
Yes
5. Consideration of Local Interest—It has given fair consideration to the interest of communities in or near where the
project may be located.
Yes
6. Consultation with Users—In making a decision to undertake an airport development project under Title 49, United
States Code, it has consulted with airport users that will potentially be affected by the project(§47105(a)(2)).
Yes. Project aligns with the Master Plan and Airport Layout Plan, which underwent public comment.
•
•
7. Public Hearings—In projects involving the location of an airport, an airport runway or a major runway extension, it
•
• has afforded the opportunity for public hearings for the purpose of considering the economic, social, and environmental
•
••
effects of the airport or runway location and its consistency with goals and objectives of such planning as has been
•
••
"carried out by the community and it shall, when requested by the Secretary, submit a copy of the transcript of such
•
• hearings to the Secretary. Further, for such projects, it has on its management board either voting representation from
the communities where the project is located or has advised the communities that they have the right to petition the
Secretary concerning a proposed project.
N/A
8. Air and Water Quality Standards—In projects involving airport location, a major runway extension, or runway
location it will provide for the Governor of the state in which the project is located to certify in writing to the Secretary
that the project will be located, designed, constructed, and operated so as to comply with applicable and air and water
quality standards. In any case where such standards have not been approved and where applicable air and water
quality standards have been promulgated by the Administrator of the Environmental Protection Agency, certification
shall be obtained from such Administrator. Notice of certification or refusal to certify shall be provided within sixty days
after the project application has been received by the Secretary.
N/A
FM Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 3 of 7
16
OMB CONTROL NUMBER: o1uo-0569
OMB EXPIRATION
}
� PART U|—SECTION C (ConUnued)
9. Exclusive Rights—There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport
i owned or controlled by the Sponsor except eofollows:
None
|
� 10. Land —(a)The sponsor holds the following property interest in the following areas of|nnd, which are to be developed
or used as part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse
� interests, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1]
See Exhibit A, approved on March 2015, on file with the FAA Seattle Airport District Office.
�
� The Sponsor further certifiesthagtheabuveiabasadunaUUeexominodonbyaquuJifiodattonneyurdUeuompenyend
' that such attorney or title company has determined that the Sponsor holds the above property interests.
� (b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work
under the Pnoject, the following property interest in the following areas of land on which such construction work is to be
performed, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1]
N/A
�
�
, (c)The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction
work under the Project, the following property interest in the following areas of land which are to be developed or used
as part of or in connection with the Airport as it will be upon completion of the Project, all of which areas are identified on
the aforementioned property map designated aa Exhibit^A' [1] �
N/A
�
y
. .
State the character ofproperty interest in each area and list and identify for each all exceptions, encumbrances, and adverse
interests of every kind and nature, including liens, easements, leases, etc.The separate areas of land need only ba identified here by
the area numbers shown un the property map.
FAA Form mon'1oo(3/16)SUPERSEDES PREVIOUS EDITION Page 4mr
17
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE:om1/2n10
PART KUU — BUDGET INFORMATION — CONSTRUCTION
SECTION /k—GENERAL
1. Federal Domestic Assistance Catalog Number: 20-100
2. Functional or Other Breakout:
SECTION B—CALCULAT ON OF FEDERAL GRANT
Latest Approved
Adjustment Total
Cost Classification Amount +or(fAmount Amount
(Use on|yfor (Uoeon|y0or `
� Required
. revisions) revisions)
1 Administration expense $ 3.000
2. Preliminary expense `
�
3. Land, structures, hght-of-woy
4. Architectural engineering basic fees 52.486
'
5. Other Architectural engineering fees
. 6. Project inspection fees
7. Land development
~
D. Relocation Expenses
9. Relocation payments to Individuals and Businesses
-
10. Demolition and removal
11. Construction and project improvement
,
12. Equipment 1.055.645
13. K4iooeUonooue '
14. Subtotal(Lines 1 through 13) $ 1.111.111
15. Estimated Income (if applicable) �
~
10. Net Project Amount(Line 14 minus 15) 1.111.111
17. Less: Ineligible Exclusions(Section O. line 23gj '
18. Subtotal(Lines 10thmugh 17) $ 1.111.111
19. Federal Share requested nf Line 1H 1.000.000
_
20� Grantee share 111.111
21. Other shares U
- - - -
22 TOTAL 2O&21) ' � 1,111,111
|
� |
18
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE: 8/31/2019
SECTION C—EXCLUSIONS
Amount Ineligible for
23.Classification (Description of non-participating work) Participation
a.
b.
C.
d.
e.
f.
g. Total
SECTION D—PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
24.Grantee Share—Fund Categories Amount
a. Securities
b. Mortgages
c. Appropriations (by Applicant) 111,111
d. Bonds
e.Tax Levies
f. Non-Cash
g. Other(Explain):
h. TOTAL-Grantee share $ 111,111
25.Other Shares Amount
a. State
b. Other
c. TOTAL-Other Shares
26.TOTAL NON-FEDERAL FINANCING
SECTION E—REMARKS
(Attach sheets if additional space is required)
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 6 of 7
19
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE:8/31 02 01 9
PART IV—PROGRAM NARRATIVE
(Suggested Format)
PROJECT: Acquire ARFF Vehicle
AIRPORT: Yakima Air Terminal - McAllister Field
1. Objective:
This grant would provide the funds for the airport to procure a new Index B ARFF Truck along with the auxiliary
equipment required for the truck.
2. Benefits Anticipated:
This vehicle with its associated equipment will replace a 15 year old truck that is the airport's only other ARFF vehicle
in the primary position. This acquisition will provide a more reliable truck, thus increasing safety measures in the
event of an airport emergency.
3. Approach: (See approved Scope of Work in Final Application)
The specifications for the ARFF vehicle will be per AC 150/5220-20. The airport fire-fighting personnel will provide
the specifics of what they desire on the truck, based on the choices found in the advisory circular.
4. Geographic Location:
Yakima Air Terminal-McAllister Field is located in Sections 34 and 35 Township 13 N, Range 18 E, and Sections 2
and 3, Township 12 N, Range 18 E.
5. If Applicable, Provide Additional Information:
6. Sponsor's Representative: (include address&telephone number)
Rob Peterson, 509-575-6149
2406 West Washington Ave, Suite B
Yakima, WA 98903
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 7 of 7
20
U.G. Oopomnom
of Transportation
Federal Aviation
Administration
FAA Form 5100~130, Drug-Free Workplace — Airport Improvement
Program Sponsor Certification
|
Paperwork Reduction Act Burden Statement
� |
Ahedons|agency may not conduct orsponsor, and o person is not required to respond to, nor shall o |
person basubject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0669. Public ,
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing inotructionn, searching existing data ooumeu, gathering and maintaining
the data naeded, completing and reviewing the collection of information. All responses 0nthis collection of
� information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this |
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 8OO Independence Ave. SW, Washington, OC 2O5Q1. Attn: Information Collection
Clearance Of5cer.AGP-11D� �
�
FAA Form 5100-13U
21
U.S.Department mTransportation OMB CONTROL NUMBER: 2120-056e
Federal Aviation Administration EXPIRATION DATE: 8/31/2018
Drug-Free Workplace
Airport Improvement Program Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal'McAllister Field
Project Number: 19
Description ofWork: Acquire ARFFVehicle
Application
49 USC§47105(d) authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (A|P). General requirements on the drug-free workplace within federal grant programs are
described in2CFR part 1D2. Sponsors are required tn certify they will be, nr will continue bo provide, o
drug-free workplace in accordance with the regulation. The AIP project grant agreement contains specific
assurances on the Drug-Free Workplace Act of1Q88.
Certification Statements
Except for certification statements below marked as not applicable (N/A), this list includes major
requirements of the construction project. Selecting"Yes" represents sponsor acknowledgement and
confirmation of the certification statement. The term"will" means Sponsor action taken at appropriate time
based on the certification statement focus area, but no later than the end of the project period of
performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source ofthe requirement is referenced within
parenthesis.
1. A statement has been or will be published prior to commencement of project notifying employees
that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled
substance is prohibited in the sponsor's workplace, and specifying the actions to be taken against
employees for violation of such prohibition (2CFR§ 182.2D5).
[9Yau El No 0N0A _
2. An ongoing drug-free awareness program (2 CIFR§ 182.215) has been or will be established
prior to commencement of project to inform employees about:
a. The dangers of drug abuse in the workplace;
b. The oponsor's policy ofmaintaining a drug-free workplace;
o. Any available drug counea|ing, nahmbi|itation, and employee assistance programs; and
d. The penalties that may be imposed upon employees for drug abuse violations occurring
in the workplace.
0Yae El No El N/A
FAA Form 51oO'18U(1/17)SUPERSEDES PREVIOUS EDITION Page Imu
22
3. Each employee to be engaged in the performance of the work has been or will be given a copy of
the statement required within item 1 above prior to commencement of project(2 CFR§ 182.21O).
@gYes []No []N/A
4. Employees have been or will be notified in the statement required by item 1 above that, auo
condition employment under the grant(2 CFR§ 183.205(c)).the employee will:
a. Abide by the terms of the statement; and
b. Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five calendar days after such conviction,
9Yeo El No El N/A
5. The Fadanm|Aviation Administration (FAA)will be notified in writing within 10 calendar days after
receiving notice under item 4b above from an employee urotherwise receiving actual notice of
such conviction (2 CFR§ 182.226). Employers of convicted employees must provide notioe,
including position title of the employee, bo the FAA(2 CFR§ 182.300).
QQYes [] No [] N/A
G. One of the following actions (2 CFR§ 182.22S(b))will be taken within 3U calendar days of
receiving a notice under item 4b above with respect to any employee who in so convicted:
a. Take appropriate personnel action against such an mmp|oyoe, uptoand including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended; and
�
� b. Require such employee to participate satisfactorily in drug abuse assistance or
n
� rehabilitation programs approved for such purposes byafederal, uhnbe, or local health,
� law enforcement, nr other appropriate agency.
� El Yes [] No []N/A
. �
� 7. A good faith effort will be made, ona continuous basis, to maintain o drug-free workplace through
implementation of items 1 through G above (2 CFR§ 182.200).
9Yem O No [] N/A
Sihy(s) of performance mY work(2 CFR§ 182.23O);
Location 1
Name ofLocation: Yakima Air Terminal McAllister Field
Address: 28UOVV Washington,Ave,Yakima,VVASOSO3
Location D(if applicable)
Name of Location: Yakima City Ho||
Address: 128N2nd Street, Yakima,VVA983O3
Location 3 (if applicable)
Name ofLocation:
Address:
FAA Form O1OO'18U(1/17)SUPERSEDES PREVIOUS EDITION Page zma
oo
Attach documentation clarifying any above item marked with a^No" response.
l SpomsonmCmrtificatun �
| cedify, for the project identified herein, responses to the forgoing items are accurate as marked and �
additional documentation an6cmm�de�e
� / correct . �
Executed onthis day of 2019
Name ofSponsor: City ofYakima �
Name ofSponoora Authorized Official: Cliff Moore �
Title cfSponoo/sAuthorized Official: City Manager �
| �' Signature f Sponao/a Authorized �
i
|
� | declare under penalty of perjury that the foregoing io true and correct. | understand that knowingly and
willfully providing false information bo the federal government imaviolation uf18 U8C§ 1001 (False
Statements) and could subject metofines, imprisonment, or both.
FAA Form 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3
^
�
24
�
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100~129' Construction Project Final Acceptance —
Airport Improvement Program Sponsor Certification
Paperwork Reduction Act Burden Statement
/\federal agency may not conduct orsponsor, and o person in not required to respond to, nor shall o
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0568. Public
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing inatructiono, searching existing data oouooao, gathering and maintaining
the data nmodmd, completing and reviewing the collection of information. All responses tothis collection of !
�
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this !
�
' collection of information, including suggestions for reducing this burden bothe Federal Aviation '
Administration at: OOO Independence Ave. SVV. VVoohington, DC 20591. Attn: Information Collection �
Clearance Officer,ASP-11O� !
FAA Form 51OO'129
on
~�~ u.S.Department mTransportation OMB CONTROL NUMBER: 2120-05O8
Federal Aviation Administration EXPIRATION DATE: 031/2O18
Construction Project Final Acceptance
Airport Improvement Program Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal 'McAllister Field
Project Number: 3-53'8089'044'2019
Description ofWork: Acquire ARFFVehicle
Application .
49 USC§47105(d), authorizes the Secretary to require me certification from the sponsor that it will
comply with the statutory and administrative requirements in carrying out a project under the Airport
Improvement Program. General standards for final acceptance and close out of federally funded
construction projects are in 2 CFR§200.343—Closeout and supplemented by FAA Order 5100.38. The
sponsor must determine that project costs are accurate and proper in accordance with specific
requirements uf the grant agreement and contract documents.
Certification Statements
Except for certification statements below marked not applicable(N/A), this list includes major
requirements of the construction project. Selecting ''Yan^ represents sponsor acknowledgment and
confirmation of the certification statement. The term''vvi||^ means Sponsor action taken at appropriate
time based on the certification statement focus area, but no later than the end of the project period of
performance. This list is not comprehensive and does not relieve the sponsor from fully complying with
all applicable statutory and administrative standards. The source of the requirement io referenced within
parenthesis.
1. The personnel engaged in project administration, engineering eupemiaion, project innpeodon, and
acceptance testing were or will be determined to be qualified and competent to perform the work
(Grant Assurance).
F� ��
Yes �� No N64
��
2. Construction nenondo, including daily|ogo, were or will be kept by the resident
engineer/construction inspector that fully document contractor's performance in complying with:
o. Technical standards (Advisory Circular(\C) 150/5370-12);
b. Contract requirements (2 CFRport 2O8 and FAA Order 518O.38); and
o. Construction safety and phasing plan measures (AC 150/5370-2).
FulYao �— �o ��N/A
3. All acceptance tests specified in the project specifications were or will be performed and
documented. (AC 1SO/S37O-12).
Yes No F-1N/A
FAA Form 51UU'1s9(1/17)SUPERSEDES PREVIOUS EDITION page 1ofa
oo
�
4. Sponsor has taken ur will take appropriate corrective action for any test result outside of
allowable tolerances (AC 160/5370-12).
��Yeo [:] No F-1N/A
5. Pay reduction factors required by the specifications were applied or will be applied in computing
final payments with a summary made available to the FAA(AC 160/5370-10).
F'--lYee F-INu F-1N6A
6. Sponsor has notified, or will promptly notify the Federal Aviation Administration (FAA) of the
following occurrences:
o. Violations of any federal requirements set forth or included by reference in the contract
documents (2 CFR part 200);
b. Disputes or complaints concerning federal labor standards (29 CFR port5); and
c. Violations of or complaints addressing conformance with Equal Employment Opportunity or
Disadvantaged Business Enterprise requirements (41 CFR ChoptarGO and 49 CFR pmrt2R)u
r17Yao F-INo F-] N/A
7. VVaaNy payroll records and statements of compliance were or will be submitted by the prime
contractor and reviewed by the sponsor for conformance with hadano| labor and civil rights
requirements as required by FAA and U.S. Department of Labor(2Q CFR Part 5).
[�lYea nNo F— N/A
8. Payments to the contractor were or will be made in conformance with federal requirements and
contract provisions using sponsor internal controls that include:
m. Retaining source documentation of payments and verifying contractor billing statements
against actual performance (2 CFR§200.302 and FAA Order 5100.38);
b. Prompt payment of subcontractors for satisfactory performance of work (49 CFR§28.29);
c Release of applicable retainage upon satisfactory performance of work(49 CFR§26.29);
and
d. Verification that payments to DBEs represent work the OBE performed by carrying out
commercially useful function (49 CFR§2G.66).
lXJ
Yao F� No �� N/A
Q. A final project inspection was or will be conducted with nopveoenboUvea of the sponsor and the
contractor present that ensure:
a. Physical completion of project work in conformance with approved plans and specifications
(Onder6lO0.38);
b. Necessary actions to correct punch list items identified during final inspection are complete
(Order 51OD.38)- and
C. Preparation of o record of final inspection and distribution to parties to the contract
(Onder51003D);
Yes �-lNo �� N/A
10. The project was or will be accomplished without material deviations, changes, or modifications
from approved plans and specifications, except as approved by the FAA(Order 5100.38).
Yes �I No �1N/A
u� u u
FAA Form 51UO'129(1/17)SUPERSEDES PREVIOUS EDITION page zofs
27
11. The construction of all buildings have complied or will comply with the seismic construction
requirements of4BCFR§41.12D.
[—] a [:] No �� N/A
12. For development projects, sponsor has taken or will take the following close-out actions:
o. Submit to the FAA a final test and quality assurance report summarizing acceptance test
noou|ta. as applicable (Grant Condition);
b. Complete all environmental requirements mo established within the project environmental
determination (Oder 51OD.38); and
n. Prepare and retain as-built plans (Order 5100.38).
ElYoo [] No N/A
13. Sponsor has revised or will navimo their airport layout plan (ALP)that reflects improvements made
and has submitted or will submit an updated ALP to the FAA no later than SO days from the
period ofperformance end date. (4SU8C§471O7 and Order 51OO.38).
E]Ymn El No r—
N/A
Attach documentation clarifying any above item marked with "No" response.
s --�� -- -- - - - -- - - - ~
Spmnmor'sCertificmiiun
| cortify, for the project identified henein, responses to the forgoing items are accurate an marked and
| additional documentation for any item marked"no" is correct and complete.
, Executed onthis day of . 2019 (
Name ofSponsor: City nfYakima
� Name of Sponoo/u Authorized Official: cliff Moore
�
' Title nf8poneora Authorized Official: City Manager
�
Signature ofSponeo/o Authorized Official:
I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and
willfully providing false information to the federal government is a violation of1O UGC Q 1001 (False
Statements) and could subject metofines, imprisonment, or both.
FAA Form 51O0'12n(1/17)SUPERSEDES PREVIOUS EDITION page aof8
28
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100~131, Equipment and Construction Contracts _
Airport Improvement Sponsor Certification
Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
` person be subject to o penalty for failure to comply with o collection of information subject to the
� requirements of the Paperwork Reduction Act unless that collection of information displays a currently
� valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public
reporting for this collection of information is estimated to be approximately 8 hours per response, |
� |
^ including the time for reviewing instmcLionn, searching existing data oounxan, gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of `
information are required under 48U.@.C. Section 471O5to retain o benefit and tomeet the reporting
� requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect ofthis
collection of information, including suggestions for reducing this burden to the Federal Aviation �
Administration at: 800 Independence Ave. SW, Washington, DC 20591,Attn: Information Collection
�
| Clearance Officer, AGP-11D.
FAA Form 5100-131
on
+�m U.S.Department vfTransportation OMB CONTROL NUMBER: 212&-05O8
Federal Aviation Administration EXPIRATION DATE: 8/31/2019
__
Equipment and Construction Contracts
Airport Improvement Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal-McAllister Field
Project Number: 3'53'0088-0+4-2019
Description ofWork: Acquire ARFFVehicle
Application
48USC §47105(d) authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Pnognym (A|P). General procurement standards for equipment and construction contracts within Federal
grant programs are described in3CFR§§200.317-200.336. Labor and Civil Rights Standards
applicable to the AIP are established by the Department of Labor(www.dol.gov)AIP Grant Assurance
CA—General Federal Requirements identifies all applicable Federal Laws, regulations, executive orders,
policies, guidelines and requirements for assistance under the/\|P. Sponsors may use state and local
� procedures provided the procurement conforms to these federal standards.
-
� This certification applies to all equipment and construction projects. Equipment projects may or may not
� employ laborers and mechanics that qualify the project aoo"covered contract" under requirements
� established by the Department of Labor requirements. Sponsor shall provide appropriate responses to
� the certification statements that reflect the character of the project regardless of whether the contract is
! for a construction project ormn equipment project.
Certification Statements
Except for certification statements below marked as not applicable (N64). this list includes major
requirements of the construction project. Selecting^Ymo^ napnaoanto sponsor acknowledgement and
confirmation of the certification statement. The term ^vvi||^ means Sponsor onUmn token at appropriate
time based on the certification statement focus area, but no later than the end of the project period of
performance.This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
1. A written code or standard of conduct is or will be in effect prior to commencement of the project
that governs the performance of the sponsor's officers, employees, or agents in soliciting,
awarding and administering procurement contracts (2 CFR§3OO.318).
§9Yem El No ON/A
FAA Form 51Oo'1a1 (1/17)SUPERSEDES PREVIOUS EDITION Page 1o,4
30
3. For all controcts, qualified and competent personnel are or will be engaged to perform contract
administration, engineering supervision, construction inspection. and testing
(Grant Assurance C.i7).
0 Yes O No O N/A
3. Sponsors that are required to have a Disadvantage Business Enterprise (DBE) program on file
with the FAA have included or will include clauses required by Title V| of the Civil Rights Act and
49 CFR Part 2G for Disadvantaged Business Enterprises in all contracts and subcontracts.
�QYan O No O N64
4. Sponsors required to have a DBE program on file with the FAA have implemented or will
implement monitoring and enforcement measures that:
a. Ensure work committed to Disadvantaged Business Enterprises at contract award is
actually performed by the named DBEs (49 CFR§26.37(b));
b. Include written certification that the sponsor has reviewed contract records and has
monitored work sites for performance by DBE firms (40 CFR§26.37(b)); and
o. Provides for a running tally of payments made to DBE firms and a means for comparing
actual attainments (i.e. payments)to original commitments(4S CFR§26.37(u)).
QQYes El No El N/A
5. Sponsor procurement actions using the competitive sealed bid method (2 CFR§200.320(c)).was
or will be:
a. Publicly advertised, allowing m sufficient response time bo solicit an adequate number of
inUon*obad contractors orvendors;
b. Prepared to include acomplete, adequate and realistic specification that defines the
items or services in sufficient detail to allow prospective bidders to nenpond�
u. Publicly opened atatime and place prescribed in the invitation for bids; and
d. Pnapensd in o manner that vaou|t in efinn fixed price contract award to the lowest
responsive and responsible bidder.
QQYes ONo 0N6A
G. For projects the Sponsor proposes to use the competitive proposal procurement method (2 CFR�
200.330(d)). Sponsor has requested or will request FAA approval prior to proceeding with a
competitive proposal procurement by submitting to the FAA the following:
o. Written justification that supports use of competitive proposal method in lieu of the
preferred sealed bid procurement method;
b. Plan for publicizing and soliciting an adequate number of qualified sources; and
n. Listing of evaluation factors along with relative importance of the factors.
§OYes ONo ON/A
7. For construction and equipment installation projects, the bid solicitation includes or will include the
current federal wage rate schedule(s)for the appropriate type of work classifications(2 CFR Part
2UO. Appendix U).
Q0Yes ONo ON/A
, FAA Form 51DO'1u1 (1/17)SUPERSEDES PREVIOUS EDITION Page oof4
-
31
8. Concurrence was or will be obtained from the Federal Aviation Administration (FAA) prior to
contract award under any of the following circumstances (Order 610O.38D):
a. Only one qualified penuon/finnsubmits m responsive bid;
b. Award iohube made ho other than the lowest responsible bidder; and
u. Life cycle costing is a factor in selecting the lowest responsive bidder.
90Ymo ONn ON/A
S. All construction and equipment installation contracts contain or will contain provisions for:
a. Access to Records (Q2OU.33G) ,
b. Buy American Preferences (Title 4QU.S.C. § 5D1O1)
o. Civil Righto'C9enens| Provisions and TiUeV|Aoounanceo(41 CFR pmrtGO)
d. Federal Fair Labor Standards(2QU.S.C. §201. ataaA)
e. Occupational Safety and Health Act requirements (2OCFFl part 1S2D)
[ Seismic Safety—building construction (4QCFR part 41)
g. State Energy Conservation Requirements-as applicable(2 CIFIR part 200, Appendix 11)
h. U.S. Trade Restriction (49 CFR part 30)
i. Veterans Preference (4QU8C§47112(u))
0 Yes [] No El N/A
10. All construction and equipment installation contracts exceeding $2,000 contain or will contain the
provisions established by:
e. Davis-Bacon and Related Acts (2BCFR part 5)
b. Copeland''AnU'Kickbach''Act(2QCFR parts 3 and 5)
QQYes O No 0N64
11. All construction and equipment installation contracts exceeding $3.000 contain or will contain a
contract provision that discourages distracted driving (E.D. 13513).
QQYes ONo ON/A
12. All contracts exceeding $10,000 contain or will contain the following provisions as applicable:
o. Construction and equipment installation projects-Applicable clauses from
41 CFR Part GO for compliance with Executive Orders 1124G and 11375onEqual
Employment Opportunity;
b. Construction and equipment installation -ContnyctC|auompnohibiUng segregated facilities
in accordance with 41 CFRpnrt 60-1.8;
u. Requirement to maximize use of products containing recovered materials in accordance
with 3CFR§30O.322 and 4DCFRpart 247; and
d. Provisions that address termination for cause and termination for convenience
(2CFFlPart 2OU.Appendix U).
QQYes O No ON/A
} FAA Form 51oo'1u1 (1/17)SUPERSEDES PREVIOUS EDITION Page 3or4
`
32
13. All contracts and subcontracts exceeding *26OOO: Measures are in place cx will bein place(a.g.
checking the System for Award Management)that ensure contracts and subcontracts are not
awarded to individuals or firms ouopended, daboned, or excluded from participating in federally
assisted projects (3 CFF(parts 180ond 1200).
0 Yes O No O N/A
14. Contracts exceeding the simplified acquisition threshold (currently$15O.ODO) include or will include
provisions, an applicable, that address the following:
a. Construction and equipment installation contracts-a bid guarantee ofS%. a performance
bond of1OU96. and opoyment bond of1D096 (% CFR§3D0.325);
b. Construction and equipment installation contracts-requirements of the Contract Work
Hours and Safety Standards Act(4OU8C37O1-37O8. Sections 1O3 and 1O7);
c. Restrictions on Lobbying and Influencing (2 CFR part 2OO. Appendiu||);
d. Conditions specifying adminintrative, contractual and legal remedies for instances where
contractor of vendor violate or breach the terms and conditions of the contract (2 CFR
§200. AppandixU); and
e. All Contracts-Applicable standards and requirements issued under Section 306 of the
Clean Air Act (42UGC74O1-7GT1q). Section 508cf the Clean Water Act(33UGC1251'
1387. and Executive Order 11738.
QQYes [] No [] N64
Attach documentation clarifying any above item marked with ''No" response.
Sponsor'mCarthDcmtion
'
| certify, for the project identified herein, responses to the forgoing items are accurate as marked and
additional documentation for any item marked ^no^ io correct and complete.
. Executed onthis day of . 2019
| Name o[Sponsor: City nfYakima
i
~ Name of8ponsor's Authorized Official: Cliff Moore
: Title ofGponooro Authorized Offioia|� City Manager
^ |
� Signature ofGponoo/oAuthorized OffiniaL�
,
I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and �
�
willfully providing false information to the federal government is a violation of 18 LISC § 1001 (False �
Statements) and could subject metu fines, imprisonment, orboth.
-
FAA Form 51OO'1a1 (1/17)SUPERSEDES PREVIOUS EDITION Page 4nf4
33
U.S. Department
ofTransportation
Federal Aviation
Administration
FAA Form 5100.132, Project PUa0Us and Specifications -- Airport
Improvement Program Sponsor Certification
Paperwork Reduction Act Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a '
| person be subject to a penalty for failure bo comply with a collection of information subject to the (
requirements of the Paperwork Reduction Act unless that collection of information displays a currently '
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0589. Public
U
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing inotructionn, searching existing data eouncea, gathering and maintaining
the data needad, completing and reviewing the collection of information. All responses to this collection of ,
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet thenaporfing
requirements of2 CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
i
' Administration at: 8OO Independence Ave. SW, Washington, OC2OSS1. Attn: Information Collection
� Clearance Officer,A8P-110 �
~�._~�~�~
FAA Form 5100-132
34
U.S.
��oona�mom Transportation OMB CONTROL NUMBER: 2120-0568
~wN� Federal Aviation Administration EXPIRATION DATE: 8/31/2018
Project Plans and Specifications
Airport Improvement Program Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal'McAllister Field
Project Number'. 19
Description ofWork: Acquire ARFFVehicle
Application
49UGC§47105(d) authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (A|P). Labor and civil rights standards applicable to/\|P are established by the Department of
Lebor( mxmv.do|.gov/). AIP Grant Assurance CA—General Federal Requirements identifies applicable
federal |avvn` raQu|mUono, executive orders, po|ioiem, guidelines and requirements for assistance under
AIP. A list of current advisory circulars with specific standards for procurement, design or construction of
[ oirporto, and installation of equipment and taoi|idae is referenced in standard airport sponsor Grant
Assurance 34 contained in the grant agreement.
Certification Statements
Except for certification statements below marked as not applicable (N/A), this list includes major
requirements of the construction project. Selecting^Yaa^ represents sponsor acknowledgement and
confirmation of the certification statement. The term''wi||^ means Sponsor action taken mtappropriate
time based on the certification statement focus area, but no later than the and of the project period of
| performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all
|
' applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
. 1. The plans and specifications were or will be prepared in accordance with applicable federal
standards and requirements, so that no deviation or modification to standards set forth in the
advisory nimu|om, orFAA'000eptad state,tandand, is necessary other than those explicitly
approved by the Federal Aviation Administration (FAA) (14USC §471O6).
QQYem O No El N/A
2. Specifications incorporate or will incorporate a clear and accurate description of the technical
requirement for the material nrproduct that does not contain limiting or proprietary features that
unduly restrict competition (2 CFR§2OO.31Q).
QQYes O No ON/A
FAA Form a1oo'1uo(1/17)SUPERSEDES PREVIOUS EDITION Page 1ofn
on
3. The development that is included or will be included in the plans is depicted on the current airport
layout plan as approved by the FAA(14 UGC§471O7).
QQYem El No 0N6A
4. Development and features that are ineligible or unallowable for AlP funding have been or will be
omitted from the plans and specifications(FAA Order 51OO.38. par. 3-43).
Q9Yeo ONo El N/A
5. The specification does not use or will not use"brand name" or equal to convey requirements
un|aoa sponsor requests and receives approval from the FAA to use brand name (FAA Order
51OO.38. Table U'S).
QQYes El No ON/A
�
� S. The specification does not impose or will not impose geographical prahsnanua in their
� procurement naquinaments(2 CFR§2OO.31S(b)and FAA Order 51UO.38. Table U-5).
�
� QQ Yes [] No [] N/A
! 7 The use ofpreqmdified lists of individuals, firms or products include cv will include sufficient
! qualified sources that ensure open and free competition and that does not preclude potential
! entities from qualifying during the solicitation period (2 CFR§318(d)).
Yea [] No [] N/A
8. Solicitations with bid oltonnabyo include or will include explicit information that aobyb|ioh o basis for
� award cf contract that io free of arbitrary decisions by the sponsor(2CFR§2OO.31S(a)(7)).
NYoo El No 0N64
A. Concurrence was or will be obtained from the FAA if Sponsor incorporates a value engineering
� clause into the contract(FAA Order 510U.38. par. 3-57).
�
QQ Yes O No ON/A
� 10. The plans and specifications incorporate orwill incorporate applicable requirements and
recommendations set forth in the federally approved environmental finding (49 USC §47106(c)),
QQ }'ee O No ON/A
11. The design of all buildings comply or will comply with the seismic design requirements of 49 CFR
§41.12O. (FAA Order 51DO.38d. por. 3-Q2)
El Yes El No E9N/A
12. The project specification include or will include process control and acceptance tests required for
the project byao per the applicable standard:
o. Construction and installation as contained in Advisory Circular(AC) 150/6370-10.
Q0Yaa [] No O N/A
FAA Form a1OO'13u(1/1T)SUPERSEDES PREVIOUS EDITION Page uorx
oo
b Snow Removal Equipment as contained in AC 150/5220-20.
OYes [] No Q§ N/A
u. Aircraft Rescue and Fire Fighting (AJRFF)vehicles eocontained in AC 150/5220-10.
§QYea [] @o [] N/A
13. For construction activities within or near aircraft operational anaea(\OA):
e. The Sponsor has or will prepare a construction safety and phasing plan (C89P) conforming
to Advisory Circular 150/5370-2.
b. Compliance with CSPP safety provisions has been or will be incorporated into the plans
and specifications eea contractor requirement.
c. Sponsor will not initiate work until receiving FAA's concurrence with the CSPP (FAA Order
5100.38. Par. 6-39).
El Yes O No QQN/A
14. The project was or will be physically completed without federal participation in costs due toerrors
and omissions in the plans and specifications that were foreseeable at the time of project design
(40USC§4711O(b)(1)and FAA Order 51OD.38d. par. 3-1OO).
QQ Yes O No O N/A
Attach documentation clarifying any above item marked with "No" response.
Sponear'aCertification
| cartify, for the project identified henain, responses bo the forgoing items are accurate as marked and
additional documentation for any item marked''no'' io correct and complete.
' Executed onthis
day of . 2018
| Name ofSponsor: City ofYakima
' Name cfGponao/a Authorized Official: Cliff Moore
Title ofSponno/nAuthorized Official: City Manager
Signature of8ponoo/o Authorized Official:
_
| declare under penalty of perjury that the foregoing is true and correct. | understand that knowingly and '
willfully providing false information to the federal government is oxio|ation of18 USC§ 1001 (False
Statements)and could subject metofines, imprisonment, or both. �
FAA Form 51OO'13o(1/1T)SUPERSEDES PREVIOUS EDITION Page oo/o
37
U.S. Department
ofTransportation
Federal Aviation
Administration
FAA Form 5100.134, Selection of Consultants _ Airport
Improvement Program Sponsor Certification
Paperwork Reduction Act Statement
Afedena|agency may not conduct orsponsor, and a person is not required to respond to, nor shall a
| person be subject to a penalty for failure to comply with a collection of information subject tothe
|
requirements of the Paperwork Reduction Act unless that collection of information displays acurrently
valid OMB Control Number. The OMB Control Number for this information collection in 3120-0560. Public
reporting for this collection of information is estimated to be approximately 8 hours per response, |
including the time for reviewing inetruntiono, searching existing data sources, gathering and maintaining \
the data neadad, completing and reviewing the collection of information. All responses to this collection of �
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of CFR 2OO� Send comments regarding this burden estimate or any other aspect of this
�
. �
collection of information, including suggestions for reducing this burden to the Federal Aviation
| Administration at: 800 Independence Ave. SVV. VVoahington, DC 20591. Attn: Information Collection
' Clearance Officer, ASP'�1D �
. �
� FAA Form 5100-184
oa
u�.Department vrTransportation OMB CONTROL NUMBER: 2120-O58S
Federal Aviation Administration EXPIRATION DATE: 031mO19
_ Selection of Consultants
Airport Improvement Program Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal-McAllister Field
Project Number 19
Description ofVVork�
� Acquire ARFFVehicle
Application
49 USC §47105(d)authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (AIP). General requirements for selection of consultant services within federal grant programs
are described in2 CFR§§2UU.317-2OU.32G. Sponsors may use other qualifications-based procedures
provided they are equivalent to standards of Title 40 chapter 11 and FAA Advisory Circular 150/5100-14,
Architectural, Engineering, and Planning Consultant Services for Airport Grant Projects.
Certification Statements
Except for certification statements below marked as not applicable(N/A), this list includes major
requirements of the construction project. Selecting"Yes" represents sponsor acknowledgement and
confirmation of the certification statement. The term^wi||^ means Sponsor action taken at appropriate time
based on the certification statement focus area, but no later than the end of the project period of
performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
1. Sponsor acknowledges their responsibility for the settlement of all contractual and administrative
issues arising out of their procurement actions (2 CFR§20O.31O(h)).
Q9Yen []No El N/A
2. Sponsor procurement actions ensure or will ensure full and open competition that does not
unduly limit competition (2CFR§JDO.319).
QQYes El No O N/A
3. Sponsor has excluded or will exclude any entity that develops or drafts specifications,
requirements, or statements of work associated with the development ofonaqueet-for-
qum|ificadonu(RFC\)hnmoompedngfortheodvediaedmen/icao(2CFR§%OU.31Q).
QQYes El No El N/A
FAA Form 51uo'184(u/17)SUPERSEDES PREVIOUS EDITION Page of
on
'
4. The advertisement describes or will describe specific project statements-of-workthat provide
clear detail of required aonviueo without unduly restricting competition (3 CFR§200.319).
Q0Yes ONo El N/A
5. Sponsor has publicized or will publicize aRF{]that:
a. Solicits an adequate number ofqualified oouvoou (2 CFR§200.320(d))� and
b. Identifies all evaluation criteria and relative importance(2 CFR§2OO.32O(d))°
0 Yes El No El N/A
G. Sponsor has based or will base selection onqualifications, expohenoe, and disadvantaged
buoinoeoenharphaapadiuipationvvdhphoencdbeingoae|aciontodor(3CFRQ20O.3J0(d))~
QQYes El No ON/A
7. Sponsor has verified or will verify that agreements exceeding $25,000 are not awarded to
individuals or firms munpended, debarred or otherwise excluded from participating in federally
ouoiotmd projects(2CFR§18O.30O).
QQYas ONo []N/A
8. A/E services covering multiple projects: Sponsor has agreed toorwill agree to:
a. Refrain from initiating work covered by this procurement beyond five years from the date
of selection (AC 15D/51OO-14)- and
b. Retain the right to conduct new procurement actions for projects identified or not
identified in the RFO (AC 15O/5100-14).
ZYea El No El N/A
S. Sponsor has negotiated or will negotiate a fair and reasonable fee with the firm they select as
most qualified for the services identified in the RFC> (2CFR§2OO.3%3).
QQYes El No El N/A
10. The Sponsor's contract identifies or will identify costs associated with ineligible work separately
from costs associated with eligible work (2 CFR§200.303).
ZYeo []No []N64
11. Sponsor has prepared or will prepare a record of negotiations detailing the history of the
procurement action, rationale for contract type and basis for contract fees(% CFR §2OO.318(i)).
QQYeo ONo ON/A
� 13. Sponsor has incorporated or will incorporate mandatory contact provisions in the consultant
contract for A|P-oaoiobad work(4SU.S.C. Chapter 471 and % CFRpart 2UD Appendix||)
'
QQYes []No El N/A
FAA Form 5100'134(2/17)SUPERSEDES PREVIOUS EDITION Page zofx
40
13. For contracts that apply aU payment provision (also known ou hourly rates,
specific rates of compensation, and labor rates), the Sponsor has established or will establish:
o. Justification that there is no other suitable contract method for the services (2 CFR
§208.3180));
b. A ceiling price that the consultant exceeds at their risk (2 CFR§200.3180)); and
u. A high degree of oversight that assures consultant is performing work in an efficient
manner with effective cost controls in place 2CFR§2OO.31D0)).
QQYes []Nm ON/A
14. Sponsor is not using or will not use the prohibited cost-plus-percentage-of-cost(CPPC) contract
method. (2CFR§200.323(d)).
QQYeo ONo ON/A
Attach documentation clarifying any above item marked with"no" response,
Spmmmor`s Certification
I certify, for the project identified herein, responses to the forgoing items are accurate as marked and
additional documentation for any item marked''no^ is correct and complete.
| declare under penalty of perjury that the foregoing io true and correct. | understand that knowingly and
willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False
�
Statements) and could subject mobo fines, imprisonment, orboth. �
'
Executed onthis day of . 2019
Name ofSponsor: City ofYakima �
Name of8ponoor'a Authorized Official: Cliff Moore
�
Tide of8poneoro Authorized Official: City Manager
�
) Signature of8ponaor'o Authorized Official:
~�
I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and |
willfully providing false information to the federal government is a violation of 18 USC § 1OO1 (False
Statements) and could subject metofineu. imprieonment. orboth�
41
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100~135, CeKt^f'cat'on and Disclosure Regarding
Potential Conflicts of Interest -- Airport Improvement Program
Sponsor Certification
Paperwork Reduction Act Statement
A federal agency may not conduct orsponsor, and m person ia not required to respond to, nor shall a
� person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The OMB Control Number for this information collection is 3120-0569. Public
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SW,Washington, DC 20591, Attn: Information Collection
| Clearance Officmr.ASP-11O.
FAA Form 5100-135
42
U.S.Departmen of Transportation OMB CONTROL NUMBER: 2120-056e
Federal Aviation Administration EXPIRATION DATE: &81/2O1S
Certification and Disclosure Regarding Potential Conflicts of Interest
Airport Improvement Program Sponsor Certification
Sponsor: City ufYakima
Airport: Yakima Air Terminal-McAllister Field
Project Number: 3'53'0089-044'2019
Description ofWork: Acquire ARFFVehicle
Application
Title CFF{§200.112 and § 1201.112 address Federal Aviation Administration (FAA) requirements for
conflict of interest. As a condition of eligibility under the Airport Improvement Program (AIP), sponsors
must comply with FAA policy on conflict of interest. Such a conflict would arise when any of the following
have a financial or other interest inthe firm selected for award:
a) The employee, officer oragent,
b) Any member of his immediate family,
o) His or her partner, or
d) An organization which employs, urio about to employ, any of the above.
Selecting"Yes" represents sponsor or sub-recipient acknowledgement and confirmation of the
certification statement. Selecting "No" represents sponsor or sub-recipient disclosure that it cannot fully
comply with the certification statement. If"No" is selected, provide support information explaining the
negative response as an attachment to this form. This includes whether the sponsor has established
standards for financial interest that are not substantial or unsolicited gifts are of nominal value(3CFR�
200.318(c)). The term "will"means Sponsor action taken at appropriate time based on the certification
statement focus area, but no later than the end of the project period of performance.
Certification Statements
� 1. The sponsor or sub-recipient maintains a written standards of conduct governing conflict of
�
' interest and the performance of their employees engaged in the award and administration of
contracts (2 CIFIR§200.318(c)). To the extent permitted by state or local law or regulations, such
standards of conduct provide for penalties, sanctions, or other disciplinary actions for violations of
such standards by the sponsor's and sub-recipient's officers, employees, or agents, or by
contractors or their agents.
ZYeo [] No
FAA Form 51uO'135(z/17)SUPERSEDES PREVIOUS EDITION Page 1vfo
43
2. The sponsor's or sub-recipient's officers, employees or agents have not and will not solicit or
accept gratuities, favors or anything of monetary value from contractors, potential contractors, or
parties bosub-agreements (3 CFR§2OO.31B(c)).
@QYes [] No
3. The sponsor or sub-recipient certifies that is has disclosed and will disclose to the FAA any
known potential conflict mf interest(2CFR§ 120O.112).
nxYao [] No
Attach documentation clarifying any above item marked with"no response.
Sponsmr'aCmrtificaMon
�
I certify, for the project identified herein, responses to the forgoing items are accurate as marked and
have the explanation for any item marked ^no^ in correct and complete.
| �
| Executed onthis day of . 2019 �v
� .
Name ofSponsor: City ufYakima
^ Name ofSponooru Authorized Official: Cliff Moore `
Title mfSponoo/m Authorized Official: City Manager .
. �
^ Signature ufSponoo/a Authorized Official:
'
' |
� I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and
willfully providing false information bo the federal government is avio|aUon of18 USC § 1001 (False
Statements) and could subject mato fines, imprisonment, orboth.
FAA Form 51UU'135(2/17)SUPERSEDES PREVIOUS EDITION Page uuf2
44
REQUIRED STATEMENTS
' AIRPORT IMPROVEMENT PROGRAM PROJECTS
AIRPORT: Yakima Air Terminal-McAllister Field
LOCATION: Yakima,Washington �
AIP PROJECT NO.: 19
STATEMENTS APPLICABLE TO THIS PROJECT Acquire ARFFVehicle
Z a. INTEREST OFNEIGHBORING COMMUNITIES: |n formulating this project, considmraUonhaabman
given to the interest mf communities that are near(Exact name ofairport) Yakima Air Tennina|-MbAllister
Field
b. THE DEVELOPMENT PROPOSED |NTHIS PROJECT will not require the use uf publicly owned land
from o public parh, recreation area, wildlife and haw| nafuQe, or historical site under Federal, 8babe. or
Local jurisdiction.
F� c. FBOCOORDINATION: The airport development proposed in this project has been coordinated with the
Fixed Base Operator(s) utilizing (Exact name of airport) Yakima Air Terminal-McAllister Field, and they
have been informed regarding the scope and nature of this project.
Z d. 7FHE_PROPOSED PROJECT IS CONSISTENT with existing approved plans for the area surrounding the
airport.
The above statements have been duly considered and are applicable to this project. (Provide comment for any
statement not checked).
BY: DATE:
. TITLE: Cib/ K8onager '
- —
! SPONSORING AGENCY: City ofYakima
NOTE: Where opposition is stated/oon airport development project,whether expressly orby proposed revision,the
x
, following specific information concerning the opposition to the project must be furnished.
a. Identification of the Federal, state, or local governmental agency, or the person or persons opposing the project;
b, The nature and basis nfopposition;
C. Gponaor'u plan hnaccommodate or otherwise satisfy the opposition;
� d Whether on opportunity for e hearing was afforded, and ifo hearing was held, an analysis of the facts developed ui the hearing
as they relate to the oocie|, eonnumic, and environmental uopaoLo of the proposed project and its consistency with the Qua|a and
objectives of such urban planning as has been carried out by the community,
e. If the opponents proposed any o|a,moUveo,what these u|uamodveu were and the reason for nonacceptance;
[ 8pnnoor'o plans, if any, to minimize any adverse effects uf the project;
g Benefits tubegained by the proposed development; and
� .
x. Any other pertinent infnnnuUnn which would be of assistance in determining whether to proceed with the project. .
45
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member
of Congress in connection with the awarding of any Federal contract, the making of any Federal
Grant, the making of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan,
or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form LLL "Disclosure of Lobby Activities", in accordance with its
instructions.
3. The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipents shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails
to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
I more than $100,000 for each such failure.
Signed Date
Sponsor's Authorized Representative
Title
46
TITLE VI PRE-AWARD SPONSOR CHECKLIST
AirportiSponsor: City of Yakima
AlP#: 3-53-0089-044-2019
Project Description(s): Ac uire ARFF Vehicle
1) Please describe any of the following IF they apply to your project: Title VI issues raised at public hearing(s)
and the conclusions made; EIS data concerning the race, color, or national origin of the affected
community; steps taken or proposed to guard against unnecessary impact on persons on the basis of
race, color or national origin.
None
2) Please list any airport related Title VI lawsuits or complaints filed in the preceding year against the
sponsor. Include a summary of the findings.
None (If"None", continue:.with questions 3 and 41.
3) Please list any current applications for federal funding (other than FAA) of airport related projects which
exceed the amount for this grant.
r None
4) Please list any airport related Title VI compliance review(s) received by the sponsor in the preceding two
years. Include who conducted the review and any findings of noncompliance.
None
To be completed by the Civil Rights Staff
Review completed and approved:
Signature
Date:
This checklist is only required for projects that involve one of the following: Environmental Assessment or Impact
Statement(EIS); airport or runway relocation; major runway extension; relocation of any structure of person; or impact
to access or preservation of any burial ceremonial or other sacred or historical structures or lands of any indigenous or
ethnic population.
Return to: FAA,Civil Rights, Northwest Mountain Region; 1601 Lind Ave. SW; Renton,WA 98057-3356. FAX: (42.5)
227-1009 Phone(425)227-2009
47
Yakima Air Terminal - Mc,
AIP Development Application Checklist
3-53-0089-044-2019
�j 1. SF424
Ir l2. SF5100-100
[ l 3. CIP Data Sheet
• 4. Standard DOT Title VI Assurances
n5. Certification for Contracts Grants Loans
[ l 6. Airport Sponsor Assurances
Ir l 7. Current FAA Advisory Circulars
• 8. SF5100-134 Sponsor Certification for Selection of Consultants
IY 9. SF5100-132 Sponsor Certification for Plans and Specs
n10. SF5100-131 Sponsor Certification for Equipment/Construction Contracts
ly l 11. SF5100-129 Sponsor Certification for Project Final Acceptance
�j 12. SF5100-130 Sponsor Certification for Drug Free Workplace
13. SF5100-133 Sponsor Certification for Land (Use only for Land Acquisition)
14. SF5100-135 Sponsor Certification for Conflict of Interest
Iv 15. Title VI Pre-Award Sponsor Checklist
48
CONTRACTOR CONTRACTUAL REQUIREMENTS
ATTACHMENT 1
During the performance of this contract, the contractor, for itself, its assignees and successors in interest
(hereinafter referred to as the "contractor") agrees as follows:
1. Compliance with Regulations. The contractor shall comply with the regulations relative to
nondiscrimination in federally assisted programs of the Department of Transportation (hereinafter, "DOT")
Title 49, Code of Federal Regulations, Part 21, as they may be amended from time to time (hereinafter
referred to as the Regulations), which are herein incorporated by reference and made a part of this contract.
2. Nondiscrimination. The contractor, with regard to the work performed by it during the contract, shall
not discriminate on the grounds of race, color, or national origin in the selection and retention of
subcontractors, including procurements of materials and leases of equipment. the contractor shall not
participate either directly of indirectly in the discrimination prohibited by section 21.5 of the Regulations,
including employment practices when the contract covers a program set forth in Appendix B of the
Regulations.
3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment. In all solicitations
either by competitive bidding or negotiation made by the contractor for work to be performed under a
subcontract, including procurements of materials or lease of equipment, each potential subcontractor or
supplier shall be notified by the contractor of the contractor's obligations under this contract and the
Regulations relative to nondiscrimination on the grounds of race, color, or national origin.
4. Information and Reports. The contractor shall provide all information and reports required by the
Regulations or directives issued pursuant thereto and shall permit access to its books, records, accounts,
other sources of information, and its facilities as may be determined by the Sponsor or the Federal Aviation
Administration (FAA) to be pertinent to ascertain compliance with such Regulations, orders, and instructions.
Where any information required of a contract is in the exclusive possession of another who fails or refuses to
furnish this information, the contractor shall so certify to the sponsor or the FAA, as appropriate, and shall
set forth what efforts it has made to obtain the information.
5. Sanctions for Noncompliance. In the event of the contractor's noncompliance with the
nondiscrimination provisions of this contract, the sponsor shall impose such contract sanctions as it or the
FAA may determine to be appropriate, including, but not limited to:
a. Withholding of payments to the contractor under the contract until the contractor complies, and/or
b. Cancellation, termination, or suspension of the contract, in whole or in part.
6. Incorporation of Provisions. The contractor shall include the provisions of paragraphs 1 through 5 in
every subcontract, including procurements of materials and leases of equipment, unless exempt by the
Regulations or directives issued pursuant thereto. The contractor shall take such action with respect to any
subcontract or procurement as the sponsor or the FAA may direct as a means of enforcing such provisions
including sanctions for noncompliance. Provided, however, that in the event a contractor becomes involved
in, or is threatened with, litigation with a subcontractor or supplier as a result of such direction, the contractor
may request the Sponsor to enter into such litigation to protect the interests of the sponsor and, in addition,
the contractor may request the United States to enter into such litigation to protect the interest of the United
States.
49
CLAUSES FOR DEEDS, LICENSES, LEASES, PERMITS OR SIMILAR INSTRUMENTS
ATTACHMENT 2
The following clauses shall be included in deeds, licenses, leases, permits, or similar instruments
entered into by the Sponsor pursuant to the provisions of Assurances 5(a) and 5(b).
1. The (grantee, licensee, permittee, etc., as appropriate) for himself, his heirs, personal
representatives, successors in interest, and assigns, as a part of the consideration
hereof, does hereby covenant and agree (in the case of deeds and leases add "as a
covenant running with the land") that in the event facilities are constructed,
maintained, or otherwise operated on the said property described in this (deed,
license, lease, permit, etc.) for a purpose for which a DOT program or activity is
extended or for another purpose involving the provision of similar services or benefits,
the (grantee, licensee, lessee, permittee, etc.) shall maintain and operate such
facilities and services in compliance with all other requirements imposed pursuant to
49 CFR Part 21, Nondiscrimination in Federally Assisted Programs of the Department
of Transportation, and as said Regulations may be amended.
2. The (grantee, licensee, lessee, permittee, etc., as appropriate) for himself, his heirs,
personal representatives, successors in interest, and assigns, as a part of the
consideration hereof, does hereby covenant and agree (in the case of deeds and
leases add "as a covenant running with the land") that: (1) no person on the grounds
of race, color, or national origin shall be excluded from participation in, denied the
benefits of, or be otherwise subjected to discrimination in the use of said facilities, (2)
that in the construction of any improvements on, over, or under such land and the
furnishing of services thereon, no person on the grounds of race, color, or national
origin shall be excluded from participation in, denied the benefits of, or otherwise be
subjected to discrimination, (3) that the (grantee, licensee, permittee, etc.) shall use
the premises in compliance with all other requirements imposed by or pursuant to 49
CFR Part 21, Nondiscrimination in Federally Assisted Programs of the Department of
Transportation, and as said Regulations may be amended.
no
FAA
Airports
�
Current ��&�� Advisory
Circulars Required
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� Updated: 4/18/2018
View the most current versions of these ACa and any associated changes at:
htto:/Iwmmfaa,g.ov/ai urcesladvisomcincularsond
http:0xmmw.h*m.cioV/reou|abonm Policies/advisory circulars/
70/7460'1L Obstruction Marking and Lighting
Change
1505000-9A Announcement of Availability Report No. DOT7FAA/PP/92'5. Guidelines for �
' the Sound Insulation of Residences Exposed ho Aircraft Operations
150/5K000-17 Critical Aircraft and Regular Use Determination
'
1505820-1 Noise Control and Compatibility Planning for Airports
1505070'613 Airport Master Plans
Changes 1 - 2
150/5070'7 The Airport System Planning Process
Chmnga1
!
1505108-13B Development of State Standards for NonprimeryAirports
150/5200'28F Notices 0o Airmen (NOTAMo)for Airport Operators
1505300-30D Airport Field Condition Assessments and Winter Operations Safety
Change1
150/5200-31C Airport Emergency Plan
Changan 1 -2
/
150/5210'51) Painting, Marking, and Lighting of Vehicles Used onanAirport
1505210-7D Aircraft Rescue and Fire Fighting Communications
�
150/5210-13C Airport Water Rescue Plans and Equipment
FAA Advisory Circulars Required for Use in uFwatemw1e/2o10 Page 1mn
A|p Funded and pFo Approved Projects ARP
51
RIM
150/5210-14B Aircraft Rescue Fire Fighting Equipment, Tools and Clothing
150/5210-15A Aircraft Rescue and Firefighting Station Building Design
150/521048A Systems for Interactive Training of Airport Personnel
/
i 150/5210-10A Driver's Enhanced Vision System (OEVe
!
150/5220-10E Guide Specification for Aircraft Rescue and Fire Fighting (ARFF)Vehicles
150/5220'16E. Automated Weather Observing Systems(AVVOE)for Non-Federal
' ChnnQe1 Applications
i
150/5220'17B Aircraft Rescue and Fire Fighting (ARFF)Training Facilities
150/5220'18A Buildings for Storage and Maintenance of Airport Snow and Ice Control
Equipment and &1ebehe|o
- --- --
' 150/5220'20A Airport Snow and Ice Control Equipment
150/5220-21C Aircraft Boarding Equipment
150/5220-22B Engineered Materials Arresting Systems(EK8AS)for Aircraft Overruns
150/5220'23 Frangible Connections
150/5220-24 Foreign Object Debris Detection Equipment
150/5220-25 Airport Avian Radar Systems
-
150/5220'26. Airport Ground Vehicle Automatic Dependent Surveillance Broadcast(ADS-
Changes 1 '2 B) Out SquitterEquipment
150/5300'13A. Airport Design
Chenge1
150/5300-14C Design nf Aircraft Deicing Facilities
150/5300'16A General Guidance and Specifications for Aeronautical Surveys: Establishment
of Geodetic Control and Submission to the National Geodetic Survey
`
15085800'17C Standards for Using Remote Sensing Technologies in Airport Surveys
Change1
150/5300'18B General Guidance and Specifications for Submission of Aeronautical Surveys
Change 1 tnNGS: Field Data Collection and Geographic Information System (G|S)
' Standards
. .
1505320'5D Airport Drainage Design
FAA Advisory Circulars Required for Use in updated 4/18/2019 Page oofu
mP Funded and PFC Approved Projects ARP
no
150/5320-61' Airport Pavement Design and Evaluation
.
' 150/5320'12C. Measurement, Construction, and Maintenance cf Skid Resistant Airport
Changes 1 - 8 Pavement Surfaces
150/5320-15A Management of Airport Industrial Waste
1505325413 Runway Length Requirements for Airport Design
`
150/ 335-5C Standardized Method of Reporting Airport Pavement Strength - PCN
150/5340-1L Standards for Airport Markings
1505340'5O Segmented Circle Airport Marker System
150/ 34O-18F Standards for Airport Sign Systems
150/5340'28C Maintenance of Airport Visual Aid Facilities
� 150/5340-30J Design and Installation Details for Airport Visual Aids
�
. 150/5345'3G ' Specification for L'821. Panels for the Control of Airport Lighting
150B345'5B Circuit Selector Switch .
' 150/5345'7F Specification for L-824 Underground Electrical Cable for Airport Lighting
' Circuits
150/5345-10H Specification for Constant Current Regulators and Regulator Monitors
�
150/5345'12F Specification for Airport and Heliport Beacons
_
'
150/5345'138 Specification for L,841 Auxiliary Relay Cabinet Assembly for Pilot Control of
Airport Lighting Circuits
150/ 345'%GD FAA Specification For L'823 Plug and Receptacle, Cable Connectors '
150/5345'27E Specification for Wind Cone Assemblies
150/5345-28G Precision Approach Path |ndivabzr(R4P|) Systems
150/5345'39D Specification for L'853. Runway and Taxiway RsdromflediveMarkers
_
150/5345-42H Specification for Airport Light Bases, Transformer Housings, Junction Boxes,
and Accessories
150/5345-43J Specification for Obstruction Lighting Equipment
FAA Advisory Circulars Required for Use in upuated/u1mzo1n Page aofo
A|P Funded and ppC Approved Projects ARP
53
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150/5345-44K Specification for Runway and Taxiway Signs
150/5345-45C Low-Impact Resistant(LIR) Structures
150/5345-46E Specification for Runway and Taxiway Light Fixtures
150/5345-47C Specification for Series to Series Isolation Transformers for Airport Lighting
Systems
150/5345-49D Specification L-854, Radio Control Equipment
150/5345-50B Specification for Portable Runway and Taxiway Lights
150/5345-51B Specification for Discharge-Type Flashing Light Equipment
150/5345-52A Generic Visual Glideslope Indicators (GVGI)
150/5345-53D Airport Lighting Equipment Certification Program
150/5345-54B Specification for L-884, Power and Control Unit for Land and Hold Short
Lighting Systems
150/5345-55A Specification for L-893, Lighted Visual Aid to Indicate Temporary Runway
Closure
150/5345-56B Specification for L-890 Airport Lighting Control and Monitoring System
(ALCMS)
150/5360-12F Airport Signing and Graphics
150/5360-13A Airport Terminal Planning
150/5360-14A Access to Airports By Individuals With Disabilities
150/5370-2G Operational Safety on Airports During Construction
150/5370-10H Standard Specifications for Construction of Airports
150/5370-11 B Use of Nondestructive Testing in the Evaluation of Airport Pavements
150/5370-13A Off-Peak Construction of Airport Pavements Using Hot-Mix Asphalt
150/5370-15B Airside Applications for Artificial Turf
150/5370-16 Rapid Construction of Rigid (Portland Cement Concrete)Airfield Pavements
150/5370-17 Airside Use of Heated Pavement Systems
150/5390-2C Heliport Design
150/5395-1 B Seaplane Bases
FAA Advisory Circulars Required for Use in Updated 4/18/2019 Page 4 of 5
AIP Funded and PFC Approved Projects ARP
54
THE FOLLOWING ADDITIONAL APPLY TO AP PROJECTS ONLY
Updated: 3/22/2019
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1.41111BRUMR5FEMER IKNitafigitSEMEEMBEEINNEERAPREPagainacabitaggkeen1181IMIONINCE
150/5100-14E, Architectural, Engineering, and Planning Consultant Services for Airport Grant
Change 1 Projects
150/5100-17, Land Acquisition and Relocation Assistance for Airport Improvement Program
Changes 1 - 7 Assisted Projects
150/5300-15A Use of Value Engineering for Engineering and Design of Airport Grant Projects
150/5320-17A Airfield Pavement Surface Evaluation and Rating Manuals
150/5370-12B Quality Management for Federally Funded Airport Construction Projects
150/5380-6C Guidelines and Procedures for Maintenance of Airport Pavements
150/5380-7B Airport Pavement Management Program
150/5380-9 Guidelines and Procedures for Measuring Airfield Pavement Roughness
FAA Advisory Circulars Required for Use in Updated 4/18/2019 Page 5 of 5
AIP Funded and PFC Approved Projects ARP
55
STANDARD DOT TITLE VI ASSURANCES
City of Yakima (hereinafter referred to as the Sponsor) hereby agrees that as a condition to
receiving Federal financial assistance from the Department of Transportation (DOT), it will
comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) and all
requirements imposed by 49 CFR Part 21, Nondiscrimination in Federally Assisted Programs
of the Department of Transportation -- Effectuation of Title VI of the Civil Rights Act of 1964
(hereinafter referred to as the "Regulations") to the end that no person in the United States
shall, on the ground of race, color, or national origin, be excluded from participation in, be
denied the benefits of, or be otherwise subjected to discrimination under any program or
activity for which the applicant receives Federal financial assistance and will immediately take
any measures necessary to effectuate this agreement. Without limiting the above general
assurance, the Sponsor agrees concerning this grant that:
1. Each "program" and "facility" (as defined in Section 21.23(a) and 21.23(b)) will be
conducted or operated in compliance with all requirements of the Regulations.
2. It will insert the clauses of Attachment 1 of this assurance in every contract subject to the
Act and the Regulations.
3. Where Federal financial assistance is received to construct a facility, or part of a facility,
the assurance shall extend to the entire facility and facilities operated in connection therewith:
4. Where Federal financial assistance is in the form or for the acquisition of real property or
an interest in real property, the assurance shall extend to rights to space on, over, or under
such property.
5. It will include the appropriate clauses set forth in Attachment 2 of this assurance, as a
covenant running with the land, in any future deeds, leases, permits, licenses, and similar
agreements entered into by the Sponsor with other parties:
(a) for the subsequent transfer of real property acquired or improved with Federal financial
assistance under this project; and
(b) for the construction or use of or access to space on, over, or under real property
acquired or improved with Federal financial assistance under this Project.
6. This assurance obligates the Sponsor for the period during which Federal financial
assistance is extended to the program, except where the Federal financial assistance is to
provide, or is in the form of personal property or real property or interest therein or structures
or improvements thereon, in which case the assurance obligates the Sponsor or any
transferee for the longer of the following periods:
(a) the period during which the property is used for a purpose for which Federal financial
assistance is extended, or for another purpose involving the provision of similar services or
benefits; or
(b) the period during which the Sponsor retains ownership or possession of the property.
7. It will provide for such methods of administration for the program as are found by the Secretary of
transportation of the official to whom he delegates specific authority to
give reasonable guarantees that it, other sponsors,subgrantees,
contractors,subcontractors,transferees, successors in interest, and
other participants of Federal financial assistance under such program
will comply with all requirements imposed or pursuant to the act,the
Regulations, and this assurance.
Page 1 of 2
STANDARD DOT TITLE VI ASSURANCES (Continued) 56
8. It agrees that the United States has a right to seek judicial enforcement with regard to any
matter arising under the Act, the Regulations, and this assurance.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining Federal financial assistance
for this Project and is binding on its contractors, the Sponsor, subcontractors, transferees, successors in
interest and other participants in the Project. The person or persons whose signatures appear below are
authorized to sign this assurance on behalf of the Sponsor.
DATED
City of Yakima
(Sponsor)
(Signature of Authorized Official)
Page 2 of 2
57
FAA
OA cit. ") •
1\,;)•„.t\147,4031c; Airports
ASSU ' ' NCES
Airport Sponsors
A. General.
1. These assurances shall be complied with in the performance of grant agreements for
airport development, airport planning, and noise compatibility program grants for
airport sponsors.
2. These assurances are required to be submitted as part of the project application by
sponsors requesting funds under the provisions of Title 49, U.S.C., subtitle VII, as
amended. As used herein, the term "public agency sponsor" means a public agency
with control of a public-use airport; the term "private sponsor" means a private owner
of a public-use airport; and the term "sponsor" includes both public agency sponsors
and private sponsors.
3. Upon acceptance of this grant offer by the sponsor, these assurances are incorporated
in and become part of this grant agreement.
B. Duration and Applicability.
1. Airport development or Noise Compatibility Program Projects Undertaken by a
Public Agency Sponsor.
The terms, conditions and assurances of this grant agreement shall remain in full
force and effect throughout the useful life of the facilities developed or equipment
acquired for an airport development or noise compatibility program project, or
throughout the useful life of the project items installed within a facility under a noise
compatibility program project, but in any event not to exceed twenty(20) years from
the date of acceptance of a grant offer of Federal funds for the project. However,
there shall be no limit on the duration of the assurances regarding Exclusive Rights
and Airport Revenue so long as the airport is used as an airport. There shall be no
limit on the duration of the terms, conditions, and assurances with respect to real
property acquired with federal funds. Furthermore, the duration of the Civil Rights
assurance shall be specified in the assurances.
2. Airport Development or Noise Compatibility Projects Undertaken by a Private
Sponsor.
The preceding paragraph 1 also applies to a private sponsor except that the useful life
of project items installed within a facility or the useful life of the facilities developed
or equipment acquired under an airport development or noise compatibility program
project shall be no less than ten (10) years from the date of acceptance of Federal aid
for the project.
Airport Sponsor Assurances 3/2014 Page 1 of 20
58
3. Airport Planning Undertaken by a Sponsor.
Unless otherwise specified in this grant agreement, only Assurances 1, 2, 3, 5, 6, 13,
18, 25, 30, 32, 33, and 34 in Section C apply to planning projects. The terms,
conditions, and assurances of this grant agreement shall remain in full force and effect
during the life of the project; there shall be no limit on the duration of the assurances
regarding Airport Revenue so long as the airport is used as an airport.
C. Sponsor Certification.
The sponsor hereby assures and certifies, with respect to this grant that:
1. General Federal Requirements.
It will comply with all applicable Federal laws, regulations, executive orders,
policies, guidelines, and requirements as they relate to the application, acceptance and
use of Federal funds for this project including but not limited to the following:
Federal Legislation
a. Title 49, U.S.C., subtitle VII, as amended.
b. Davis-Bacon Act -40 U.S.C. 276(a), et seq.1
c. Federal Fair Labor Standards Act - 29 U.S.C. 201, et seq.
d. Hatch Act—5 U.S.C. 1501, et seq.2
e. Uniform Relocation Assistance and Real Property Acquisition Policies Act of
1970 Title 42 U.S.C. 4601, et seq.1 2
f. National Historic Preservation Act of 1966 - Section 106 - 16 U.S.C. 470(0.1
g. Archeological and Historic Preservation Act of 1974 - 16 U.S.C. 469 through
469c.1
h. Native Americans Grave Repatriation Act-25 U.S.C. Section 3001, et seq.
i. Clean Air Act, P.L. 90-148, as amended.
j. Coastal Zone Management Act, P.L. 93-205, as amended.
k. Flood Disaster Protection Act of 1973 - Section 102(a) -42 U.S.C. 4012a.1
I. Title 49, U.S.C., Section 303, (formerly known as Section 4(f))
m. Rehabilitation Act of 1973 - 29 U.S.C. 794.
n. Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252)
(prohibits discrimination on the basis of race, color, national origin);
o. Americans with Disabilities Act of 1990, as amended, (42 U.S.C. § 12101 et
seq.), prohibits discrimination on the basis of disability).
p. Age Discrimination Act of 1975 -42 U.S.C. 6101, et seq.
q. American Indian Religious Freedom Act, P.L. 95-341, as amended.
r. Architectural Barriers Act of 1968 -42 U.S.C. 4151, et seq.I
s. Power plant and Industrial Fuel Use Act of 1978 - Section 403- 2 U.S.C. 8373.1
t. Contract Work Hours and Safety Standards Act-40 U.S.C. 327, et seq.1
u. Copeland Anti-kickback Act - 18 U.S.C. 874.1
v. National Environmental Policy Act of 1969 -42 U.S.C. 4321, et seq.1
w. Wild and Scenic Rivers Act, PA,. 90-542, as amended.
•
x. Single Audit Act of 1984 - 31 U.S.C. 7501, et seq.2
•
y. Drug-Free Workplace Act of 1988 -41 U.S.C. 702 through 706.
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z. The Federal Funding Accountability and Transparency Act of 2006, as amended
(Pub. L. 109-282, as amended by section 6202 of Pub. L. 110-252).
Executive Orders
a. Executive Order 11246 - Equal Employment Opportunity'
b. Executive Order 11990 - Protection of Wetlands
c. Executive Order 11998—Flood Plain Management
d. Executive Order 12372 - Intergovernmental Review of Federal Programs
e. Executive Order 12699 - Seismic Safety of Federal and Federally Assisted New
Building Construction'
f. Executive Order 12898 - Environmental Justice
Federal Regulations
a. 2 CFR Part 180 - OMB Guidelines to Agencies on Governmentwide Debarment
and Suspension (Nonprocurement).
b. 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards. [OMB Circular A-87 Cost Principles
Applicable to Grants and Contracts with State and Local Governments, and OMB
Circular A-133 - Audits of States, Local Governments, and Non-Profit
Organizations].4'5'6
c. 2 CFR Part 1200—Nonprocurement Suspension and Debarment
d. 14 CFR Part 13 - Investigative and Enforcement Procedures14 CFR Part 16 -
Rules of Practice For Federally Assisted Airport Enforcement Proceedings.
e. 14 CFR Part 150 - Airport noise compatibility planning.
f. 28 CFR Part 35- Discrimination on the Basis of Disability in State and Local
Government Services.
g. 28 CFR § 50.3 - U.S. Department of Justice Guidelines for Enforcement of Title
VI of the Civil Rights Act of 1964.
h. 29 CFR Part 1 - Procedures for predetermination of wage rates.'
i. 29 CFR Part 3 - Contractors and subcontractors on public building or public work
financed in whole or part by loans or grants from the United States.'
j. 29 CFR Part 5 - Labor standards provisions applicable to contracts covering
federally financed and assisted construction (also labor standards provisions
applicable to non-construction contracts subject to the Contract Work Hours and
Safety Standards Act).'
k. 41 CFR Part 60 - Office of Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor(Federal and federally assisted
contracting requirements).1
I. 49 CFR Part 18 - Uniform administrative requirements for grants and cooperative
agreements to state and local governments.3
m. 49 CFR Part 20 -New restrictions on lobbying.
n. 49 CFR Part 21 —Nondiscrimination in federally-assisted programs of the
Department of Transportation - effectuation of Title VI of the Civil Rights Act of
1964.
o. 49 CFR Part 23 - Participation by Disadvantage Business Enterprise in Airport
Concessions.
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p. 49 CFR Part 24— Uniform Relocation Assistance and Real Property Acquisition
for Federal and Federally Assisted Programs.' 2
q. 49 CFR Part 26—Participation by Disadvantaged Business Enterprises in
Department of Transportation Programs.
r. 49 CFR Part 27—Nondiscrimination on the Basis of Handicap in Programs and
Activities Receiving or Benefiting from Federal Financial Assistance.'
s. 49 CFR Part 28—Enforcement of Nondiscrimination on the Basis of Handicap in
Programs or Activities conducted by the Department of Transportation.
t. 49 CFR Part 30 - Denial of public works contracts to suppliers of goods and
services of countries that deny procurement market access to U.S. contractors.
u. 49 CFR Part 32—Governmentwide Requirements for Drug-Free Workplace
(Financial Assistance)
v. 49 CFR Part 37—Transportation Services for Individuals with Disabilities
(ADA).
w. 49 CFR Part 41 - Seismic safety of Federal and federally assisted or regulated
new building construction.
Specific Assurances
Specific assurances required to be included in grant agreements by any of the above
laws, regulations or circulars are incorporated by reference in this grant agreement.
Footnotes to Assurance C.1.
These laws do not apply to airport planning sponsors.
2 These laws do not apply to private sponsors.
3 49 CFR Part 18 and 2 CFR Part 200 contain requirements for State and Local
Governments receiving Federal assistance. Any requirement levied upon State
and Local Governments by this regulation and circular shall also be applicable
to private sponsors receiving Federal assistance under Title 49, United States
Code.
4
On December 26, 2013 at 78 FR 78590, the Office of Management and Budget
(OMB) issued the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200. 2 CFR Part 200
replaces and combines the former Uniform Administrative Requirements for
Grants (OMB Circular A-102 and Circular A-110 or 2 CFR Part 215 or
Circular) as well as the Cost Principles (Circulars A-21 or 2 CFR part 220;
Circular A-87 or 2 CFR part 225; and A-122, 2 CFR part 230). Additionally it
replaces Circular A-133 guidance on the Single Annual Audit. In accordance
with 2 CFR section 200.110, the standards set forth in Part 200 which affect
administration of Federal awards issued by Federal agencies become effective
once implemented by Federal agencies or when any future amendment to this
Part becomes final. Federal agencies, including the Department of
Transportation, must implement the policies and procedures applicable to
Federal awards by promulgating a regulation to be effective by December 26,
2014 unless different provisions are required by statute or approved by OMB.
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5
Cost principles established in 2 CFR part 200 subpart E must be used as
guidelines for determining the eligibility of specific types of expenses.
6 Audit requirements established in 2 CFR part 200 subpart F are the guidelines
for audits.
2. Responsibility and Authority of the Sponsor.
a. Public Agency Sponsor:
It has legal authority to apply for this grant, and to finance and carry out the proposed
project; that a resolution, motion or similar action has been duly adopted or passed as
an official act of the applicant's governing body authorizing the filing of the
application, including all understandings and assurances contained therein, and
directing and authorizing the person identified as the official representative of the
applicant to act in connection with the application and to provide such additional
information as may be required.
b. Private Sponsor:
It has legal authority to apply for this grant and to finance and carry out the proposed
project and comply with all terms, conditions, and assurances of this grant agreement.
It shall designate an official representative and shall in writing direct and authorize
that person to file this application, including all understandings and assurances
contained therein; to act in connection with this application; and to provide such
additional information as may be required.
3. Sponsor Fund Availability.
It has sufficient funds available for that portion of the project costs which are not to
be paid by the United States. It has sufficient funds available to assure operation and
maintenance of items funded under this grant agreement which it will own or control.
4. Good Title.
a. It, a public agency or the Federal government, holds good title, satisfactory to the
Secretary, to the landing area of the airport or site thereof, or will give assurance
satisfactory to the Secretary that good title will be acquired.
b. For noise compatibility program projects to be carried out on the property of the
sponsor, it holds good title satisfactory to the Secretary to that portion of the
property upon which Federal funds will be expended or will give assurance to the
Secretary that good title will be obtained.
5. Preserving Rights and Powers.
a. It will not take or permit any action which would operate to deprive it of any of
the rights and powers necessary to perform any or all of the terms, conditions, and
assurances in this grant agreement without the written approval of the Secretary,
and will act promptly to acquire, extinguish or modify any outstanding rights or
claims of right of others which would interfere with such performance by the
sponsor. This shall be done in a manner acceptable to the Secretary,
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b. It will not sell, lease, encumber, or otherwise transfer or dispose of any part of its
title or other interests in the property shown on Exhibit A to this application or,
for a noise compatibility program project, that portion of the property upon which
Federal funds have been expended, for the duration of the terms, conditions, and
assurances in this grant agreement without approval by the Secretary. If the
transferee is found by the Secretary to be eligible under Title 49, United States
Code, to assume the obligations of this grant agreement and to have the power,
authority, and financial resources to carry out all such obligations, the sponsor
shall insert in the contract or document transferring or disposing of the sponsor's
interest, and make binding upon the transferee all of the Willis, conditions, and
assurances contained in this grant agreement.
c. For all noise compatibility program projects which are to be carried out by
another unit of local government or are on property owned by a unit of local
government other than the sponsor, it will enter into an agreement with that
government. Except as otherwise specified by the Secretary, that agreement shall
obligate that government to the same terms, conditions, and assurances that would
be applicable to it if it applied directly to the FAA for a grant to undertake the
noise compatibility program project. That agreement and changes thereto must be
satisfactory to the Secretary. It will take steps to enforce this agreement against
the local government if there is substantial non-compliance with the terms of the
agreement.
d. For noise compatibility program projects to be carried out on privately owned
property, it will enter into an agreement with the owner of that property which
includes provisions specified by the Secretary. It will take steps to enforce this
agreement against the property owner whenever there is substantial non-
compliance with the terms of the agreement.
e. If the sponsor is a private sponsor, it will take steps satisfactory to the Secretary to
ensure that the airport will continue to function as a public-use airport in
accordance with these assurances for the duration of these assurances.
f. If an arrangement is made for management and operation of the airport by any
agency or person other than the sponsor or an employee of the sponsor, the
sponsor will reserve sufficient rights and authority to insure that the airport will
be operated and maintained in accordance Title 49, United States Code, the
regulations and the terms, conditions and assurances in this grant agreement and
shall insure that such arrangement also requires compliance therewith.
g. Sponsors of commercial service airports will not permit or enter into any
arrangement that results in permission for the owner or tenant of a property used
as a residence, or zoned for residential use, to taxi an aircraft between that
property and any location on airport. Sponsors of general aviation airports
entering into any arrangement that results in permission for the owner of
residential real property adjacent to or near the airport must comply with the
requirements of Sec. 136 of Public Law 112-95 and the sponsor assurances.
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6. Consistency with Local Plans.
The project is reasonably consistent with plans (existing at the time of submission of
this application) of public agencies that are authorized by the State in which the
project is located to plan for the development of the area surrounding the airport.
7. Consideration of Local Interest.
It has given fair consideration to the interest of communities in or near where the
project may be located.
8. Consultation with Users.
In making a decision to undertake any airport development project under Title 49,
United States Code, it has undertaken reasonable consultations with affected parties
using the airport at which project is proposed.
9. Public Hearings.
In projects involving the location of an airport, an airport runway, or a major runway
extension, it has afforded the opportunity for public hearings for the purpose of
considering the economic, social, and environmental effects of the airport or runway
location and its consistency with goals and objectives of such planning as has been
carried out by the community and it shall, when requested by the Secretary, submit a
copy of the transcript of such hearings to the Secretary. Further, for such projects, it
has on its management board either voting representation from the communities
where the project is located or has advised the communities that they have the right to
petition the Secretary concerning a proposed project.
10. Metropolitan Planning Organization.
In projects involving the location of an airport, an airport runway, or a major runway
extension at a medium or large hub airport, the sponsor has made available to and has
provided upon request to the metropolitan planning organization in the area in which
the airport is located, if any, a copy of the proposed amendment to the airport layout
plan to depict the project and a copy of any airport master plan in which the project is
described or depicted.
11. Pavement Preventive Maintenance.
With respect to a project approved after January 1, 1995, for the replacement or
reconstruction of pavement at the airport, it assures or certifies that it has
implemented an effective airport pavement maintenance-management program and it
assures that it will use such program for the useful life of any pavement constructed,
reconstructed or repaired with Federal financial assistance at the airport. It will
provide such reports on pavement condition and pavement management programs as
the Secretary determines may be useful.
12. Terminal Development Prerequisites.
For projects which include terminal development at a public use airport, as defined in
Title 49, it has, on the date of submittal of the project grant application, all the safety
equipment required for certification of such airport under section 44706 of Title 49,
United States Code, and all the security equipment required by rule or regulation, and
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has provided for access to the passenger enplaning and deplaning area of such airport
to passengers enplaning and deplaning from aircraft other than air carrier aircraft.
13. Accounting System, Audit, and Record Keeping Requirements.
a. It shall keep all project accounts and records which fully disclose the amount and
disposition by the recipient of the proceeds of this grant, the total cost of the
project in connection with which this grant is given or used, and the amount or
nature of that portion of the cost of the project supplied by other sources, and such
other financial records pertinent to the project. The accounts and records shall be
kept in accordance with an accounting system that will facilitate an effective audit
in accordance with the Single Audit Act of 1984.
b. It shall make available to the Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, for the purpose of audit and
examination, any books, documents, papers, and records of the recipient that are
pertinent to this grant. The Secretary may require that an appropriate audit be
conducted by a recipient. In any case in which an independent audit is made of the
accounts of a sponsor relating to the disposition of the proceeds of a grant or
relating to the project in connection with which this grant was given or used, it
shall file a certified copy of such audit with the Comptroller General of the United
States not later than six(6) months following the close of the fiscal year for which
the audit was made.
14. Minimum Wage Rates.
It shall include, in all contracts in excess of$2,000 for work on any projects funded
under this grant agreement which involve labor, provisions establishing minimum
rates of wages, to be predetermined by the Secretary of Labor, in accordance with the
Davis-Bacon Act, as amended (40 U.S.C. 276a-276a-5), which contractors shall pay
to skilled and unskilled labor, and such minimum rates shall be stated in the invitation
for bids and shall be included in proposals or bids for the work.
15. Veteran's Preference.
It shall include in all contracts for work on any project funded under this grant
agreement which involve labor, such provisions as are necessary to insure that, in the
employment of labor(except in executive, administrative, and supervisory positions),
preference shall be given to Vietnam era veterans, Persian Gulf veterans,
Afghanistan-Iraq war veterans, disabled veterans, and small business concerns owned
and controlled by disabled veterans as defined in Section 47112 of Title 49, United
States Code. However, this preference shall apply only where the individuals are
available and qualified to perform the work to which the employment relates.
16. Conformity to Plans and Specifications.
It will execute the project subject to plans, specifications, and schedules approved by
the Secretary. Such plans, specifications, and schedules shall be submitted to the
Secretary prior to commencement of site preparation, construction, or other
performance under this grant agreement, and, upon approval of the Secretary, shall be
incorporated into this grant agreement. Any modification to the approved plans,
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specifications, and schedules shall also be subject to approval of the Secretary, and
incorporated into this grant agreement.
17. Construction Inspection and Approval.
It will provide and maintain competent technical supervision at the construction site
throughout the project to assure that the work conforms to the plans, specifications,
and schedules approved by the Secretary for the project. It shall subject the
construction work on any project contained in an approved project application to
inspection and approval by the Secretary and such work shall be in accordance with
regulations and procedures prescribed by the Secretary. Such regulations and
procedures shall require such cost and progress reporting by the sponsor or sponsors
of such project as the Secretary shall deem necessary.
18. Planning Projects.
In carrying out planning projects:
a. It will execute the project in accordance with the approved program narrative
contained in the project application or with the modifications similarly approved.
b. It will furnish the Secretary with such periodic reports as required pertaining to
the planning project and planning work activities.
c. It will include in all published material prepared in connection with the planning
project a notice that the material was prepared under a grant provided by the
United States.
d. It will make such material available for examination by the public, and agrees that
no material prepared with funds under this project shall be subject to copyright in
the United States or any other country.
e. It will give the Secretary unrestricted authority to publish, disclose, distribute, and
otherwise use any of the material prepared in connection with this grant.
f. It will grant the Secretary the right to disapprove the sponsor's employment of
specific consultants and their subcontractors to do all or any part of this project as
well as the right to disapprove the proposed scope and cost of professional
services.
g. It will grant the Secretary the right to disapprove the use of the sponsor's
employees to do all or any part of the project.
h. It understands and agrees that the Secretary's approval of this project grant or the
Secretary's approval of any planning material developed as part of this grant does
not constitute or imply any assurance or commitment on the part of the Secretary
to approve any pending or future application for a Federal airport grant.
19. Operation and Maintenance.
a. The airport and all facilities which arc necessary to serve the aeronautical users of
the airport, other than facilities owned or controlled by the United States, shall be
operated at all times in a safe and serviceable condition and in accordance with
the minimum standards as may be required or prescribed by applicable Federal,
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state and local agencies for maintenance and operation. It will not cause or permit
any activity or action thereon which would interfere with its use for airport
purposes. It will suitably operate and maintain the airport and all facilities thereon
or connected therewith, with due regard to climatic and flood conditions. Any
proposal to temporarily close the airport for non-aeronautical purposes must first
be approved by the Secretary. In furtherance of this assurance, the sponsor will
have in effect arrangements for-
1) Operating the airport's aeronautical facilities whenever required;
2) Promptly marking and lighting hazards resulting from airport conditions,
including temporary conditions; and
3) Promptly notifying airmen of any condition affecting aeronautical use of the
airport. Nothing contained herein shall be construed to require that the airport
be operated for aeronautical use during temporary periods when snow, flood
or other climatic conditions interfere with such operation and maintenance.
Further, nothing herein shall be construed as requiring the maintenance,
repair, restoration, or replacement of any structure or facility which is
substantially damaged or destroyed due to an act of God or other condition or
circumstance beyond the control of the sponsor.
b. It will suitably operate and maintain noise compatibility program items that it
owns or controls upon which Federal funds have been expended.
20. Hazard Removal and Mitigation.
It will take appropriate action to assure that such terminal airspace as is required to
protect instrument and visual operations to the airport(including established
minimum flight altitudes)will be adequately cleared and protected by removing,
lowering, relocating, marking, or lighting or otherwise mitigating existing airport
hazards and by preventing the establishment or creation of future airport hazards.
21. Compatible Land Use.
It will take appropriate action, to the extent reasonable, including the adoption of
zoning laws, to restrict the use of land adjacent to or in the immediate vicinity of the
airport to activities and purposes compatible with normal airport operations, including
landing and takeoff of aircraft. In addition, if the project is for noise compatibility
program implementation, it will not cause or permit any change in land use, within its
jurisdiction, that will reduce its compatibility, with respect to the airport, of the noise
compatibility program measures upon which Federal funds have been expended.
22. Economic Nondiscrimination.
a. It will make the airport available as an airport for public use on reasonable terms
and without unjust discrimination to all types, kinds and classes of aeronautical
activities, including commercial aeronautical activities offering services to the
public at the airport.
b. In any agreement, contract, lease, or other arrangement under which a right or
privilege at the airport is granted to any person, firm, or corporation to conduct or
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to engage in any aeronautical activity for furnishing services to the public at the
airport, the sponsor will insert and enforce provisions requiring the contractor to-
t) furnish said services on a reasonable, and not unjustly discriminatory, basis to
all users thereof, and
2) charge reasonable, and not unjustly discriminatory, prices for each unit or
service, provided that the contractor may be allowed to make reasonable and
nondiscriminatory discounts, rebates, or other similar types of price reductions
to volume purchasers.
c. Each fixed-based operator at the airport shall be subject to the same rates, fees,
rentals, and other charges as are uniformly applicable to all other fixed-based
operators making the same or similar uses of such airport and utilizing the same
or similar facilities.
d. Each air carrier using such airport shall have the right to service itself or to use
any fixed-based operator that is authorized or permitted by the airport to serve any
air carrier at such airport.
e. Each air carrier using such airport(whether as a tenant, non-tenant, or subtenant
of another air carrier tenant) shall be subject to such nondiscriminatory and
substantially comparable rules, regulations, conditions, rates, fees, rentals, and
other charges with respect to facilities directly and substantially related to
providing air transportation as are applicable to all such air carriers which make
similar use of such airport and utilize similar facilities, subject to reasonable
classifications such as tenants or non-tenants and signatory carriers and non-
signatory carriers. Classification or status as tenant or signatory shall not be
unreasonably withheld by any airport provided an air carrier assumes obligations
substantially similar to those already imposed on air carriers in such classification
or status.
f. It will not exercise or grant any right or privilege which operates to prevent any
person, firm, or corporation operating aircraft on the airport from performing any
services on its own aircraft with its own employees [including, but not limited to
maintenance, repair, and fueling] that it may choose to perform.
g. In the event the sponsor itself exercises any of the rights and privileges referred to
in this assurance, the services involved will be provided on the same conditions as
would apply to the furnishing of such services by commercial aeronautical service
providers authorized by the sponsor under these provisions.
h. The sponsor may establish such reasonable, and not unjustly discriminatory,
conditions to be met by all users of the airport as may be necessary for the safe
and efficient operation of the airport.
i. The sponsor may prohibit or limit any given type, kind or class of aeronautical
use of the airport if such action is necessary for the safe operation of the airport or
necessary to serve the civil aviation needs of the public.
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23. Exclusive Rights.
It will permit no exclusive right for the use of the airport by any person providing, or
intending to provide, aeronautical services to the public. For purposes of this
paragraph, the providing of the services at an airport by a single fixed based operator
shall not be construed as an exclusive right if both of the following apply:
a. It would be unreasonably costly, burdensome, or impractical for more than one
fixed based operator to provide such services, and
b. If allowing more than one fixed-based operator to provide such services would
require the reduction of space leased pursuant to an existing agreement between
such single fixed-based operator and such airport, It further agrees that it will not,
either directly or indirectly, grant or permit any person, firm, or corporation, the
exclusive right at the airport to conduct any aeronautical activities, including, but
not limited to charter flights, pilot training, aircraft rental and sightseeing, aerial
photography, crop dusting, aerial advertising and surveying, air carrier operations,
aircraft sales and services, sale of aviation petroleum products whether or not
conducted in conjunction with other aeronautical activity, repair and maintenance
of aircraft, sale of aircraft parts, and any other activities which because of their
direct relationship to the operation of aircraft can be regarded as an aeronautical
activity, and that it will terminate any exclusive right to conduct an aeronautical
activity now existing at such an airport before the grant of any assistance under
Title 49, United States Code.
24. Fee and Rental Structure.
It will maintain a fee and rental structure for the facilities and services at the airport
which will make the airport as self-sustaining as possible under the circumstances
existing at the particular airport, taking into account such factors as the volume of
traffic and economy of collection.No part of the Federal share of an airport
development, airport planning or noise compatibility project for which a grant is
made under Title 49, United States Code, the Airport and Airway Improvement Act
of 1982,the Federal Airport Act or the Airport and Airway Development Act of 1970
shall be included in the rate basis in establishing fees, rates, and charges for users of
that airport.
25. Airport Revenues.
a. All revenues generated by the airport and any local taxes on aviation fuel
established after December 30, 1987, will be expended by it for the capital or
operating costs of the airport; the local airport system; or other local facilities
which are owned or operated by the owner or operator of the airport and which
are directly and substantially related to the actual air transportation of passengers
or property; or for noise mitigation purposes on or off the airport. The following
exceptions apply to this paragraph:
1) If covenants or assurances in debt obligations issued before September 3,
1982, by the owner or operator of the airport, or provisions enacted before
September 3, 1982, in governing statutes controlling the owner or operator's
financing, provide for the use of the revenues from any of the airport owner or
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operator's facilities, including the airport, to support not only the airport but
also the airport owner or operator's general debt obligations or other facilities,
then this limitation on the use of all revenues generated by the airport(and, in
the case of a public airport, local taxes on aviation fuel) shall not apply.
2) If the Secretary approves the sale of a privately owned airport to a public
sponsor and provides funding for any portion of the public sponsor's
acquisition of land, this limitation on the use of all revenues generated by the
sale shall not apply to certain proceeds from the sale. This is conditioned on
repayment to the Secretary by the private owner of an amount equal to the
remaining unamortized portion (amortized over a 20-year period)of any
airport improvement grant made to the private owner for any purpose other
than land acquisition on or after October 1, 1996, plus an amount equal to the
federal share of the current fair market value of any land acquired with an
airport improvement grant made to that airport on or after October 1, 1996.
3) Certain revenue derived from or generated by mineral extraction, production,
lease, or other means at a general aviation airport(as defined at Section 47102
of title 49 United States Code), if the FAA determines the airport sponsor
meets the requirements set forth in Sec. 813 of Public Law 112-95.
b. As part of the annual audit required under the Single Audit Act of 1984, the
sponsor will direct that the audit will review, and the resulting audit report will
provide an opinion concerning, the use of airport revenue and taxes in paragraph
(a), and indicating whether funds paid or transferred to the owner or operator are
paid or transferred in a manner consistent with Title 49, United States Code and
any other applicable provision of law, including any regulation promulgated by
the Secretary or Administrator.
c. Any civil penalties or other sanctions will be imposed for violation of this
assurance in accordance with the provisions of Section 47107 of Title 49, United
States Code.
26. Reports and Inspections.
It will:
a. submit to the Secretary such annual or special financial and operations reports as
the Secretary may reasonably request and make such reports available to the
public; make available to the public at reasonable times and places a report of the
airport budget in a format prescribed by the Secretary;
b. for airport development projects, make the airport and all airport records and
documents affecting the airport, including deeds, leases, operation and use
agreements, regulations and other instruments, available for inspection by any
duly authorized agent of the Secretary upon reasonable request;
c. for noise compatibility program projects, make records and documents relating to
the project and continued compliance with the terms, conditions, and assurances
of this grant agreement including deeds, leases, agreements, regulations, and other
instruments, available for inspection by any duly authorized agent of the Secretary
upon reasonable request; and
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d. in a format and time prescribed by the Secretary, provide to the Secretary and
make available to the public following each of its fiscal years, an annual report
listing in detail:
1) all amounts paid by the airport to any other unit of government and the
purposes for which each such payment was made; and
2) all services and property provided by the airport to other units of government
and the amount of compensation received for provision of each such service
and property.
27. Use by Government Aircraft.
It will make available all of the facilities of the airport developed with Federal
financial assistance and all those usable for landing and takeoff of aircraft to the
United States for use by Government aircraft in common with other aircraft at all
times without charge, except, if the use by Government aircraft is substantial, charge
may be made for a reasonable share, proportional to such use, for the cost of
operating and maintaining the facilities used. Unless otherwise determined by the
Secretary, or otherwise agreed to by the sponsor and the using agency, substantial use
of an airport by Government aircraft will be considered to exist when operations of
such aircraft are in excess of those which, in the opinion of the Secretary, would
unduly interfere with use of the landing areas by other authorized aircraft, or during
any calendar month that—
a. Five (5)or more Government aircraft are regularly based at the airport or on land
adjacent thereto; or
b. The total number of movements (counting each landing as a movement) of
Government aircraft is 300 or more, or the gross accumulative weight of
Government aircraft using the airport(the total movement of Government aircraft
multiplied by gross weights of such aircraft) is in excess of five million pounds.
28. Land for Federal Facilities.
It will furnish without cost to the Federal Government for use in connection with any
air traffic control or air navigation activities, or weather-reporting and communication
activities related to air traffic control, any areas of land or water, or estate therein, or
rights in buildings of the sponsor as the Secretary considers necessary or desirable for
construction, operation, and maintenance at Federal expense of space or facilities for
such purposes. Such areas or any portion thereof will be made available as provided
herein within four months after receipt of a written request from the Secretary.
29. Airport Layout Plan.
a. It will keep up to date at all times an airport layout plan of the airport showing
I) boundaries of the airport and all proposed additions thereto, together with the
boundaries of all offsite areas owned or controlled by the sponsor for airport
purposes and proposed additions thereto;
2) the location and nature of all existing and proposed airport facilities and
structures(such as runways, taxiways, aprons, terminal buildings, hangars and
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roads), including all proposed extensions and reductions of existing airport
facilities;
3) the location of all existing and proposed nonaviation areas and of all existing
improvements thereon; and
4) all proposed and existing access points used to taxi aircraft across the airport's
property boundary. Such airport layout plans and each amendment, revision,
or modification thereof, shall be subject to the approval of the Secretary which
approval shall be evidenced by the signature of a duly authorized
representative of the Secretary on the face of the airport layout plan. The
sponsor will not make or permit any changes or alterations in the airport or
any of its facilities which are not in conformity with the airport layout plan as
approved by the Secretary and which might, in the opinion of the Secretary,
adversely affect the safety, utility or efficiency of the airport.
b. If a change or alteration in the airport or the facilities is made which the Secretary
determines adversely affects the safety, utility, or efficiency of any federally
owned, leased, or funded property on or off the airport and which is not in
conformity with the airport layout plan as approved by the Secretary, the owner or
operator will, if requested, by the Secretary (1) eliminate such adverse effect in a
manner approved by the Secretary; or(2) bear all costs of relocating such
property(or replacement thereof) to a site acceptable to the Secretary and all costs
of restoring such property (or replacement thereof) to the level of safety, utility,
efficiency, and cost of operation existing before the unapproved change in the
airport or its facilities except in the case of a relocation or replacement of an
existing airport facility due to a change in the Secretary's design standards beyond
the control of the airport sponsor.
30. Civil Rights.
It will promptly take any measures necessary to ensure that no person in the United
States shall, on the grounds of race, creed, color, national origin, sex, age, or
disability be excluded from participation in, be denied the benefits of, or be otherwise
subjected to discrimination in any activity conducted with, or benefiting from, funds
received from this grant.
a. Using the definitions of activity, facility and program as found and defined in §§
21.23 (b) and 21.23 (e)of 49 CFR § 21, the sponsor will facilitate all programs,
operate all facilities, or conduct all programs in compliance with all non-
discrimination requirements imposed by, or pursuant to these assurances.
b. Applicability
1) Programs and Activities. If the sponsor has received a grant (or other federal
assistance) for any of the sponsor's program or activities, these requirements
extend to all of the sponsor's programs and activities.
2) Facilities. Where it receives a grant or other federal financial assistance to
construct, expand, renovate, remodel, alter or acquire a facility, or part of a
facility, the assurance extends to the entire facility and facilities operated in
connection therewith.
Airport Sponsor Assurances 3/2014 Page 15 of 20
72
3) Real Property. Where the sponsor receives a grant or other Federal financial
assistance in the form of, or for the acquisition of real property or an interest
in real property, the assurance will extend to rights to space on, over, or under
such property.
c. Duration.
The sponsor agrees that it is obligated to this assurance for the period during
which Federal financial assistance is extended to the program, except where the
Federal financial assistance is to provide, or is in the form of, personal property,
or real property, or interest therein, or structures or improvements thereon, in
which case the assurance obligates the sponsor, or any transferee for the longer of
the following periods:
1) So long as the airport is used as an airport, or for another purpose involving
the provision of similar services or benefits; or
2) So long as the sponsor retains ownership or possession of the property.
d. Required Solicitation Language. It will include the following notification in all
solicitations for bids, Requests For Proposals for work, or material under this
grant agreement and in all proposals for agreements, including airport
concessions, regardless of funding source:
"The L C;k3cf Yktz"., , in accordance with the provisions of Title VI of the
Civil Rights Act of 1964 (78 Stat. 252, 42 U.S.C. §§ 2000d to 2000d-4) and the
Regulations, hereby notifies all bidders that it will affirmatively ensure that any
contract entered into pursuant to this advertisement, disadvantaged business
enterprises and airport concession disadvantaged business enterprises will be
afforded full and fair opportunity to submit bids in response to this invitation and
will not be discriminated against on the grounds of race, color, or national origin
in consideration for an award."
e. Required Contract Provisions.
1) It will insert the non-discrimination contract clauses requiring compliance
with the acts and regulations relative to non-discrimination in Federally-
assisted programs of the DOT, and incorporating the acts and regulations into
the contracts by reference in every contract or agreement subject to the non-
discrimination in Federally-assisted programs of the DOT acts and
regulations.
2) It will include a list of the pertinent non-discrimination authorities in every
contract that is subject to the non-discrimination acts and regulations.
3) It will insert non-discrimination contract clauses as a covenant running with
the land, in any deed from the United States effecting or recording a transfer
of real property, structures, use, or improvements thereon or interest therein to
a sponsor.
4) It will insert non-discrimination contract clauses prohibiting discrimination on
the basis of race, color, national origin, creed, sex, age, or handicap as a
Airport Sponsor Assurances 3/2014 Page 16 of 20
73
covenant running with the land, in any future deeds, leases, license, permits,
or similar instruments entered into by the sponsor with other parties:
a) For the subsequent transfer of real property acquired or improved under
the applicable activity, project, or program; and
b) For the construction or use of, or access to, space on, over, or under real
property acquired or improved under the applicable activity, project, or
program.
f. It will provide for such methods of administration for the program as are found by
the Secretary to give reasonable guarantee that it, other recipients, sub-recipients,
sub-grantees, contractors, subcontractors, consultants, transferees, successors in
interest, and other participants of Federal financial assistance under such program
will comply with all requirements imposed or pursuant to the acts, the regulations,
and this assurance.
g. It agrees that the United States has a right to seek judicial enforcement with
regard to any matter arising under the acts, the regulations, and this assurance.
31. Disposal of Land.
a. For land purchased under a grant for airport noise compatibility purposes,
including land serving as a noise buffer, it will dispose of the land, when the land
is no longer needed for such purposes, at fair market value, at the earliest
practicable time. That portion of the proceeds of such disposition which is
proportionate to the United States' share of acquisition of such land will be, at the
discretion of the Secretary, (1) reinvested in another project at the airport, or(2)
transferred to another eligible airport as prescribed by the Secretary. The
Secretary shall give preference to the following, in descending order, (1)
reinvestment in an approved noise compatibility project, (2) reinvestment in an
approved project that is eligible for grant funding under Section 47117(e) of title
49 United States Code, (3) reinvestment in an approved airport development
project that is eligible for grant funding under Sections 47114, 47115, or 47117 of
title 49 United States Code, (4)transferred to an eligible sponsor of another public
airport to be reinvested in an approved noise compatibility project at that airport,
and (5) paid to the Secretary for deposit in the Airport and Airway Trust Fund. If
land acquired under a grant for noise compatibility purposes is leased at fair
market value and consistent with noise buffering purposes, the lease will not be
considered a disposal of the land. Revenues derived from such a lease may be
used for an approved airport development project that would otherwise be eligible
for grant funding or any permitted use of airport revenue.
b. For land purchased under a grant for airport development purposes (other than
noise compatibility), it will, when the land is no longer needed for airport
purposes, dispose of such land at fair market value or make available to the
Secretary an amount equal to the United States' proportionate share of the fair
market value of the land. That portion of the proceeds of such disposition which
is proportionate to the United States' share of the cost of acquisition of such land
will, (1) upon application to the Secretary, be reinvested or transferred to another
Au-port Sponsor Assurances 3/2014 Page 17 of 20
74
eligible airport as prescribed by the Secretary. The Secretary shall give
preference to the following, in descending order: (1) reinvestment in an approved
noise compatibility project, (2) reinvestment in an approved project that is eligible
for grant funding under Section 47117(e) of title 49 United States Code, (3)
reinvestment in an approved airport development project that is eligible for grant
funding under Sections 47114, 47115, or 47117 of title 49 United States Code, (4)
transferred to an eligible sponsor of another public airport to be reinvested in an
approved noise compatibility project at that airport, and (5) paid to the Secretary
for deposit in the Airport and Airway Trust Fund.
c. Land shall be considered to be needed for airport purposes under this assurance if
(1) it may be needed for aeronautical purposes(including runway protection
zones) or serve as noise buffer land, and (2)the revenue from interim uses of such
land contributes to the financial self-sufficiency of the airport. Further, land
purchased with a grant received by an airport operator or owner before December
31, 1987, will be considered to be needed for airport purposes if the Secretary or
Federal agency making such grant before December 31, 1987, was notified by the
operator or owner of the uses of such land, did not object to such use, and the land
continues to be used for that purpose, such use having commenced no later than
December 15, 1989.
d. Disposition of such land under(a) (b) or(c) will be subject to the retention or
reservation of any interest or right therein necessary to ensure that such land will
only be used for purposes which are compatible with noise levels associated with
operation of the airport.
32. Engineering and Design Services.
It will award each contract, or sub-contract for program management, construction
management, planning studies, feasibility studies, architectural services, preliminary
engineering, design, engineering, surveying, mapping or related services with respect
to the project in the same manner as a contract for architectural and engineering
,• services is negotiated under Title IX of the Federal Property and Administrative
•
Services Act of 1949 or an equivalent qualifications-based requirement prescribed for
or by the sponsor of the airport.
33. Foreign Market Restrictions.
It will not allow funds provided under this grant to be used to fund any project which
uses any product or service of a foreign country during the period in which such
foreign country is listed by the United States Trade Representative as denying fair
and equitable market opportunities for products and suppliers of the United States in
procurement and construction.
34. Policies, Standards, and Specifications.
It will carry out the project in accordance with policies, standards, and specifications
approved by the Secretary including but not limited to the advisory circulars listed in
the Current FAA Advisory Circulars for ALP projects, dated 04/18/2019 (the latest
approved version as of this grant offer) and included in this grant, and in accordance
Airport Sponsor Assurances 3/2014 Page 18 of 20
75
with applicable state policies, standards, and specifications approved by the
Secretary.
35. Relocation and Real Property Acquisition.
a. It will be guided in acquiring real property, to the greatest extent practicable under
State law, by the land acquisition policies in Subpart B of 49 CFR Part 24 and
will pay or reimburse property owners for necessary expenses as specified in
Subpart B.
b. It will provide a relocation assistance program offering the services described in
Subpart C and fair and reasonable relocation payments and assistance to displaced
persons as required in Subpart D and E of 49 CFR Part 24.
c. It will make available within a reasonable period of time prior to displacement,
comparable replacement dwellings to displaced persons in accordance with
Subpart E of 49 CFR Part 24.
36. Access By Intercity Buses.
The airport owner or operator will permit, to the maximum extent practicable,
intercity buses or other modes of transportation to have access to the airport;
however, it has no obligation to fund special facilities for intercity buses or for other
modes of transportation.
37. Disadvantaged Business Enterprises.
The sponsor shall not discriminate on the basis of race, color, national origin or sex in
the award and performance of any DOT-assisted contract covered by 49 CFR Part 26,
or in the award and performance of any concession activity contract covered by 49
CFR Part 23. In addition, the sponsor shall not discriminate on the basis of race,
color, national origin or sex in the administration of its DBE and ACDBE programs
or the requirements of 49 CFR Parts 23 and 26. The sponsor shall take all necessary
and reasonable steps under 49 CFR Parts 23 and 26 to ensure nondiscrimination in the
award and administration of DOT-assisted contracts, and/or concession
contracts. The sponsor's DBE and ACDBE programs, as required by 49 CFR Parts
26 and 23, and as approved by DOT, are incorporated by reference in this
agreement. Implementation of these programs is a legal obligation and failure to
carry out its terms shall be treated as a violation of this agreement. Upon notification
to the sponsor of its failure to carry out its approved program, the Department may
impose sanctions as provided for under Parts 26 and 23 and may, in appropriate cases,
refer the matter for enforcement under 18 U.S.C. 1001 and/or the Program Fraud
Civil Remedies Act of 1936 (31 U.S.C. 3801).
38. Hangar Construction.
If the airport owner or operator and a person who owns an aircraft agree that a hangar
is to be constructed at the airport for the aircraft at the aircraft owner's expense, the
airport owner or operator will grant to the aircraft owner for the hangar a long term
lease that is subject to such terms and conditions on the hangar as the airport owner or
operator may impose.
Airport Sponsor Assurances 3/2014 Page 19 of 20
76
39. Competitive Access.
a. If the airport owner or operator of a medium or large hub airport(as defined in
section 47102 of title 49, U.S.C.)has been unable to accommodate one or more
requests by an air carrier for access to gates or other facilities at that airport in
order to allow the air carrier to provide service to the airport or to expand service
at the airport, the airport owner or operator shall transmit a report to the Secretary
that-
1) Describes the requests;
2) Provides an explanation as to why the requests could not be accommodated;
and
3) Provides a time frame within which, if any, the airport will be able to
accommodate the requests.
b. Such report shall be due on either February 1 or August 1 of each year if the
airport has been unable to accommodate the request(s) in the six month period
prior to the applicable due date.
Airport Sponsor Assurances 3/2014 Page 20 of 20
77
CIP DATA SHEET
Yakima Air Terminal-McAllister Field**. • YKM i* ' • 1
• •
• •
* • • ARFF Vehicle Acquisition * 2019
SKETCH;
Acquire one (1) Aircraft Rescue and Firefighting (ARFF) Vehicle, Index B
- The existing ARFF Vehicle is nearing the end of its useful life span,
COST ESTIMATE:
ADMINISTRATION: $3,000„,00 1.Construction $ 4$
ENGINEERING: $50,000.00 2.Equipment $1,058,111.00 5 $
INSPECTION: $ 3 TOTAL: $1.111,111.00
$ ,000,000.00 ;*,:1$55,555.00 $55556.00
•
•
SPONSOR VERIFICATION; Date (see instruction sheet or attached comments for more information)
For each and every N/A -Date of approved ALP with project shown
project as applicable 11/27/1a-Date of environmental determination(ROD,FONSI,CatEx)
N/A -Date of land acquisition or signed purchase agreement
N/A -Date of pavement maintenance program
N/A -Date of Benefit Cost Analysis(RCA)as required
SPONSOR'S SIGNATURE: -*.*; DATE: o I io/oxict
PRINTED NAME: Cliff Mo & TITLE: City Manager
PHONE NUMBER: (509)575-6149 EMAIL: rob,petersonavakirnaairterminatcorn
FAA USE ONLY
1J, , ' ; ::*41.;; ;i:ill;-**-*.i #1" *.*:* *... j
78
INSTRUCTIONS FOR COMPLETING
CAPITAL IMPROVEMENT PLAN DATA SHEET
•
A Capital Improvement Plan(CIP)Data Sheet must be submitted for each major work item that is requesting Federal assistance over
the next 5 years. Submittal of this information is necessary to effectively administer the Airport Improvement Program.
HEADER INFORMATION-Include the name of the airport,the LOCID,the local priority of the requested work,the project description
and the desired Federal fiscal year(October 1st to September 30th)that you desire the project.
SKETCH-Color-coded sketch that depicts and identifies the scope of the proposed project. An aerial photo can be used as long as it
shows the proposed project information.
JUSTIFICATION-Answers the questions of what it is,why is it needed and what is the benefit. This is a very important part of your
Capital Improvement Plan. The information is required to accurately determine the eligibility of your project and its priority for
funding. Projects without adequate justification cannot be added to the CIP. To help you prepare solid justification we have
compiled the following list of suggestions,which you can use to support your assessment of the need for this project. Be sure to list
all reasons and needs for your project and include a detailed description of existing conditions.Use extra pages if needed.
• For pavement rehabilitation include the age of the pavement,distresses,Pavement Condition Index
(PCI)Rating(may be able to obtain this info from ODA),or any other factor that would affect pavement life.
Include type of pavement(apron,runway)and dimensions(linear feet and width or square footage). Also
include what you have done to maintain the pavement over its lifetime and the date of the last major
rehabilitation(i.e.overlays,sealcoats,etc.)
• New taxiways/taxilanes—what will this taxiway/taxilane serve? Does it serve a hangar area? Is it a
parallel taxiway? What width are you proposing? If you propose a width that is wider than FAA standards,
indicate how that additional pavement will be funded.
• For Apron Expansion indicate the current size of the apron and what you plan to add. Indicate why you
need more apron space and how the apron area will be used(tie down area,etc).
• For fencing projects—indicate the height of the fence and lineal footage. Also,explain why the fence is
.•
needed(i.e.deer fencing,security,etc)
• Land acquisition explain what the land is needed for—approach protection? Development such as a
new hangar area? Also include if it is fee or easement. Include parcel numbers and acreage of those parcels.
Please state if residences or businesses will be acquired.
• For Arrival/Departure Building,provide what type of facility you currently have and what you plan to
build(square footage,types of rooms)
COST ESTIMATE-The estimate of total cost including the Federal,State and Local shares. For first year projects,attach a detailed
cost estimate showing unit costs;aggregate In square yards(S.Y.),concrete paving in square yards(S.Y.)and asphaltic paving in tons.
Separate the costs for land acquired in fee and land acquired in easement. Note if the project is dependent on other sources of
funding(i.e.other agency grants)
SPONSOR VERIFICATION-The verification that the project is properly planned and is ready to"go"within the first year of the CIP for
applicable projects. Except for equipment acquisition,proposed development and land acquisition must be shown on an approved
1 ALP,have cleared environmental processing,and the land already acquired or have a signed purchase agreement. These
requirements must be completed before a project can be considered for upcoming year funding. For the 2nd and 3rd years of the CIP
program,the sponsor should be working towards satisfying these requirements. Date each item verifying that all project
requirements are satisfied(check marks are not acceptable).
•
�
79
CERTIFICATION REGARDING LOBBYING
Certification for Contracts,Grants,Loans,and Cooperative Agreements
The undersigned certifies,m the best of his v,her knowledge and belief,that:
(1)No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any
person for influencing or attempting to influence an officer or employee of an agency,a Member of
Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with
the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the
entering into of any cooperative agreement,and the extension,continuation,renewal,amendment,or
modification m any Federal contract,grant,loan,v,cooperative agreement.
(2)If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an
offiGer or employee of Congress,or an employee of a Member of Congress in connection with this Federal
contract,grant,loan,or cooperative agreement,the undersigned shall complete and submit Standard
Form-LILL,"Disclosure of Lobbying Activities,"in accordance with its instructions.
(3)The undersigned shall require that the language m this certification uo included in the award documents
for all subawards at all tiers(including subcontracts,subgrants,and contracts under grants,loans,and
cooperative agreements)and that all subrecipients shall certify and disclose accordingly,This certification
|oa material representation m fact upon which reliance was placed when this transaction was made ur
entered into.Submission of this certification is a prerequisite for making or entering into this transaction
imposed by section 1352,title 31,U.S.Code.Any person who fails to file the required certification shall be
subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states,to the best o,his v,her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencing of attempting to influence an officer
or employee of any agency,a Member of Congress,an officer or employee of Congress,or an employee of
a Member of Congress in connection with this commitment providing for the United States to insure or
guarantee a loan,the undersigned shall complete and submit Standard Form-LILL,"Disclosure of Lobbying
Activities,"in accordance with its instructions.Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352,title 31,U.S.Code,Any person who fails to file the
required statement shall be subject to a civil penalty of not less than$10,000 and not more than$100,000
for each such failure.
�
APPLICANT'S ORGANIZATION
~�^
City of Yakima
| PRINTED NAME AND TITLE op AUTHORIZED REPRESENTATIVE �
| Prefix: ^F|m�wumo� Ci�c�— 3� �iom�wuma�
~�~
*Last Name: " � Suffix:
| �~^~^-
~nUo]Ciw a°"��o,
, .
80
OMB Number:4040-0004
Expiration Date: 12/31/2019
Application for Federal Assistance SF-424
*1.Type of Submission: *2.Type of Application: •If Revision,select appropriate letter(s):
Preapplication [A New
Z Application L Continuation *Other(Specify):
Changed/Corrected Application Revision
*3.Date Received: 4.Applicant Identifier:
5a.Federal Entity Identifier: 5b.Federal Award Identifier:
]3-53-0089-013-2019
State Use Only:
6,Date Received by State: 7.State Application Identifier:
8.APPLICANT INFORMATION:
*a.Legal Name: c it y of Y. k irna
b,Employer/Taxpayer Identification Number(EINfTIN): •c.Organizational DUNS:
[91-6001293 mi H8217.6510000
d.Address:
Street1: ;129 2nd St.
Street2:
•City: Yakina
County/Parish: I
*State: WA: Wa5hington
Province:
•Country: USA: UNITED STATES
*Zip/Postal Code: --
e.Organizational Unit:
Department Name: Division Name:
........
„. „.
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: *First Name: -Robert
Middle Name: -
*Last Name: 'Vet o n
Suffix:
Title: fAirport Director
Organizational Affiliation:
*Telephone Number: 50 9-575-61.49 Fax Number: I
•
Email Rob.Pet.er tich @ye P..i.stAaairterta i.tut com
81
Application for Federal Assistance SF-424
*9.Type of Applicant 1:Select Applicant Type:
C: City or Township Goverauaent
Type of Applicant 2:Select Applicant Type:
Type of Applicant 3:Select Applicant Type:
"Other(specify):
*10.Name of Federal Agency:
DOT-FAA
11.Catalog of Federal Domestic Assistance Number:
2(1.106
CFDA Title:
Airport Improvement Program
*12.Funding Opportunity Number:
"Title:
13.Competition Identification Number:
Title:
14.Areas Affected by Project(Cities,Counties,States,etc.):
• : Add Attachment Delete Attachment ; View Attachment
*15.Descriptive Title of Applicant's Project:
2Phan I, Design RP 9-27 HJRL & Re Crack and Seal Coat
Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments : View Attachments
82
Application for Federal Assistance SF-424
16.Congressional Districts Of:
*a.Applicant WA-004 *b.ProgramlProject PA-004
Attach an additional list of Program/Project Congressional Districts if needed,
........................................
Add Attachment Deiete Attachment View Attachtnent
17.Proposed Project:
*a,Start Date: 04/01/2019 *b.End Date: 12/31/2uzo
18.Estimated Funding($):
*a.Federal 132,426.00
*b.Applicant 7 357.00
•c,State 7,357.00
d.Local 1
*e.Other � I
.... .................
*f, Program Income
"g,TOTAL 117,140.001
"19.Is Application Subject to Review By State Under Executive Order 12372 Process?
a.This application was made available to the State under the Executive Order 12372 Process for review on ( J
Z b.Program is subject to E.O.12372 but has not been selected by the State for review.
c.Program is not covered by E.O. 12372.
.... ........ .... ........
*20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.)
Yes ®No
If"Yes",provide explanation and attach
Add Attachment Delete Attachment " View Attachment
.... ................
21.*By signing this application, I certify (1)to the statements contained in the list of certifications**and(2)that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may
subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001)
*"I AGREE
** The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
•
Prefix: "First Name: lc 1 i t
Middle Name:
*Last Name: Moe re
Suffix: •
'Title: City Manager
*Telephone Number: =509-575-60(10 Fax Number:
*Email. ci [F.moorc@yakimawa.gov
*Signature of Authorized Representative: "Date Signed.
. .... ........ .... ........
83
U.S. Department
o,Transportation
Federal Aviation
Administration
FAA Form 5100~100, AppU'cat'on for Federal Assistance
������U��K�K���� ��� ����'������� Projects)
' ' ' ^
Paperwork Reduction Act Burden Statement
Afedera| agency may not conduct or sponsor, and o person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection cf information displays acurrently
valid OMB Control Number. The OMB Control Number for this information collection io212O'0S8Q. Public
/ reporting for this collection of information is nnUmotod to be approximately 28 hours per reaponno,
including the time for reviewing inotructions, searching existing data sources, gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of i
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of CFR 200; no assurance of confidentiality is provided. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing
� this burden tn the FAA at: 8O0 Independence Ave. SW, Washington, OC 2O501. Attn� Information
� Collection Clearance Officer 11O �
`.__ASP' �
INSTRUCTIONS FOR FORM 5100-100
PARTU — AppUicaKionNor Federal Assistance
Part| of the Application for Federal Assistance consists of a completed Standard Form (SF)424.The
remaining parts of Form 5100-100 (Parts 11, 1111 and IV) represent continuation pages that the Sponsor
must attach to the associated SF-424 form. The signature of the Sponsor's authorized representative on
the SF'424 form represents acceptance of the representations and certifications made within the
corresponding FAA 51OO'1OOform.
PART UU — Project Approval Information
This information is necessary for the Federal Aviation Administration to evaluate this request for Federal
assistance. Responses do not require an explanation unless explicitly requested by the question.
SECTION A. STATUTORY CONDITIONS
Item 1 —Indicate whether the Sponsor maintains an active registration in the Federal System for Award
[Nonagement(SAK8). Pursuant to2CFR§25.%0O(b). a Sponsor must maintain an active registration in
the Central Contractor Registration repository(housed within 8AyN) with current information at the time of
the application and during the active period o[the Federal award.
Item 2—Indicate whether the Sponsor can commence the project within the same fiscal year the grant is
made or within G months of when the grant is made, whichever in later. Attach explanation for negative
� responses. This information is considered when allocating discretionary funds. (48 U.S.C. §47115(d)(2))
84
Item 3—Indicate whether the Sponsor can complete the project without unreasonable delays. If
applicable, provide listing of foreseeable events (winter shutdown, land acquisition issues, non-
aeronautical nvenho. etcjthodhavepobenUa|tode|oyoomp|aUunofthepnoject. (4QUSC §47iOG(o))
Item 4—Indicate whether the environmental review(i.e. environmental assessment, mitigated F0NS|,
o±j identified impacts or effects nn the environment that require mitigating measures that lessen the
impact or effect on the environment. If yes, provide a summary listing of mitigating measures.
(49U.SI. §471OO(c))
Item 8—Indicate whether the project covered by this request is also covered by an approved Passenger
Facility Charge (PFC) application or other Federal assistance program by selecting all applicable check
boxes (4QU.S.C. §4O117(d) and 2CFR§ 2OO.4U3). |f the approved PFC application only addresses the
Sponoor'mA|P matching mhere, select the eppvuphab»check box.
If the pnojoct, or portions thereof, is covered by another Federal assistance program, identify the Federal
assistance program by name and the Catalog of Federal Domestic Assistance (CFDA) number.
Item 6—Indicate whether the Sponsor intends to seek reimbursement of Sponsor indirect costs as
defined by2CFR§20D.414 and 2CFR Appendix V||to Part 20O. This information request does not
include the indirect costs claimed by a for-profit entity(e.g. consultant).
° The de minimis rate may only be used if the Sponsor has not previously received a negotiated
Indirect Cost Rata (ICR) and does not exceed the limitations prescribed in Appendix V11 to Part
208.
° A Sponsor with an existing approved negotiated ICR must identify the ICR value, the name of the
cognizant agency that approved the |CR and the date ofapproval.
Limitations ofuse:Per policy, Spnnaur's may only apply an approved/CRto allowable direct salary
expenses that are reasonable and necessary h»carry-out the project.
SECTION B. CERTIFICATION REGARDING LOBBYING
This section addresses the Sponsor's declaration regarding lobbying activities. The declaration made in
the section are under signature of the authorized representative as identified in box 21 of form SF'424. to
which this form ioattached.
Title 31 U.S.C. § 1352 establishes that no appropriated funds may be expended by a recipient of a
( Federal grant to pay any person for influencing or attempting to influence an officer or employee of any
�
agency, Member cfCongress, an officer oremployee of Congress, or an employee ofa Member of
Congress in connection with this covered Federal assistance action. Pursuant 0o40CFR part 2O. this
certification attests that the Sponsor has not made, and will not make, any payment prohibited payment
by31 U.S.C. § 1352.
an
SECTION C. RGpRE8ENTATONS AND CERTIFICATION ,
1. Compatible Land Use (4AU.S.C. §471D7(a)(10))—Identify actions the Sponsor has taken to
assure land uses in close proximity hnthe oiqoud are compatible with normal airport operations.
2. Defaults—Confirm that Sponsor ia not in default on any obligation to the United States or any
agency of the United States government.
3. PmaaibUo Disabilities—Confirm that Sponsor has no facts or circumstances (i.e. legal, financial
or otherwise)that might adversely affect the Sponsor in completing the project and carrying out
the provisions of the associated Grant Assurances.
4. Consistency with Local Plans (48 U.S.C. §471OO(a))—Confirm project im consistent with plans
(existing at the time the project is approved) of public agencies authorized by the State in which
the airport io located toplan.
5. Consideration uf Local Interests (4QU.S.C. §47108(b))—Confirm the Sponsor has given fair
consideration to the community in and near the project.
8. Consultation with Users (49 U.S.C. §471O5(m))'Confirm the Sponsor has consulted with
airport users that will be affected by the project.
7. Public Hearings (4QU.S.C. §4718G(o))—For projects involving the location ofanairport,
runway ur major runway extension, confirm the Sponsor:
a. Provided on opportunity for a public hearing to consider ecnnomin, social and
environmental effects of the project.
b. Has voting representation from the communities in which the project is located-, or has
advised the communities that they have the right to petition the Secretary about the
proposed project.
8. Air and Water Quality Gtandmrda-Confirm Sponsor will comply with applicable air and water
quality standards.
8' GxcAoaina Rights (49 U.S.C. §47107(a)—Identify all instances of exclusive rights to conduct
aeronautical services et the airport.
10' Land (49 U.S.C. §47106(b))—
e. Identify property interests specific to the development project and/or land acquisition.The
( declaration of property interest ioto be booed upon a title opinion submitted by an
�
attorney. When identifying the property inbaneot, use the same parcel numbers as used to
identify the property on the associated Exhibit property map.
Example: "Sponsor maintains property interest as depicted within the property table on
the Exhibit A property map dabpd__/ / originally filed with A/P Pnoj*nt###."
b. Complete this subpart if the Sponsor proposes a project for which they have not yet
obtained appropriate property interests. Note that the work may not commence until
Sponsor obtains annepdob|a property interests. Identify such property byparcel number
that corresponds to the associated Exhibit property mop.
n. Complete this subpart when acquiring property interests under the grant. Identify such
property by parcel number that corresponds to the associated Exhibit A property map.
FAA Form s1oo'1nu �
ao
PARTUUU — BudgetUnformallon
SECTION A. GENERAL
1. Federal Domestic Assistance Catalog Number- Show the Federal Domestic Assistance Catalog
Number from which the assistance iorequested.
2' Functional or Other Breakout: Indicate"Airport Improvement Program" Prepare a separate set of
Part III forms for other Federal program categories.
SECTION B. CALCULATION OF FEDERAL GRANT
^ When applying for a new grant, use the Total Amount Column only. Use all columns when requesting
revisions uf previously awarded amounts.
Line 1 ' Enter amounts needed for administration expenoeo, which may include such items as: legal fees,
mailing/shipping oxpenoeo, audit fees and documented Sponsor employee time that is necessary to
administer the grant.
Line 2' Enter amounts pertaining to allowable preliminary expenses. These include such expenses ae
independent fee estimate preporation, advertising expenses and permits.
Line 3' Enter amounts directly associated with the acquisition of land, existing ntructurno, and related
right-of-way.
Line 4' Enter fees for architectural engineering beok:oem/oeo.
Line 5' Enter amounts for architectural engineering special services (e.g. oumeyo, tests and borings).
Line 0' Enter fees for inmpeodon, testing and monitoring of construction and related programs.
Line 7- Enter amounts associated with the development of land where the primary purpose of the grant
is land improvement. Site work no/maUyausociotedwith major construction should be excluded from this
category and shown on line 11.
Line 8' Enter the dollar amounts needed to provide relocation advisory aouiotonce, and the net amounts
for replacement (last resort) housing. Dn not include relocation administration expenses on this Line-
include them on Line 1.
Line W' Enter the aoUmotad amount of relocation payments to be made to displaced peroonn, business
ouncerna, and non-profit organizations for moving expenses and replacement housing.
Line 10- Enter the cost of demolition or removal of improvements on developed land. Reduce the costs
on this line by the amount of expected proceeds from the no|e of salvage, if so instructed by the Federal
grantor agency. Othemwiae, show the proceeds on Line 15.
Line 11 - Enter amounts for the actual construction of, addition to or restoration of a facility. Include in this
� category the amounts of project improvements such as gxodinQ, dnsinage, paving, marking. lighting,
; buildings, oeeding/oodding. etc.
' Line 12- Enter amounts for equipment. Examples include ARFF vehicles, SIRE equipment, AWOS
equipment, interactive training, NAVAOequipmord. etc.)
Line 13' Enter miscellaneous amounts for items not specifically covered by previous categories.
87
Line 14' Enter the sum of Lines 1-13s
Line 15- Enter the estimated amount of program income that will be earned during the grant period and
applied to the program. Examples include vehicle trade-in va|ue, ou|e of millings resulting from pnojeot,
credits passed on from contractor, etc. This line may bo used to indicate applied liquidated damages.
Line 1G- Enter the difference between Line 14 and Line 1S.
Umm 17' Enter the aggregate amount for those bamo,which are a part of the project but not subject to
Federal participation. Refer to Section C. exclusions.
Line 18—Enter the subtotal sum of Lines 18and 17. (This io the amount tn which the matching share
ratio prescribed inprogram legislation ioepp|iedj
Line 19-Indicate the total amount of the Federal assistance requested. This value is determined by
multiplying the grant participation rate by the amount indicated in line 18.
Line 20—Indicate the amount cf the Grantee's share (from Section D),
Line 21 —Indicate the amount of other ohanaa (from Section D)
Line 22—Indicate sum of Lines 1Q. 2U and 21.
SECTION C. EXCLUSIONS
Line 23 m'Q ' Identify and list those costs which are port of the project cost but are not subject bo Federal
participation because of program legislation or Federal grantor agency instructions. The total amount on
Lino g should agree with the amount shown on Line 17 of Section B.
SECTION D. PROPOSED METHOD C3FFINANCING NON-FEDERAL SHARE
Line 24 a-g- Show the source of the grantee's share. If cash is not immediately available, specify the
actions completed to date and those actions remaining to make cash available under Section E-
Remarks. Indicate also the period of time that will be required after execution of the grant agreement to
obtain the funds. If there is a non-cash oontribudon, explain what this contribution will consist of.
Line 24h ' Indicate total of Lines 24 o'g. This amount must equal the amount in Section B. Lino 20.
Line 25m- Show the amount that will be contributed by o State or state ogency, only if the applicant is not
a State or state agency. If there is a non-cash or other conthbuUon, explain what the contribution will
consist of under Section E' Remarks.
Line 25b' Show the amount that will be contributed from other sources. If there is e non-cash
uonthbuUon, explain what the contribution will consist of under Section E' Remarks.
[
� Line 25o- Show the total of Lines 38a and 28b. This amount must be the same as the amount shown in
Section B. Line21.
Line 26' Enter the totals of Lines 24h and 25o.
SECTION E. OTHER REMARKS
Make any remarks pertinent hothe project and provide any other information required by these
instructions or the grantor agency. Attach additional sheets, if necessary.
FAA Form u1o0-1oo «
88
PART IV— Program Narrative
Prepare the program narrative statement in accordance with the following instructions for all new grant
programs. Requests for supplemental assistance should be responsive to Item 5b only. Requests for
continuation or refunding or other changes of an approved project should be responsive to Item 5uon|y.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE
Provide a short and concise description of the proposed improvement. Include n narrative on why this
improvement ieneeded.
2. RESULTS OpK BENEFITS EXPECTED
Identify results and benefits to be derived. For example, include a description of who will occupy the
facility and show how the facility will be used. For land acquisition or development pnojeuto, explain how
the project will benefit the public.
3. APPROACH
o. Outline a plan of action pertaining to the scope and detail of how the Sponsor proposes to
accomplish the work.
b. Cite factors, which might ecne|exoba or decelerate the work, and your reason for taking this
approach as opposed to others. Describe any unusual features of the project such as
construction approach, reductions in cost nr time or extraordinary social and community
involvements.
n. Provide projections of project milestone dates.As o minimum, identify target dates for defining
project costs (i.e. bid opening or completion of negotiations), anticipated issuance ofnotice-to-
proceed and anticipated project completion date.
d. Identify monitoring and oversight mechanisms the Sponsor proposes to implement.
e. List key individuals and entities such aoconsultant, Sponsor personnel and contractor who will
work on the project. Provide o short description of the nature of their effort nrcontribution.
4. GEOGRAPHIC LOCATION
Identify location of the project. This will typically be the name of the airport.
5. |F APPLICABLE, PROVIDE THE FOLLOWING INFORMATION:
o. Describe the relationship between this project and other work p|anned, anticipated or underway
under the Federal Assistance listed under Part||. Section A. Item 5.
b. Explain the reason for all requests for supplemental assistance and justify the need for additional
funding.
' o. If there have been significant changes in the project objectives, |onation, approach or time delays,
explain and justify. For other requests for changes or amendments, explain the reason for the
chongu(u). |f the scope, budget, or objectives have changed or an extension of time is necessary,
explain the circumstances and justify.
6. SFONSOR'SREPRESGNTAJUVE
( Identify contact information ofSponaor'erepresentative.
�
FAA Form o1un'1oo Vi
8&
10% U.S.Department of Transportation mmo CONTROL NUMBER-2120-0569
4W Federal Aviation Administration EXPIRATION DAT�:8/31/2019
Application for Federal Assistance (Development and Equipment Projects)
PARTUU — PROJECT APPROVAL INFORMATION
' partU -SGCT|ON A
The term "Sponsor" refers to the applicant name provided in box 8 of the associated SF-424 form.
|homn 1' - - -- - `
Does Sponsor maintain on active registration in the System for Award Management ��Yes �l No
(wvww.SAYN.gov)? �� ��
Item 2. -- -
Can Sponsor commence the work identified in the application in the fiscal year the
grant is made or within six months after the grant is made, whichever is later? ���� Yee ���� No ��l�N/A
' Kmmn 3.
Are there any foreseeable events that would delay completion of the project? If yes, �� yeo ��Nn �lN�\
provide o�aohmantto this form that lists the eve�m. �~ ^� ^~
Item 4.
Will the pnoject(o) covered by this request have impacts or effects unthe
� environment that require mitigating measures? If yes, attach a summary listing of E] Yes 0 No E1 N/A
mitigating measures to this application and identify the name and date ufthe !
' environmentalnnen�(a),
| Item 5'
| |o the project covered by this request included inan approved Passenger Facility
Charge(PFC) application or other Federal assistance program? If yes, please NYoa El No N/4 �
identify other funding sources by checking all applicable boxes.
�
�8The project ia included inan approved PFCapplication.
�
If included inan approved PFCapplication,
: does the application only address/UP matching share? 0Yam El No |
� �l
�� Theproject is included in another Federal Assistance program. Its CFDA number is below,
,
|� Item G'
VNU the requested Federal assistance include Sponsor indirect costs am described in~~ ' [lYea No �l N�`
2CFR Appendix VUtnPad2DO. States and Local Government and Indian Thbe �� -- ��
Indirect Cost Proposals?
�
If the request for Federal assistance includes a claim for allowable indirect costs, selectthe applicable indirect cost rate �
the Sponsor proposes toapply:
�lDeK8inimio rate uf1O96aa permitted by2CFR § 2OO.414.
FlNegotiated Rate equal to Y6ao approved by (the Cognizant !
on (Oate) (2CFR part 2UO. appendix Vl|).
Note: Refer to the instructions for limitations o/application associated with claiming Sponsor indirect costs.
FAA Form mn*1nn(3/1o)SUPERSEDES PREVIOUS EDITION Page 1mr
no
OMB CONTROL NUMBER:x1zo-0oon
�CxmB EXPIRATION DATE:em112o1s_
� PART U| 'SECTION B
�
Certification
Regarding Lobbying
The declarations made un this page are under the signature cf the authorized representative ao identified in box 21of �
form SF-424, to which this form is attached. The term "Sponsor" refers to the applicant name provided in box 8 of the `
associated SF'424form.
The Authorized Representative certifies, to the best of his or her knowledge and belief, that:
� (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor, to any person
| for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, anofficer
i or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
� contract, grant, loan, or cooperative agreement.
�
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for ^
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer `
or employee of Congress, oranemployee ofa Member cf Congress in connection with this Federal contract, �
�
� gxart, ban, or cooperative agreement, the Authorized Representative ohoU complete and submit Standard
Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3)The Authorized Representative shall require that the language of this certification be included in the award
' documents for all sub-awards at all dom (including mubnontrocta, aubgnanta, and contracts under grants, loans,
. and cooponsUwa agreements) and that all aubmaoipientn shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
' made or entered into. Submission cf this certification ioa prerequisite for making or entering into this
transaction imposed by section 1352. title 31. U.S. Code. Any person who fails Uu file the required certification
shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
FAA Form n1on'1oo(3/1n)SUPERSEDES PREVIOUS EDITION Page uof7
91
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE:8/31/2019
PART II—SECTION C
The Sponsor hereby represents and certifies as follows:
1. Compatible Land Use—The Sponsor has taken the following actions to assure compatible usage of land adjacent
to or in the vicinity of the airport:
Airport Overlay Ordinance protects land uses that are incompatible with airports. Yakima Municipal Code Chapter
15.30 and 15.04 discusses zoning and incompatible land uses in relation to the airport.
2. Defaults—The Sponsor is not in default on any obligation to the United States or any agency of the United States
Government relative to the development, operation, or maintenance of any airport, except as stated herewith:
Correct
3. Possible Disabilities—There are no facts or circumstances (including the existence of effective or proposed leases,
use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other
legal proceedings) which in reasonable probability might make it impossible for the Sponsor to carry out and complete
•
the Project or carry out the provisions of the Grant Assurances, either by limiting its legal or financial ability or
otherwise, except as follows:
N/A
•<< 4. Consistency with Local Plans—The project is reasonably consistent with plans existing at the time of submission
of this application) of public agencies that are authorized by the State in which the project is located to plan for the
development of the area surrounding the airport.
Yes
€ 5. Consideration of Local Interest—It has given fair consideration to the interest of communities in or near where the
project may be located.
Yes
• 6. Consultation with Users—In making a decision to undertake an airport development project under Title 49, United
States Code, it has consulted with airport users that will potentially be affected by the project(§47105(a)(2)).
Yes. Project aligns with the Master Plan and Airport Layout Plan, which underwent public comment.
7. Public Hearings—In projects involving the location of an airport, an airport runway or a major runway extension, it
has afforded the opportunity for public hearings for the purpose of considering the economic, social, and environmental
effects of the airport or runway location and its consistency with goals and objectives of such planning as has been
carried out by the community and it shall, when requested by the Secretary, submit a copy of the transcript of such
hearings to the Secretary. Further, for such projects, it has on its management board either voting representation from
the communities where the project is located or has advised the communities that they have the right to petition the
Secretary concerning a proposed project.
N/A
8. Air and Water Quality Standards— In projects involving airport location, a major runway extension, or runway
location it will provide for the Governor of the state in which the project is located to certify in writing to the Secretary
that the project will be located, designed, constructed, and operated so as to comply with applicable and air and water
quality standards. In any case where such standards have not been approved and where applicable air and water
quality standards have been promulgated by the Administrator of the Environmental Protection Agency, certification
shall be obtained from such Administrator. Notice of certification or refusal to certify shall be provided within sixty days
after the project application has been received by the Secretary.
N/A
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 3 of 7
no
OMB CONTROL NUMBER:e1uo-0em
OMB EXPIRATION
| PART UU—SECTION C (CunUnued)
9. Exclusive Rights—There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport
owned or controlled by the Sponsor except an follows:
�
None '
� |
�
�
'
^ 1O. Land—(a)The sponsor holds the following property interest in the following areas of land, which are tobodeveloped
or used as port of or in connection with the Airport subject to the following excephnno, encumbnsnoeo, and adverse
interests, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1]
� See Exhibit A, approved on March 2015, on file with the FAA Seattle Airport District Office.
�
| `
The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and
� that such attorney or title company has determined that the Sponsor holds the above property interests.
(b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work '
under the Pnojeut, the following property interest in the following areas of land on which such construction work is to be
performed, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1]
|
/ N/A
^
^
(c)The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction
work under the Pnojeci, the following property interest in the following areas of land which one to be developed or used
as part of or in connection with the Airport as it will be upon completion of the Project, all of which areas are identified on
� the aforementioned property map designated oe Exhibit"A" [1]
N/A |
'
. �
�
State the character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse
interests of every kind and nature, including liens, easements, leases, etc.The separate areas of land need only be identified here by
the area numbers shown nn the property map,
FAA Form o1oo'1on(3/1o)SUPERSEDES PREVIOUS EDITION Page 4vvr
no
OMB CONTROL NUMBER:z1uoeuoV
OMB EXPIRATION DATE:8131o019
PART UUU — BUDGET INFORMATION — CONSTRUCTION
- -
SECT|ONA—GENERAL
- -
1. Federal Domestic Assistance Catalog Number: 20-106
2. Functional or Other Breakout:
i
' SECTION 8—CALCULATION OF FEDERAL GRANT
Latest' Adjustment Total
Cost C|msmUDoaUnn Amount +o'(-)Amount Amount
(Use only for (Umeon|yfbr
Required
revisions) revisions)
1 Administration expense $ 3.000
. .
2. Preliminary expense
3. Land, structures, hght-of-way
'
4. Architectural engineering basic fees 144.14O
- '
' 5. Other Architectural engineering fees
5. Project inspection fees
7. Land development
`
8. Relocation Expenses
�
! 8. Relocation payments Lo Individuals and Businesses
10. Demolition and removal �
�
11. Construction and project improvement
12. Equipment
18. Miscellaneous
___ -
14. Subtotal(Lines 1 Mhmugh 13) $ 147.14O
15. Estimated Income(if applicable) �
—
16. Net Project Amount(Line 14 minus 15) 147.14O
-- '
17. Loss Ineligible Exclusions(Section C. line 3Jgl
1O.Subtotal(Lines 1O through 17) $ 147.14O
19. Federal Share requested of Line 18 132.426
20. Grantee share 7.357
'
21. Otherohoea � 7.357
._ . ,
� !
| 22. TOTAL PROJECT(Lines 19. 20&21) { $ 147.140 !
-
FAA Form/nnn-1nn(3n6)SUPERSEDES PREVIOUS EDITION Page om7
94
OMB CONTROL NUMBER:u1oo-0one
OMB EXPIRATION DATE:am1oo10
SECTION C-EXCLUS|ONS
. . �
Amount for�
oo.CkameUDumUnn(Doouhpt�noxnonpanicipo�ngwmM4 Ineligible—
cipation
b.
C.
d.
e,
� t
g. Total
SECTION D-PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
. 24.Grantee Share-Fund Categories Amount
a. Soouhhee �
b. Mortgages
c.Appmphationa(by Applicant) 7.357
. d. Bondo
,
a.Tax Levies
[ Non'Caoh
g. Other(Exp|ein):
h.TOTAL'Grantee share $7.357
`
%5.Other Shares Amount .
o. State 7.357
-
b. Otho
c TOTAL-OthsrShaen $7.357 !
36.TOTAL NON-FEDERAL FINANCING $ 14.714
SECTION E-REMARKS
(Attach sheets n additional space iorequired)
The following items are attached:
- SoopoofVVork
- PnojeotSketoh
-Airport Sponsor Assurances
' Exhibit �
- SponoorCertifinatinnforDrug'FreeVVorkp|ece .
- Listing of Advisory Circulars for A|p/PFCProjects
-Tit|eV|Ameunanoe
The following items are incorporated by reference: .
-Plans and Specifications, dated: xx'2010
FAA Form o1oo'1no(m1o)SUPERSEDES PREVIOUS EDITION Page nn,7
95
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE:8/31/2019
PART IV—PROGRAM NARRATIVE
(Suggested Format)
PROJECT: Phase 1, Design RW 9-27 HIRL& RW Crack and Seal Coat
AIRPORT: Yakima Air Terminal - McAllister Field'
1. Objective:
This project will replace the existing High Intensity lighting system with a new HIRLs, and provide pavement
maintenance to the 9-27 runway.
2. Benefits Anticipated:
This is the design phase to extend the useful life of the pavement through crack seal and seal coat. The new
pavement markings and HIRLs will improve and enhance safety.
3. Approach: (See approved Scope of Work in Final Application)
Coordinate Runway closures and phaseing with the Owner, FAA, GA tenants, FBO and Alaska Airlines.
Construction is anticipated to begin in the Summer of 2020.
4. Geographic Location:
Yakima Air Terminal-McAllister Field is located in Sections 34 and 35 Township 13 N, Range 18 E, and Sections 2
and 3, Township 12 N, Range 18 E.
5. If Applicable, Provide Additional Information:-
6. Sponsor's Representative: (include address&telephone number)
Rob Peterson, 509-575-6149
2406 West Washington Ave, Suite B
Yakima, WA 98903
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 7 of 7
-
no
U.S. Department �
of Transportation
Federal Aviation
Administration
FAA Form 5100~129, ConstrKUct'on Project F'naUAcceptance —
A'rport Improvement Program Sponsor Certification
Paperwork Reduction Act Burden Statement
� Afedenn|agency may not conduct orsponsor, and a person is not required to respond to, nor shall o
person be subject to n penalty for failure to comply with o collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid C>N1B Control Number. The OMB Control Number for this information collection in 2120-0569. Public
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing inutructimno, searching existing data oounoeo, gathering and maintaining
the data needmd, completing and reviewing the collection of information. All responses tn this collection of �
| �
i information are required under 49U.S.C. Section 471O6hu retain a benefit and hn meet the reporting �
'^ requirements of% CFR 200-Send comments regarding this burden estimate or any other aspect of this
�.
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection |
Clearance Officer.ASP-11D. i
FAA Form 5100-129
,
^
&7
U.S.Department of Transportation OMB CONTROL NUMBER: 2120-0569
Federal Aviation Administration EXPIRATION DATE: 8/31/2018
Construction Project Final Acceptance
Airport Improvement Program Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal'McAllister Field
Project Number: 3-53'0080'043'2019
Description ofWork: phaao1. Design RVVQ'27H|RL&RVV Crack and Seal Coat
Application
49 USC§47105(d), authorizes the Secretary to require me certification from the sponsor that it will
comply with the statutory and administrative requirements in carrying out a project under the Airport
Improvement Program. General standards for final acceptance and close out of federally funded
construction projects are in2CFR§2OO.343—Closeout and supplemented by FAA Order 51OD.38. The
sponsor must determine that project costs are accurate and proper in accordance with specific
requirements of the grant agreement and contract documents.
Certification Statements
Except for certification statements below marked not applicable(NIA). this list includes major
requirements of the construction project. Selecting "Yes" represents sponsor acknowledgment and
confirmation of the certification statement. The term"will" means Sponsor action taken at appropriate
time based on the certification statement focus area, but no later than the end of the project period of
performance. This list is not comprehensive and does not relieve the sponsor from fully complying with
all applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
1. The personnel engaged in project administration, engineering supervision, project inspection, and
acceptance testing were or will be determined to be qualified and competent to perform the work
(Grant Assurance).
��Yes ���� No ����N/A
%. Construction records, including daily logs, were or will be kept by the resident
engineer/construction inspector that fully document contractor's performance in complying with:
� a. Technical standards (Advisory Circular(\C) 16O/537O-12);
b. Contract requirements (2CFR part 2OOand FAA Order 51OO.38); and
o. Construction safety and phasing plan measures (AC 15D/637O-2).
| ��Yes No N/A
| u�/ �_/ ��
! 3. All aooa[tonca tests specified in the project specifications were or will be performed and
' documented. (4C15O/537O'12).
�
r'-1Yeo — No F— N/A
FAA Form 5100'129(1/17)SUPERSEDES PREVIOUS EDITION page 1 of
na
4. Sponsor has taken ov will take appropriate corrective action for any test result outside of
allowable tolerances (AC 150/ 37O-12). �
r;7Yeu FNo F-IN/A
5. Pay reduction factors required by the specifications were applied or will be applied in computing
final payments with a summary made available tothe FAA(/\C 150/5370-10).
Yes F-1No F-IN/A
6. Sponsor has nodfied, or will promptly notify the Federal Aviation Administration (FAA) of the
following occurrences:
m. Violations of any federal requirements set forth or included by reference in the contract
documents (2 CFR part 200);
b. Disputes or complaints concerning federal labor standards (2gCFR part 5); and
o. Violations oforcomplaints addressing conformance with Equal Employment Opportunity or
Disadvantaged Business Enterprise requirements (41 CFR Chapter 60 and 49 CFR part 26).
r1-1Yea F-INo F-] N/A
7. Weekly payroll records and statements of compliance were or will be submitted by the prime
contractor and reviewed by the sponsor for conformance with federal labor and civil rights
requirements as required by FAA and U.S. Department of Labor(2Q CFR Part 5).
Yes E] No F N/A
B. Payments to the contractor were or will be made in conformance with federal requirements and
contract provisions using sponsor internal controls that include:
o. Retaining source documentation of payments and verifying contractor billing statements
against actual performance (2CFR§2OO.3O2 and FAA Order 51O8.3O);
b. Prompt payment of subcontractors for satisfactory performance of work (49 CFR§2G.28);
C. Release of applicable retainage upon satisfactory performance of work (49 CFFl§36.29);
and
d. Verification that payments to DBEs represent work the DBE performed by carrying out
commercially useful function (49CFR§26.55).
�- Yes r-J No R N/A
Q. A final project inspection was or will be conducted with representatives of the sponsor and the
contractor present that ensure:
a. Physical completion of project work in conformance with approved plans and specifications
(Order51OD.38);
b. Necessary actions to correct punch list items identified during final inspection are complete
(Ondar51DO.38); and
c. Preparation of a record of final inspection and distribution to parties to the contract
(C>nder61UO38);
��Yeo F-1No F— N/A
10. The project was or will be accomplished without material deviations, changes, or modifications
from approved plans and specifications, except aa approved by the FAA(Order 51OD.38).
( ��Ymm �� No �� N/A
u�
� �-- �� .'- �� .—.
FAA Form 51OO'129(1/17)SUPERSEDES PREVIOUS EDITION page oof8
nn
11. The construction of all buildings have complied or will comply with the seismic construction
requirements cf4SCFR §4112O.
[-I Yes F-1No FX_J N/A
12. For development projects, sponsor has taken or will take the following close-out actions:
a. Submit bothe FAA afina|baat and quality assurance report summarizing oncmpbonue bao
nsou|te. as applicable (Grant Condition);
b. Complete all environmental requirements ou established within the project environmental
determination (Odar61UO.38)- and
o. Prepare and retain as-built plans (Onder51OO.38).
`/ea E] No [_1N/A
13. Sponsor has revised or will revise their airport layout plan (ALP)that reflects improvements mode
and has submitted or will submit on updated ALP to the FAA no later than QO days from the
period of performance end date. (49U@CQ471O7 and Order 5lDO.3B).
Yes El No FlN/A
Attach documentation clarifying any above item marked with "No" response.
� Spmnsor'sCmrtd5cmtimn
| �
,
� | cortify, for the project identified heroin. responses Uo the forgoing items are accurate as marked and
additional documentation for any item marked "no" is correct and complete. Y
� Executed onthis day of . 2019 �
�
Name ofSponsor: City ofYakima �
Name ofSponaor'a Authorized Official: Cliff Moore
Td|a ofGponoor'uAuthorized Official: City Manager
, Signature of8ponsor's Authorized Official:
� | declare under penalty of perjury that the foregoing is true and correct. | understand that knowingly and
willfully providing false information to the federal government is oxio|otion of18 USC § 1001 (False |
Statements) and could subject mmtnfines, imprioonmont, or both.
FAA Form 51OO'1re(1/17)SUPERSEDES PREVIOUS EDITION page 3uf3
100
U.S. Department
ofTransportation
Federal Aviation
Administration
FAA Form 5100.130, Drug-Free Workplace _ Airport Improvement
Program Sponsor Certification
Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person bmsubject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently �
� valid OMB Control Number. The OMB Control Number for this information collection is 3120-0569. Public �
|
reporting for this collection of information is estimated to be approximately 8 hours per response,
, including the time for reviewing inotruotiona, searching existing data oounoeu, gathering and maintaining
the data naodod, completing and reviewing the collection of information. All responses tothis collection of |
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
� requirements of2CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
' Administration at 800 Independence Ave. SVV. VVmnhington, DC 20581. Attn: Information Collection �
� Clearance Offine� ASP-11U� '
FAA Form 51OO'13o
101
�
u.S.Department mTransportation OMB CONTROL NUMBER: 31%O-05O
Federal Aviation Administration EXPIRATION DATE: 001/2O19
Drug-Free Workplace
Airport Improvement Program Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal'McAllister Field
Project Number 19
Description of Work: Phase 1, Design RVVS'27 H|RL&RVV Crack and 8oa|Coot
Application
49 USC §47105(d) authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (4|P). General requirements on the drug-free workplace within federal grant programs are
described in 2 CFR pod 182. 8pononno are required to certify they will be, or will continue to pnovide, o
drug-free workplace in accordance with the regulation. TheA|P project grant agreement contains specific
assurances on the Drug-Free Workplace Act of1888.
Certification Statements
Except for certification statements below marked as not applicable (N/A), this list includes major
requirements of the construction project. Selecting''Yao^ represents sponsor acknowledgement and ~
confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time
based on the certification statement focus area, but no later than the end of the project period of
performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
1. A statement has been or will be published prior to commencement of project notifying employees
that the unlawful manutouture, diotribuUon, diopenoinQ, poonaoaion, or use of controlled
substance is prohibited in the oponuo/ovvorbp|oca. and specifying the actions tobetaken against
employees for violation of such prohibition (2CFR§ 1B2.2O6).
El Yes [] No [] N64
2. An ongoing drug-free awareness program (2 CFR§ 182.215) has been or will be established
prior to commencement mf project to inform employees about:
' a. The dangers cf drug abuse in the workplace;
' b. The uponoor'o policy of maintaining e drug-free workplace;
o. Any available drug oounea|ing, rahabi|itodion, and employee assistance programs; and
d. The penalties that may be imposed upon employees for drug abuse violations occurring
in the workplace.
�Yes ONo El N/A
FAA Form s1OO'13O(1/17)SUPERSEDES PREVIOUS EDITION Page 1o,u
102
'
3. Each employee to be engaged in the performance of the work has been or will be given a copy of
the statement required within item 1 above prior bo commencement cf project(ZCFR§ 182.21O).
9Yoa El No ON/A
4. Employees have been or will be notified in the statement required by item 1 above that, as a
condition employment under the grant(3CFR§ 182.2O5(n)). the employee will:
a. Abide by the terms of the statement; and
b. Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five calendar days after such conviction,
ZYee El No El N/A
5. The Federal Aviation Administration (FAA)will be notified in writing within 10 calendar days after
receiving notice under item 4b above from an employee or otherwise receiving actual notice of
such conviction (2CFR§ 182.225). Employers of convicted employees must provide notice,
including position title of the employee, tn the FAA(2CFR§ 182.3OO).
0Yao El No El N/A
8. One of the following actions (2 CFR§ 182.326(b))wiU be taken within 30 calendar days nf
receiving a notice under item 4b above with respect to any employee who iaooconvicted:
o. Take appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended; and
b. Require such employee to participate satisfactorily in drug abuse assistance or
rehabilitation programs approved for such purposes by a federal, state, or local health,
law enforcement, or other appropriate agency.
QQYes ONo ON/A
7. A good faith effort will be made, on a continuous basis, to maintain a drug-free workplace through
implementation of items 1 through G above (3CFRQ1B2.2DD).
QQYes O No O N/A
Sitm(s) nf performance of work(2CFR§ 182.33U):
Location
Name cfLocation: Yakima Air Terminal'McAllister Field
Address: 23OOVV Washington,Ave, Yakima,VVA988O3
Location D (if applicable)
Name cfLocation: Yakima City Hall
( Address: 128N2nd Street, Yakima,VVA989O3
Location 3 (if applicable)
Name cfLocation:
Address:
FAA Form 51UO'13U(1/1T)SUPERSEDES PREVIOUS EDITION Page cma
103
Attach documentation clarifying any above item marked with a^No^ response.
' Spommor's Certification
I certify, for the project identified herein, responses to the forgoing items are accurate as marked and
additional documentation for any item marked''no^ io correct and complete.
Executed onthis day of . 2018
Name ofSponsor: City ofYakima
| Name ofGponoor'o Authorized Official: Cliff Moore
�
Title cfSponoor'o Authorized Official: City Manager '
'
Signature ofSponou/m Authorized Official:"
| I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and
� willfully providing false information hn the federal government iosviolation of18 U8C § 1001 (False
Statements) and could subject mebo fines, imphmonment. orboth.
FAA Form 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3
104
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100~131, Equipment and Construction Contracts —
Airport Improvement Sponsor Certification
) Paperwork Reduction Act Burden Statement
Afedeno|agency may not conduct or sponsor, and o person is not required to respond to, nor shall e
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The C)K8B Control Number for this information collection in 2120-0569. Public
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing inotructiono, searching existing data oounueo, gathering and maintaining
the data needod, completing and reviewing the collection of information. All responses to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of2CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at 800 Independence Ave. GVV. VVoohington, DC 20591.Attn: Information Collection
� Clearance Ofhcar.ASP-11U�
FAA Fonn51OO'181
105
u.a,Department mTransportation OMB CONTROL NUMBER: 2120-0569
14W Federal Aviation Administration EXPIRATION DATE: 8/31/2019
Equipment and Construction Contracts
Airport Improvement Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal McAllister Field
Project Number: 3'53'0045'2018
Description ofWork: Phase 1. Design RVVS'27H|RL& RVV Crack and Seal Coat
Application
48UGC§47105(d) authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (A|P), General procurement standards for equipment and construction contracts within Federal
grant programs are described in2CFR§Q2OD.317-280.328. Labor and Civil Rights Standards
applicable to the AIP are established by the Department of Labor(www.dol.gov)AIP Grant Assurance
CA—General Federal Requirements identifies all applicable Federal Lavve, neQu|aUono, executive orders,
po|inieo, guidelines and requirements for assistance under the A|P. Sponsors may use state and local
procedures provided the procurement conforms to these federal standards.
This certification applies to all equipment and construction projects. Equipment projects may or may not
employ laborers and mechanics that qualify the project as a"covered contract" under requirements
established by the Department of Labor requirements. Sponsor shall provide appropriate responses to
^ the certification statements that reflect the character of the project regardless of whether the contract is
for a construction project oron equipment project.
Certification Statements
Except for certification etmUamanto below marked as not applicable (N/A), this list includes major
requirements of the construction project. Selecting ^Yeo" represents sponsor acknowledgement and
confirmation of the certification statement. The term ''wi||^ means Sponsor action taken atappropriate
time based on the certification statement focus area, but no later than the and of the project period of
performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
| 1. A written code or standard of conduct is or will be in effect prior to commencement of the project
|
. that governs the performance cf the aponun/nofficers, emp|oyaee, ur agents in soliciting,
/ awarding and administering procurement contracts (2CFR§200.318).
59Yem O No O N/A
FAA Form 5100'131 (1/17)GUPER3EDES PREVIOUS EDITION Page of
106
^
%. For all contracts, qualified and competent personnel are or will be engaged to perform contract
administration, engineering supervision, construction inspection, and testing
(Grant Assurance C.17).
ZYoo ONo ONA\
3. Sponsors that are required to have a Disadvantage Business Enterprise (DBE) program on file
with the FAA have included or will include clauses required by Title V| ofthe Civil Rights Act and
49 CFR Part 26 for Disadvantaged Business Enterprises in all contracts and subcontracts.
QgYem O No O N/A
4. Sponsors required to have a DBE program on file with the FAA have implemented or will
implement monitoring and enforcement measures that:
a. Ensure work committed to Disadvantaged Business Enterprises at contract award is
actually performed by the named DBEs (48CFR§26.37(b));
b. Include written certification that the sponsor has reviewed contract records and has
monitored work sites for performance by DBE firms (4QCFR§3G.37(b)); and
u. Provides for a running tally of payments made to DBE firms and a means for comparing
actual attainments (i.e. payments)to original commitments (49CFR §28.37(c)).
QQYes O No O N/A
S. Sponsor procurement actions using the competitive sealed bid method (2 CFR§200.320(c)). was
or will be:
a. Publicly advertised, allowing a sufficient response time to solicit an adequate number of
interested contractors mrvendo��
.
i b. Prepared to include a complete, adequate and realistic specification that defines the
! items or services in sufficient detail to allow prospective bidders to respond;
'
! o. Publicly opened sdo time and place prescribed in the invitation for bids; and
! d. Prepared ine manner that result ine firm fixed price contract award to the lowest
! responsive and responsible bidder.
! QQYes [] No [] N/A
! G. For projects the Sponsor proposes to use the competitive proposal procurement method (2 CFR§
2OO.32O(d)). Sponsor has requested or will request FAA approval prior bz proceeding with m
competitive proposal procurement by submitting 0o the FAA the following:
� a. Written justification that supports use of competitive proposal method in lieu of the
| preferred aeo|ad bid procurement method;
b. Plan for publicizing and soliciting an adequate number of qualified sources: and
u. Listing of evaluation factors along with relative importance of the factors.
| QQYes O No O N/A
�
� 7. For construction and equipment installation pnojecto, the bid solicitation includes or will include the
� current federal wage rate schedule(s)for the appropriate type of work classifications (2 CFR Part
2OO.Appendix U).
QQYes ONo ON6A
� FAA Form 51O0'131 (1/17)SUPERSEDES PREVIOUS EDITION Page unf4
�
107
8. Concurrence was or will ba obtained from the Federal Aviation Administration (FAA) prior to
contract award under any of the following circumstances (Order 610O.38D):
a. Only one qualified penoon/finnsubmits o responsive bid;
b. Award intmbe made bo other than the lowest responsible bidder; and
c Life cycle costing iee factor in selecting the lowest responsive bidder.
QQYes El No ON/A -
Q. All construction and equipment installation contracts contain or will contain provisions for:
m. Access to Records(§2UU.33G)
b. Buy American Preferences (Title 4SU.G.C. § 5OiO1)
c. Civil Rights-General Provisions and Title V|Aoaunancoa(41CFR part 60)
d. Federal Fair Labor Standards (29U.8.C. §2O1. etaaq)
o. Occupational Safety and Health Act requirements (2OCFR part 1S2U)
[ Seismic Safety—building construction (49CFR part 41)
g. State Energy Conservation Requirements-as applicable(2 CFR part 200, Appendix 11)
h. U.8. Trade Restriction (4QCFFl part 3O)
i. Veterans Preference (4SUSC§47112(c))
9 Yes O No ON/A
10. All construction and equipment installation contracts exceeding s2.000oontain or will contain the
provisions established by:
� o. Davis-Bacon and Related Acts (29 CFR part 5) _
�
� b. Copeland ^/\ndi-Kiohbook^Act(2SCFR parts 3 and 5)
� Z Yes El No ON/A
11. All construction and equipment installation contracts exceeding $3.8OU contain or will contain o
contract provision that discourages distracted driving (E.O. 13513).
@QYes El No El N/A
13. All contracts exceeding $10.000contain or will contain the following provisions as applicable:
m. Construction and equipment installation projects-Applicable clauses from
41CFR Part GO for compliance with Executive Orders 11248 and 11375onEqual
Employment Opportunity;
b. Construction and equipment installation -ContnyctC|auoapvohibiting segregated facilities
in accordance with 41 CFRport 80-1.8;
o. Requirement to maximize use of products containing recovered materials in accordance
with 2CFR§2OO.322 and 4OCFRpart 247; and
d. Provisions that address termination for cause and termination for convenience
(2CFR Part 3OU.Appendix||).
� QQYea ONo [] N/A
|
' FAA Form 51UU'131 (1/17)SUPERSEDES PREVIOUS EDITION Page 3of4
108
13. All contracts and subcontracts exceeding $25.00O: Measures are in place or will bein place(a.g.
checking the System for Award Management)that ensure contracts and subcontracts are not
awarded to individuals or firms suspended, debarred, or excluded from participating in federally
assisted projects (2CFR parts 180 and 12OO).
ZYea [] No O N/A
14. Contracts exceeding the simplified acquisition threshold (currently$150,000) include or will include
proxiniono, as app|icab|o, that address the following:
o. Construction and equipment installation contracts-a bid guarantee of 5%. a performance
bond of1OO96. and m payment bond of1OUY6 (2CFF{§3O0.32S);
b. Construction and equipment installation contracts -naquinamantomfthaControctVVork
Hours and Safety Standards Act(4UUSC37O1-37O8. Sections 1O3 and 1O7);
c. Restrictions on Lobbying and Influencing (2CFR part%DU. Appendix||);
d. Conditions specifying administrative, contractual and legal remedies for instances where
contractor of vendor violate or breach the terms and conditions of the contract (2 CFR
§2OU.Appendix||); and
e. All Contracts-Applicable standards and requirements issued under Section 306 of the
Clean Air Act(42USC7401-7671q). Section 5O8of the Clean Water Act(33UGC1251'
1387. and Executive Order 11738.
D� Yes [] No [] N/A
Attach documentation clarifying any above item marked with"No" response.
Sponsor'sCmrtd5cmtion
I certify, for the project identified herein, responses to the forgoing items are accurate as marked and
� additional documentation for any item marked ^no^ in correct and complete.
Executed onthis day of . 2019
Name ofSponsor: City ufYakima �
Name of8ponoor'o Authorized Offioio|� Cliff Moore
Title ofGponuo/m Authorized Official: City Manager !
�
Signature nfGponour'o Authorized Official:
-
| declare under penalty cf perjury that the foregoing is true and correct. | understand that knowingly and
willfully providing false information to the federal government is a violation of 18 USC § 1001 (False
Statements) and could subject mo&ofines, imprisonment, or both.
FAA Form 51O0'1a1 (1/1r)SUPERSEDES PREVIOUS EDITION Page 4of4
109
�
U.G. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100.132, Project Plans and Specifications _ Airport
Improvement Program Sponsor Certification
� Paperwork Reduction Act Statement
'
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person besubject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays acurrently
valid OK88 Control Number. The OMB Control Number for this information collection is 2120'0569. Public
� reporting for this collection of information is estimated to be approximately 8 hours per response,
| �
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection �
| Clearance[)ffivar. AGP-118. f
� � -- --
FAA Form 5100-132
llO
u�.Department mTransportation -' B CONTROL NUMBER: 2120-0569
Federal Aviation Administration EXPIRATION DATE: 8/31/2019
Project Plans and Specifications
Airport Improvement Program Sponsor Certification
Sponsor: City ofYakima
Airport: Yakima Air Terminal McAllister Field
Project Number: 19
Description cfVVork� Phase 1. Design RVV9-o7M|nL& RVV Crack and Seal Coat
Application
49UGC§47105(d) authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (4|P). Labor and civil rights standards applicable toA|P are established by the Department of
Loborkwvmw.do|.gov0. AIP Grant Assurance CA—General Federal Requirements identifies applicable
hadona| |awo, negu|mUono, executive undenu, po|ioieo, guidelines and requirements for assistance under
A|P. A list of current advisory circulars with specific standards for procurement, design or construction of
mirpodu, and installation of equipment and facilities is referenced in standard airport sponsor Grant
Assurance 34 contained in the grant agreement.
Certification Statements
Except for certification statements below marked as not applicable (N64). this list includes major
requirements of the construction project. Selecting"Yes" represents sponsor acknowledgement and
confirmation of the certification statement. The term ^vvi||^ means Sponsor action taken atappropriate
time based on the certification statement focus area, but no later than the end of the project period of
performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source cf the requirement io referenced within
parenthesis.
1. The plans and specifications were or will be prepared in accordance with applicable federal
standards and requirements, so that no deviation or modification to standards set forth in the
advisory circulars, orFAA'aocmptad state mtandenj, is necessary other than those explicitly
approved by the Federal Aviation Administration (FA\) (14USC §471DS).
ZYee El No []N/A
2. Specifications incorporate or will incorporate a clear and accurate description of the technical
requirement for the material or product that does not contain limiting or proprietary features that
| unduly restrict competition (2CFR§3UO.31Q).
/
QQYes ONo ON/A
FAA Form 5100-132 (1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3
111
'
3. The development that is included or will be included in the plans is depicted on the current airport
layout plan mo approved by the FAA(14USC §471O7).
E9 Yes O No [] N/A
4. Development and haetunao that are ineligible or unallowable forA|P funding have been or will be
omitted from the plans and specifications(FAA Order 51UO.38. par. 3-43).
0Yeo El No ON/A
5. The specification does not use or will not use"brand name"or equal to convey requirements
unless sponsor requests and receives approval from the FAA to use brand name (FAA Order
5100.38. Table U-S).
9Yao El No ON/A
G. The specification does not impose or will not impose geographical preference in their
procurement requirements (2 CFR§2OO.31Q(b) and FAA Order 51OO.38. Table U-6).
QQ Yes O No ON/A
7. The use of prequalified lists of individuals, firms or products include or will include sufficient
qualified sources that ensure open and free competition and that does not preclude potential
entities from qualifying during the solicitation period (2 CFR§31Q(d)).
' QQ Yon O No El N/A
8. Solicitations with bid alternates include or will include explicit information that establish a basis for
award of contract that io free cf arbitrary decisions by the sponsor CZCFR§3OO.31O(a)(7)).
QQYeo El No El N/A
Q. Concurrence was or will be obtained from the FAA if Sponsor incorporates a value engineering
clause into the contract(FAA Order51OO.38. par. 3-57).
QQYes El No ON/A
10. The plans and specifications incorporate or will incorporate applicable requirements and
recommendations set forth in the federally approved environmental finding (49 USC§47108(c)).
QQ Yes O No El N/A
11. The design of all buildings comply or will comply with the seismic design requirements of 49 CFR
� §41.128. (FAA Order 51UO.38d. par. 3-92)
[] Yea [] No QQ N/A
12. The project specification include or will include process control and acceptance tests required for
the project byoo per the applicable standard: '
o. Construction and installation as contained in Advisory Circular(4C) 150/5370-10.
Q8Yes El No 0N64
112
kz Snow Removal Equipment oo contained inAC1SO/522O-M
[]Yes O No E9 N/A
c. Aircraft Rescue and Fire Fighting (ARFF)vehicles oocontained in AC 150/6320'10i
OYeo O No QQ N6A
'
13. For construction activities within or near aircraft operational anoae(AOA):
o. The Sponsor has or will prepare a construction safety and phasing plan (CSPP) conforming
bo Advisory Circular 15U/637O-2.
b. Compliance with CSPP safety provisions has been or will be incorporated into the plans
and specifications omo contractor requirement.
c. Sponsor will not initiate work until receiving FAA's concurrence with the CSPP (FAA Order
5100.38. Par. 5'28).
0Yeu O No ON/A
14. The project was or will be physically completed without federal participation in costs due to errors
and omissions in the plans and specifications that were foreseeable at the time of project design
(49USC§4711O(b)(1) and FAA Order 51UO.3Od. par. 3-1OO).
FNIYeo El No ON/A
Attach documentation clarifying any above item marked with "No" response.
/ Sponanr'sCmrtification
�
! | madify, for the project identified hensin, responses to the forgoing items are euoun*by as marked and
additional documentation for any item marked ^no'' ie correct and complete.
Executed onthis day of . 2019
Name of Sponsor: City nfYakima
�
Name ufGpmnsor'o Authorized Official: Cliff Moore
Title ofSponnor'o Authorized Official: City Manager
Signature of8ponmmr'm Authorized Offiuioi^ _
� | declare under penalty of perjury that the foregoing is true and correct. | understand that knowingly and
�
willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False
Statements) and could subject metofines, imprisonment, or both.
FAA Form 51OD'13o(1/17)SUPERSEDES PREVIOUS EDITION Page oma
113
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100.134, Selection of Consultants _ Airport
Improvement Program Sponsor Certification
Paperwork Reduction Act Statement '
Ahadena| agency may not conduct orsponsor, and m person is not required to respond to, nor shall n
person basubject to a penalty for failure to comply with a collection of information subject to the )
requirements of the Paperwork Reduction Act unless that collection of information displays a currently '
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0969. Public
reporting for this collection of information is estimated to be approximately 8 hours per response �
| �
! including the time for reviewing inotructiona, searching existing data omurneo. gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of
information are required under 4SU.Q.C. Section 47iO5to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ASP'11O.
FAA Form 5100-134
114
�� �
U.S.u�s�oeno�mo�mrmnopv�un OMB CONTROL NUMBER: 212O�50-
�m�� Federal Aviation EXPIRATION DATE: 8/31/201
Selection of Consultants
Airport Improvement Program Sponsor Certification
�
Sponsor'. City ofYakima
Airport: Yakima Air Terminal-McAllister Field
Project Number 3 18
Description ofVVorh�
� Phase 1. Design RVv9'z7M|RL& RVV Crack and Seal Coat
Application
49UGC §47105(d)authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (AIP). General requirements for selection of consultant services within federal grant programs
are daouhbad in 2 CFFl§§200.317-200.326. Sponsors may use other qualifications-based procedures
provided they are equivalent to standards of Title 4O chapter 11 and FAA Advisory Circular 15O/51OO-14.
Architectural, Engineering, and Planning Consultant Services for Airport Grant Projects.
� Certification Statements
�
� Except for certification statements below marked as not applicable(N/A), this list includes major
� requirements of the construction project. Selecting ^Yao^ represents sponsor acknowledgement and
; confirmation of the certification statement. The term"will" means Sponsor action taken at appropriate time
! based on the certification statement focus area, but no later than the and of the project period of
! performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all
! applicable statutory and administrative standards. The source of the requirement io referenced within
parenthesis.
1. Sponsor acknowledges their responsibility for the settlement of all contractual and administrative
issues arising out of their procurement actions (2CFR§200.318(h)).
QQYes []No ON/A ^
2. Sponsor procurement actions ensure or will ensure full and open competition that does not
unduly limit competition (2CFR§2DO.319).
QQYen []No [] N/A
3. Sponsor has excluded or will exclude any entity that develops or drafts specifications,
requirements, or statements of work associated with the development ufanmquoat-for-
qua|ifioadono (RF<])hnmnompeUngfortheadvartiaednen/iceo (2CFR§2OO.31S).
9Yeu El No 0N6A
FAA Form s1ou'1a4(a/17) SUPERSEDES PREVIOUS EDITION Page Iofx
115
4. The advertisement describes or will describe specific project statements-of-workthat provide
clear detail of required services without unduly restricting competition (2 CFR§2OO.319).
@QYes []No El N/A
6. Sponsor has publicized or will publicize aRFC>that:
o. Go|iuiho an adequate number of qualified sources (2 CFR§200.320(d)); and
b. Identifies all evaluation criteria and relative importance(2 CFR§200.320(d)).
QQYes El No ON/A
G. Sponsor has based or will base selection on qualifications, experience, and disadvantaged
business enterprise participation with price not being o selection factor(Z CFR§2OD.32U(d)).
QQYes ONo ON/4
7. Sponsor has verified or will verify that agreements exceeding $25,000 are not awarded to
individuals or firms suspended, debarred or otherwise excluded from participating in federally
assisted projects (3CFR§180.300).
0Yaa [I No El N/A
'
B. AJE services covering multiple projects: Sponsor has agreed boor will agree to:
m. Refrain from initiating work covered by this procurement beyond five years from the date
of selection (AC 15D/51OO-14); and
b. Retain the right to conduct new procurement actions for projects identified ornot
identified in the RFQ (AC 160/5100-14).
Z Yes El No El N/A
0. Sponsor has negotiated or will negotiate a fair and reasonable fee with the firm they select as
most qualified for the services identified in the RFC> (2 CFR§2OO.323).
QQYes []No El N/A
10. The Sponsor's contract identifies or will identify costs associated with ineligible work separately
from costs associated with eligible work(2 CFR§200.302).
QQYes []No []N/A
11. Sponsor has prepared or will prepare a record of negotiations detailing the history of the
procurement action, rationale for contract type and basis for contract fees (2 CFR§200.318(i)),^
QQYeu []No El N/A
12. Sponsor has incorporated or will incorporate mandatory contact provisions in the consultant
contract for AIP-assisted work (49 U.S.C. Chapter 471 and 2 CFR part 200 Appendix 11)
QQYeo []No ON/A
FAA Form 51U0'1s4(z/1r)SUPERSEDES PREVIOUS EDITION Page zv<n
116
13. For contracts that apply aU payment provision (also known oa hourly rates,
specific rates of compensation, and labor rates), the Sponsor has established or will mobub|iob:
o. Justification that there is no other suitable contract method for the services (2 CFR
§300.3180));
b. A ceiling price that the consultant exceeds at their risk (2 CFR§2OO.3180)); and
c. A high degree ofoversight that assures consultant io performing work inanefficient
manner with effective cost controls in place 3CFR§2OO.31O0)).
21Yem []No []N/A
14. Sponsor is not using or will not use the prohibited cost-plus-percentage-of-cost(CPPC) contract
method. (2CFR§200.323(d)).
9 Yes ONm El N/A
Attach documentation clarifying any above item marked with "no" response.
Spmnmmr`s Certification ^
�
| madify, for the project identified henain, responses tothe forgoing items are accurate as marked and
additional documentation for any item marked^no^ io correct and complete.
| declare under penalty ufparjurythat the foregoingia true and corne��� | understand that knovving|yand
�
� mx|Ku||y providing false information Uo the federal government is avio|sdion of18 USC§ 1001 (False
� Statements) and could subject metofines, imprisonment, or both.
�
Executed onthis day of . 2019
� Name ofSponsor: City ofYakima
Name cf8pnnmo/o Authorized Official: Cliff Moore
� Title ofSpnnonro Authorized Official: City Manager
�
Signature ofSponno/n Authorized Cfficial- �����
^ | declare under penalty of perjury that the foregoing is true and correct. | understand that knowingly and
willfully providing false information to the federal government is a violation of 18 USC§ 10O1 (False
Statements) and could subject mebofines, imprisonment, or both.
FAA Form 510-134(2/17)SUPERSEDES PREVIOUS EDITION Page no,o
117
'
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100~135, Certification and Disclosure Regarding
Potential Conflicts of Interest -- Airport Improvement Program
Sponsor Certification
�
� Paperwork Reduction Act Statement
Ahadero| agency may not conduct orsponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the |
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0568. Public
reporting for this collection of information is estimated to be approximately 8 hours per response, �
including the time for reviewing inutruutiona, searching existing data omunoma, gathering and maintaining '
the data naeded, completing and reviewing the collection of information. All responses tothis collection of
information are required under 4QU.S.C. Section 471O5to retain a benefit and to meet the reporting
� requirements of CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SVV. VVaohington, DC 20591. Attn: Information Collection
Clearance Officer,/\SP-11O.
FAA Form 5100-135
118
^�# U.S. opo�memmTmn�o�nn OMB � 2120��9
~
Federal Aviation Administration EXPIRATION DATE: 031/2O19
Certification and Disclosure Regarding Potential Conflicts of Interest
Airport Improvement Program Sponsor Certification
Sponsor: City of Yakima
Airport: Yakima Air Terminal-McAllister Field
Project Number: 19
Description ofWork: Phase 1. Design RVV9'D'H|RL&RVx Crack and Seal Coat
Application
Title 2CFR§2UD.113 and § 12U1.112 address Federal Aviation Administration (FA\) requirements for
conflict of interest. As a condition of eligibility under the Airport Improvement Program (AIP), sponsors
must comply with FAA policy on conflict ofinterest. Such m conflict would arise when any of the following
have a financial or other interest in the firm selected for award:
o) The emp|oyme, officer oragent,
b) Any member ufhis immediate family,
n) His mr her partner, or
,
d) /\n organization which employs, oris about Uo employ, any of the above.
Selecting "Yes" represents sponsor or sub-recipient acknowledgement and confirmation of the
certification statement. Ga|eodng "No" represents sponsor orsub-recipient disclosure that it cannot fully
comply with the certification statement. If"No" is selected, provide support information explaining the
negative response as an attachment to this form. This includes whether the sponsor has established
standards for financial interest that are not substantial or unsolicited gifts are of nominal value(2 CFR §
200.318(c)). The term "will" means Sponsor action taken at appropriate time based on the certification
statement focus area, but no later than the and of the project period of performance.
Certification Statements
1. The sponsor or sub-recipient maintains a written standards of conduct governing conflict of
interest and the performance of their employees engaged in the avvond and administration of
contracts (2CFR§200.318(c)). To the extent permitted by state or local law or regulations, such
standards of conduct provide for penalties, sanctions, or other disciplinary actions for violations of
such standards by the oponoo/u and sub-recipient's offioaro, emp|oyees, or agents, or by
contractors ur their agents.
QQYes [] No
FAA Form 51OO'135(2/17)SUPERSEDES PREVIOUS EDITION Page 1ufe
ll&
2. The sponsor's or sub-recipient's officers, employees or agents have not and will not solicit or -
accept gratuities, favors or anything of monetary value from contnactom, potential oortraotom, or
parties to sub-agreements (2 CFR§200.318(n)).
QQYes O No
3. The sponsor or sub-recipient certifies that is has disclosed and will disclose to the FAA any
, known potential conflict of interest(2CFR§ 1200.113).
�Yes ONo
Attach documentation clarifying any above item marked with ^no^ response,
Spomsor'aCertification
| certify, for the project identified herein, responses to the forgoing items are accurate ao marked and _
have the explanation for any item marked ''no^ io correct and complete.
' Executed onthis day of . 2019
Name ofSponsor: City ofYakima
Name ofSponaor'o Authorized Official: Cliff Moore
�
� Title of8ponsor'a Authorized <]fficiai City Manager
� Signature cfSponoo/aAuthorized Official-,,�~
. �
| declare under penalty of perjury that the foregoing is true and correct. | understand that knowingly and '
� | willfully providing false information to the federal government is e violation of 18 USC § 1001 (Fo|na
' | �
� Statements) and could subject meto fines, imprisonment, orboth. �
FAA Form 51oO'135(u/17)SUPERSEDES PREVIOUS EDITION Page%of2
. 120 �
REQUIRED STATEMENTS '
AIRPORT IMPROVEMENT PROGRAM PROJECTS
AIRPORT: Yakima Air Term ina|-McA||iater Field
| LOCATION: ....Y.P.,kiTa,Washington
AIP PROJECT NO.: 3-53-0089-043-2019
�
� STATEMENTS APPLICABLE TO THIS PROJECT Phase 1. Design RVVQ-27H|RL & RVVCraoh and Seal
Coat
a' INTEREST OF NEIGHBORING COMMUNITIES: In formulating this pnoject, consideration has been
| given to the interest of communities that are near(Exact name of airport)Yakima Air Term>nm|-K0cA|lister
Field.
b. THE DEVELOPMENT PROPOSED IN THIS PROJECT will not require the use of publicly owned land ,
from a public psrh, reoraotion area, wildlife and fowl nefuga, or historical site under Fedena|. State, or
^ Local jurisdiction.
|
m' FBO COORDINATION: The airport development proposed in this project has been coordinated with the
' Fixed Base Operator(s) utilizing (Exact name of airport) Yakima Air Term iQal-KHcAUister Fie|d, and they �
have been informed regarding the scope and nature of this project.
d. THE PROPOSED PROJECT IS CONSNSTE1NTvvith existing approved plans for the area surrounding the
airport.
The above statements have been duly considered and are applicable to this project. (Provide comment for any
statement not ohonhad).
BY: DATE: �
TITLE: City Manager '
SPONSORING AGENCY: City of Yakima
NOTE: Where opposition is stated to an airport development project,whether expressly orby proposed revision,the
following specific information concerning the opposition to the project must be furnished.
a. Identification of the Federal, state, or local governmental agency, or the person or persons opposing the project;
b, The nature and basis nfopposition;
c Spnnoor'o plan to accommodate or otherwise satisfy the opposition; .
� d. Whether an opportunity for a hearing was afforded, and if a hearing was held, an analysis of the facts developed at the hearing
as they relate to the social,economic, and environmental aspects of the proposed project and its consistency with the goals and
objectives of such urban planning oe has been carried out by the community.
e, |f the opponents proposed any alternatives,what these alternatives were and the reason for nonacceptance;
t Spunoor's plans, if any,(o minimize any adverse effects of the project;
g� Benefits tnbo gained by the proposed development; and
h� Any other pertinent information which would be of assistance in determining whether to proceed with the project,
121
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREE ENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member
of Congress in connection with the awarding of any Federal contract, the making of any Federal
Grant, the making of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan,
or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form LLL "Disclosure of Lobby Activities", in accordance with its
instructions.
3. The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipents shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails
to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
Signed Date
Sponsor's Authorized Representative
Title City Manager
1 22
TITLE VI PRE-AWARD SPONSOR CHECKLIST
Airport/Sponsor: City of Yakima
AIP#: 3-53-0089-043-2019
Project Description(s): Phase 1, Desi n RIN 9-27 HIRL & RW Crack and Seal Coat
1) Please describe any of the following IF they apply to your project: Title VI issues raised at public hearing(s)
and the conclusions made; EIS data concerning the race, color, or national origin of the affected
community; steps taken or proposed to guard against unnecessary impact on persons on the basis of
race, color or national origin.
None
2) Please list any airport related Title VI lawsuits or complaints filed in the preceding year against the
sponsor. Include a summary of the findings.
None (If"None", continue with questions 3 and 4).
3) Please list any current applications for federal funding (other than FAA) of airport related projects which
exceed the amount for this grant.
None
4) Please list any airport related Title VI compliance review(s) received by the sponsor in the preceding two
years. Include who conducted the review and any findings of noncompliance.
None
To be completed by the Civil Rights Staff
Review completed and approved:
Signature
Date:
This checklist is only required for projects that involve one of the following: Environmental Assessment or Impact
Statement(EIS); airport or runway relocation; major runway extension; relocation of any structure of person; or impact
to access or preservation of any burial ceremonial or other sacred or historical structures or lands of any indigenous or
ethnic population.
Return to: FAA,Civil Rights,Northwest Mountain Region; 1601 Lind Ave. SW; Renton,WA 98057-3356. FAX: (425)
227-1009 Phone(425)227-2009
123
Yakima Air Terminal - Mci6
ACP Development Application Checklist
3-53-0089-043-2019
r41. SF424
f 2. SF5100-100
U 3. CIP Data Sheet
f 4. Standard DOT Title VI Assurances
17 15. Certification for Contracts Grants Loans
f 6. Airport Sponsor Assurances
U7. Current FAA Advisory Circulars
® 8. SF5100-134 Sponsor Certification for Selection of Consultants
9. SF5100-132 Sponsor Certification for Plans and Specs
f 10. SF5100-131 Sponsor Certification for Equipment/Construction Contracts
U11. SF5100-129 Sponsor Certification for Project Final Acceptance
f 12. SF5100-130 Sponsor Certification for Drug Free Workplace
7 13. SF5100-133 Sponsor Certification for Land (Use only for Land Acquisition)
f 14. SF5100-135 Sponsor Certification for Conflict of Interest
�'15. Title VI Pre-Award Sponsor Checklist
124
CONTRACTOR CONTRACTUAL REQUIREMENTS
ATTACHMENT 1
During the performance of this contract, the contractor, for itself, its assignees and successors in interest
(hereinafter referred to as the "contractor") agrees as follows:
1. Compliance with Regulations. The contractor shall comply with the regulations relative to
nondiscrimination in federally assisted programs of the Department of Transportation (hereinafter, "DOT")
Title 49, Code of Federal Regulations, Part 21, as they may be amended from time to time (hereinafter
referred to as the Regulations), which are herein incorporated by reference and made a part of this contract.
2. Nondiscrimination. The contractor, with regard to the work performed by it during the contract, shall
not discriminate on the grounds of race, color, or national origin in the selection and retention of
subcontractors, including procurements of materials and leases of equipment. the contractor shall not
participate either directly of indirectly in the discrimination prohibited by section 21.5 of the Regulations,
including employment practices when the contract covers a program set forth in Appendix B of the
Regulations.
3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment. In all solicitations
either by competitive bidding or negotiation made by the contractor for work to be performed under a
subcontract, including procurements of materials or lease of equipment, each potential subcontractor or
supplier shall be notified by the contractor of the contractor's obligations under this contract and the
Regulations relative to nondiscrimination on the grounds of race, color, or national origin.
4. Information and Reports. The contractor shall provide all information and reports required by the
Regulations or directives issued pursuant thereto and shall permit access to its books, records, accounts,
other sources of information, and its facilities as may be determined by the Sponsor or the Federal Aviation
Administration (FAA) to be pertinent to ascertain compliance with such Regulations, orders, and instructions.
Where any information required of a contract is in the exclusive possession of another who fails or refuses to
furnish this information, the contractor shall so certify to the sponsor or the FAA, as appropriate, and shall
set forth what efforts it has made to obtain the information.
5. Sanctions for Noncompliance. In the event of the contractor's noncompliance with the
nondiscrimination provisions of this contract, the sponsor shall impose such contract sanctions as it or the
FAA may determine to be appropriate, including, but not limited to:
a. Withholding of payments to the contractor under the contract until the contractor complies, and/or
b. Cancellation, termination, or suspension of the contract, in whole or in part.
6. Incorporation of Provisions. The contractor shall include the provisions of paragraphs 1 through 5 in
every subcontract, including procurements of materials and leases of equipment, unless exempt by the
Regulations or directives issued pursuant thereto. The contractor shall take such action with respect to any
subcontract or procurement as the sponsor or the FAA may direct as a means of enforcing such provisions
including sanctions for noncompliance. Provided, however, that in the event a contractor becomes involved
in, or is threatened with, litigation with a subcontractor or supplier as a result of such direction, the contractor
may request the Sponsor to enter into such litigation to protect the interests of the sponsor and, in addition,
the contractor may request the United States to enter into such litigation to protect the interest of the United
States.
125
CLAUSES FOR DEEDS, LICENSES, LEASES, PER ITS OR SI ILAR INSTRUMENTS
ATTACHMENT 2
The following clauses shall be included in deeds, licenses, leases, permits, or similar instruments
entered into by the Sponsor pursuant to the provisions of Assurances 5(a) and 5(b).
1. The (grantee, licensee, permittee, etc., as appropriate) for himself, his heirs, personal
representatives, successors in interest, and assigns, as a part of the consideration
hereof, does hereby covenant and agree (in the case of deeds and leases add "as a
covenant running with the land") that in the event facilities are constructed,
maintained, or otherwise operated on the said property described in this (deed,
license, lease, permit, etc.) for a purpose for which a DOT program or activity is
extended or for another purpose involving the provision of similar services or benefits,
the (grantee, licensee, lessee, permittee, etc.) shall maintain and operate such
facilities and services in compliance with all other requirements imposed pursuant to
49 CFR Part 21, Nondiscrimination in Federally Assisted Programs of the Department
of Transportation, and as said Regulations may be amended.
2. The (grantee, licensee, lessee, permittee, etc., as appropriate) for himself, his heirs,
personal representatives, successors in interest, and assigns, as a part of the
consideration hereof, does hereby covenant and agree (in the case of deeds and
leases add "as a covenant running with the land") that: (1) no person on the grounds
of race, color, or national origin shall be excluded from participation in, denied the
benefits of, or be otherwise subjected to discrimination in the use of said facilities, (2)
that in the construction of any improvements on, over, or under such land and the
furnishing of services thereon, no person on the grounds of race, color, or national
origin shall be excluded from participation in, denied the benefits of, or otherwise be
subjected to discrimination, (3) that the (grantee, licensee, permittee, etc.) shall use
the premises in compliance with all other requirements imposed by or pursuant to 49
CFR Part 21, Nondiscrimination in Federally Assisted Programs of the Department of
Transportation, and as said Regulations may be amended.
}
126
� •: FAA
Airports
TaStViii
NillvisTok
Current FAA Advisory Circulars Required for Use in AIP
Funded and PFC Approved Projects
Updated: 4/18/2019
View the most current versions of these ACs and any associated changes at:
http://www.faa.Qov/airports/resources/advisory circulars and
http://wwwfaa.00v/regulations policies/advisory circulars/
.............:::..............::...
.:. ...:..:::::.
.
70/7460-1 L Obstruction Marking and Lighting
Change 2
150/5000-9A Announcement of Availability Report No. DOT/FAA/PP/92-5, Guidelines for
the Sound Insulation of Residences Exposed to Aircraft Operations
150/5000-17 Critical Aircraft and Regular Use Determination
150/5020-1 Noise Control and Compatibility Planning for Airports
150/5070-6B Airport Master Plans
Changes 1 -2
150/5070-7 The Airport System Planning Process
Change 1
150/5100-13B Development of State Standards for Nonprimary Airports
150/5200-28F Notices to Airmen (NOTAMs)for Airport Operators
150/5200-30D Airport Field Condition Assessments and Winter Operations Safety
Change 1
150/5200-31C Airport Emergency Plan
Changes 1 -2
150/5210-5D Painting, Marking, and Lighting of Vehicles Used on an Airport
150/5210-7D Aircraft Rescue and Fire Fighting Communications
150/5210-13C Airport Water Rescue Plans and Equipment
FAA Advisory Circulars Required for Use in Updated 4/18/2019 Page 1 of 5
AIP Funded and PFC Approved Projects ARP
127
�
' 150/5210'14B Aircraft Rescue Fire Fighting Equipment, Tools and Clothing
i 150/5210'15A Aircraft Rescue and Firefighting Station Building Design
|
| 150/5210-18A Systems for Interactive Training cf Airport Personnel
i 150/5210-19A Driver's Enhanced Vision System (OEVe
150/5220'10E Guide Specification for Aircraft Rescue and Fire Fighting (4RFF)Vehicles
150/6228-16E. Automated Weather Observing Systems (AWOS)for Non-Federal
Chonge1 Applications
' 150/5220-17B Aircraft Rescue and Fire Fighting (ARFF)Training Facilities
'
150/5220-18A Buildings for Storage and Maintenance of Airport Snow and Ice Control
Equipment and Materials
^ 150/5220-20A Airport Snow and Ice Control Equipment
150/6220-21C Aircraft Boarding Equipment
___ __
150/5220-22B Engineered Materials Arresting Systems(EN1AS)for Aircraft Overruns
� 150/5220-23 Frangible Connections
�
� 150/6220-24 Foreign Object Debris Detection Equipment
-
150/5220-25 Airport Avian Radar Systems
150/5220-26. Airport Ground Vehicle Automatic Dependent Surveillance' Broadcast(4OS'
Changen 1 '2 B) Out GquitterEquipment
_
150/5300-13A. Airport Design
Chnnga1
150/5300'14C Design of Aircraft Deicing Facilities
' 150/5300-16A General Guidance and Specifications for Aeronautical Surveys: Establishment
of Geodetic Control and Submission to the National Geodetic Survey
150/5300-17C Standards for Using Remote Sensing Technologies in Airport Surveys
Change1
150/530048B General Guidance and Specifications for Submission of Aeronautical Surveys
Ohenge1 toNG8: Field Data Collection and Geographic Information System (G|S)
Standards
150/5320-5D Airport Drainage Design
FAA Advisory Circulars Required for Use in upuooeu*/1muo10 Page omu
A|P Funded and PFo Approved Projects ARP
128
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.... ...r........ .r �.m r. r r.... . r..w.............::Y..::.w::::.r......:::::::::::.r:.r::.:..:.;......:::r.:::::::r ::::�:::s:.w::;r:i
150/5320-6F Airport Pavement Design and Evaluation
150/5320-12C, Measurement, Construction, and Maintenance of Skid Resistant Airport
Changes 1 - 8 Pavement Surfaces
150/5320-15A Management of Airport Industrial Waste
•
150/5325-4B Runway Length Requirements for Airport Design
•
•
150/5335-5C Standardized Method of Reporting Airport Pavement Strength - PCN
150/5340-1 L Standards for Airport Markings
150/5340-5D Segmented Circle Airport Marker System
150/5340-18F Standards for Airport Sign Systems
150/5340-26C Maintenance of Airport Visual Aid Facilities
150/5340-30J Design and Installation Details for Airport Visual Aids
150/5345-3G Specification for L-821, Panels for the Control of Airport Lighting
150/5345-5B Circuit Selector Switch
150/5345-7F Specification for L-824 Underground Electrical Cable for Airport Lighting
Circuits
150/5345-10H Specification for Constant Current Regulators and Regulator Monitors
150/5345-12F Specification for Airport and Heliport Beacons
150/5345-13B Specification for L-841 Auxiliary Relay Cabinet Assembly for Pilot Control of
Airport Lighting Circuits
150/5345-26D FAA Specification For L-823 Plug and Receptacle, Cable Connectors
150/5345-27E Specification for Wind Cone Assemblies
150/5345-28G Precision Approach Path Indicator(PAPI) Systems
150/5345-39D Specification for L-853, Runway and Taxiway Retroreflective Markers
150/5345-42H Specification for Airport Light Bases, Transformer Housings, Junction Boxes,
and Accessories
150/5345-43J Specification for Obstruction Lighting Equipment
FAA Advisory Circulars Required for Use in Updated 4/18/2019 Page 3 of 5
AIP Funded and PFC Approved Projects ARP
129
'ENUw.
r:.....r:.. �r.:::: :.v .. ... .......�:::....::.....: :::.:.... �:::::w::s::::mm::�::....s�:::....;;;:.;.r::::�::::w.::::::�::::::::�r:.::::r:::w=:ssw:::::::::�.;.;;:
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150/5345-44K Specification for Runway and Taxiway Signs
150/5345-45C Low-Impact Resistant(LIR) Structures
150/5345-46E Specification for Runway and Taxiway Light Fixtures
150/5345-47C Specification for Series to Series Isolation Transformers for Airport Lighting
Systems
150/5345-49D Specification L-854, Radio Control Equipment
150/5345-50B Specification for Portable Runway and Taxiway Lights
150/5345-51 B Specification for Discharge-Type Flashing Light Equipment
150/5345-52A Generic Visual Glideslope Indicators (GVGI)
150/5345-53D Airport Lighting Equipment Certification Program
150/5345-54B Specification for L-884, Power and Control Unit for Land and Hold Short
Lighting Systems
150/5345-55A Specification for L-893, Lighted Visual Aid to Indicate Temporary Runway
Closure
150/5345-56B Specification for L-890 Airport Lighting Control and Monitoring System
(ALCMS)
150/5360-12F Airport Signing and Graphics
150/5360-13A Airport Terminal Planning
150/5360-14A Access to Airports By Individuals With Disabilities
150/5370-2G Operational Safety on Airports During Construction
150/5370-10H Standard Specifications for Construction of Airports
150/5370-11 B Use of Nondestructive Testing in the Evaluation of Airport Pavements
150/5370-13A Off-Peak Construction of Airport Pavements Using Hot-Mix Asphalt
150/5370-15B Airside Applications for Artificial Turf
150/5370-16 Rapid Construction of Rigid (Portland Cement Concrete)Airfield Pavements
150/5370-17 Airside Use of Heated Pavement Systems
150/5390-2C Heliport Design
150/5395-1 B Seaplane Bases
FAA Advisory Circulars Required for Use in Updated 4/18/2019 Page 4 of 5
AIP Funded and PFC Approved Projects ARP
' 130
THE FOLLOWING ADDITIONAL APPLY TO AIP PROJECTS ONLY
i Updated: 3/22/2010
i 150/5100-14E. Archite
ctural, � Air
port Gnamd
ChenQe1 Projects
150/5180-17. Land Acquisition and Relocation Assistance for Airport Improvement Program
Changes 1 -7 Aaaimbyd Projects !
150/5300-15A Use of Value Engineering for Engineering and Design of Airport Grant Projects
-
150/5320-17A Airfield Pavement Surface Evaluation and Rating Manuals
150/5370-128 Quality Management for Federally Funded Airport Construction Projects
�
' 150/5380-8C Guidelines and Procedures for Maintenance of Airport Pavements
�
150/5380-7B Airport Pavement Management Program
150/5380'9 Guidelines and Procedures for Measuring Airfield Pavement Roughness
' .
FAA Advisory Circulars Required for Use m upuateu*womo10 --Page smn
mp Funded and PFC Approved Projects ARP
131
STANDARD DOT TITLE VI ASSURANCES
The City of Yakima (hereinafter referred to as the Sponsor) hereby agrees that as a condition
to receiving Federal financial assistance from the Department of Transportation (DOT), it will
comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) and all
requirements imposed by 49 CFR Part 21, Nondiscrimination in Federally Assisted Programs
of the Department of Transportation -- Effectuation of Title VI of the Civil Rights Act of 1964
(hereinafter referred to as the "Regulations") to the end that no person in the United States
shall, on the ground of race, color, or national origin, be excluded from participation in, be
denied the benefits of, or be otherwise subjected to discrimination under any program or
activity for which the applicant receives Federal financial assistance and will immediately take
any measures necessary to effectuate this agreement. Without limiting the above general
assurance, the Sponsor agrees concerning this grant that:
1. Each "program" and "facility" (as defined in Section 21.23(a) and 21.23(b)) will be
conducted or operated in compliance with all requirements of the Regulations.
2. It will insert the clauses of Attachment 1 of this assurance in every contract subject to the
Act and the Regulations.
3. Where Federal financial assistance is received to construct a facility, or part of a facility,
the assurance shall extend to the entire facility and facilities operated in connection therewith
4. Where Federal financial assistance is in the form or for the acquisition of real property or
an interest in real property, the assurance shall extend to rights to space on, over, or under
such property.
5. It will include the appropriate clauses set forth in Attachment 2 of this assurance, as a
covenant running with the land, in any future deeds, leases, permits, licenses, and similar
agreements entered into by the Sponsor with other parties:
(a) for the subsequent transfer of real property acquired or improved with Federal financial
assistance under this project; and
(b) for the construction or use of or access to space on, over, or under real property
acquired or improved with Federal financial assistance under this Project.
6. This assurance obligates the Sponsor for the period during which Federal financial
assistance is extended to the program, except where the Federal financial assistance is to
provide, or is in the form of personal property or real property or interest therein or structures
or improvements thereon, in which case the assurance obligates the Sponsor or any
transferee for the longer of the following periods:
(a) the period during which the property is used for a purpose for which Federal financial
assistance is extended, or for another purpose involving the provision of similar services or
benefits; or
(b) the period during which the Sponsor retains ownership or possession of the property.
7. It will provide for such methods of administration for the program as are found by the Secretary of
transportation of the official to whom he delegates specific authority to
give reasonable guarantees that it, other sponsors, subgrantees,
contractors, subcontractors,transferees, successors in interest, and
other participants of Federal financial assistance under such program
will comply with all requirements imposed or pursuant to the act,the
Regulations, and this assurance.
Page 1 of 2
STANDARD DOT TITLE VI ASSURANCES (Continued)
132
8. It agrees that the United States has a right to seek judicial enforcement with regard to any
matter arising under the Act, the Regulations, and this assurance.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining Federal financial assistance
for this Project and is binding on its contractors, the Sponsor, subcontractors, transferees, successors in
interest and other participants in the Project. The person or persons whose signatures appear below are
authorized to sign this assurance on behalf of the Sponsor.
DATED
Ci of Yakima
(Sponsor)
(Signature of Authorized Official)
�... Page 2 of 2
133
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ASSU ' NCES
Airport Sponsors
A. General.
1. These assurances shall be complied with in the performance of grant agreements for
airport development, airport planning, and noise compatibility program grants for
airport sponsors.
2. These assurances are required to be submitted as part of the project application by
sponsors requesting funds under the provisions of Title 49, U.S.C., subtitle VII, as
amended. As used herein, the term "public agency sponsor" means a public agency
with control of a public-use airport; the term "private sponsor" means a private owner
of a public-use airport; and the term "sponsor" includes both public agency sponsors
and private sponsors.
3. Upon acceptance of this grant offer by the sponsor, these assurances are incorporated
in and become part of this grant agreement.
B. Duration and Applicability.
1. Airport development or Noise Compatibility Program Projects Undertaken by a
Public Agency Sponsor.
The terms, conditions and assurances of this grant agreement shall remain in full
force and effect throughout the useful life of the facilities developed or equipment
acquired for an airport development or noise compatibility program project, or
throughout the useful life of the project items installed within a facility under a noise
compatibility program project, but in any event not to exceed twenty (20) years from
the date of acceptance of a grant offer of Federal funds for the project. However,
there shall be no limit on the duration of the assurances regarding Exclusive Rights
and Airport Revenue so long as the airport is used as an airport. There shall be no
limit on the duration of the terms, conditions, and assurances with respect to real
property acquired with federal funds. Furthermore, the duration of the Civil Rights
assurance shall be specified in the assurances.
2. Airport Development or Noise Compatibility Projects Undertaken by a Private
Sponsor.
The preceding paragraph I also applies to a private sponsor except that the useful life
of project items installed within a facility or the useful life of the facilities developed
or equipment acquired under an airport development or noise compatibility program
project shall be no less than ten (10) years from the date of acceptance of Federal aid
for the project.
Airport Sponsor Assurances 3/2014 Page I of 211
134
3. Airport Planning Undertaken by a Sponsor.
Unless otherwise specified in this grant agreement, only Assurances 1, 2, 3, 5, 6, 13,
18, 25, 30, 32, 33, and 34 in Section C apply to planning projects. The terms,
conditions, and assurances of this grant agreement shall remain in full force and effect
during the life of the project; there shall be no limit on the duration of the assurances
regarding Airport Revenue so long as the airport is used as an airport.
C. Sponsor Certification.
'[he sponsor hereby assures and certifies, with respect to this grant that:
1. General Federal Requirements.
It will comply with all applicable Federal laws, regulations, executive orders,
policies, guidelines, and requirements as they relate to the application, acceptance and
use of Federal funds for this project including but not limited to the following:
Federal Legislation
a. Title 49, U.S.C., subtitle VII, as amended.
b. Davis-Bacon Act- 40 U.S.C. 276(a), et seq.1
c. Federal Fair Labor Standards Act - 29 U.S.C. 201, et seq.
d. Hatch Act—5 U.S.C. 1501, et seq.2
e. Uniform Relocation Assistance and Real Property Acquisition Policies Act of
1970 Title 42 U.S.C. 4601, et seq.'2
f. National Historic Preservation Act of 1966 - Section 106 - 16 U.S.C. 470(0.1
g. Archeological and Historic Preservation Act of 1974 - 16 U.S.C. 469 through
469c.1
h. Native Americans Grave Repatriation Act- 25 U.S.C. Section 3001, et seq.
i. Clean Air Act, P.L. 90-148, as amended.
j. Coastal Zone Management Act, P.L. 93-205, as amended.
k. Flood Disaster Protection Act of 1973 - Section 102(a) -42 U.S.C. 4012a.I
1. Title 49, U.S.C., Section 303, (formerly known as Section 4(f))
m. Rehabilitation Act of 1973 - 29 U.S.C. 794.
n. Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252)
(prohibits discrimination on the basis of race, color, national origin);
o. Americans with Disabilities Act of 1990, as amended, (42 U.S.C. § 12101 et
seq.), prohibits discrimination on the basis of disability).
p. Age Discrimination Act of 1975 - 42 U.S.C. 6101, et seq.
q. American Indian Religious Freedom Act, P.L. 95-341, as amended.
r. Architectural Barriers Act of 1968 -42 U.S.C. 4151, et seq.I
s. Power plant and Industrial Fuel Use Act of 1978 - Section 403- 2 U.S.C. 8373.1
t. Contract Work Hours and Safety Standards Act - 40 U.S.C. 327, et seq.'
u. Copeland Anti-kickback Act - 18 U.S.C. 874.1
v. National Environmental Policy Act of 1969 -42 U.S.C. 4321, et seq.I
w. Wild and Scenic Rivers Act, P,L. 90-542, as amended.
x. Single Audit Act of 1984 - 31 U.S.C. 7501, et seq.2
y. Drug-Free Workplace Act of 1988 - 41 U.S.C. 702 through 706.
Airport Sponsor Assurances 3/2014 Page 2 of 20
135
z. The Federal Funding Accountability and Transparency Act of 2006, as amended
(Pub. L. 109-282, as amended by section 6202 of Pub. L. 110-252).
Executive Orders
a. Executive Order 11246 - Equal Employment Opportunity
b. Executive Order 11990 - Protection of Wetlands
c. Executive Order 11998—Flood Plain Management
d. Executive Order 12372 - Intergovernmental Review of Federal Programs
e. Executive Order 12699 - Seismic Safety of Federal and Federally Assisted New
Building Construction'
f. Executive Order 12898 - Environmental Justice
Federal Regulations
a. 2 CFR Part 180 - OMB Guidelines to Agencies on Governmentwide Debarment
and Suspension (Nonprocurement).
b. 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards. [OMB Circular A-87 Cost Principles
Applicable to Grants and Contracts with State and Local Governments, and OMB
Circular A-133 - Audits of States, Local Governments, and Non-Profit
Organizations].4'5'6
c. 2 CFR Part 1200—Nonprocurement Suspension and Debarment
d. 14 CFR Part 13 - Investigative and Enforcement Procedures14 CFR Part 16 -
Rules of Practice For Federally Assisted Airport Enforcement Proceedings.
e. 14 CFR Part 150 - Airport noise compatibility planning.
f. 28 CFR Part 35- Discrimination on the Basis of Disability in State and Local
Government Services.
g. 28 CFR § 50.3 - U.S. Department of Justice Guidelines for Enforcement of Title
VI of the Civil Rights Act of 1964.
h. 29 CFR Part 1 - Procedures for predetermination of wage rates.'
i. 29 CFR Part 3 - Contractors and subcontractors on public building or public work
financed in whole or part by loans or grants from the United States.1
j. 29 CFR Part 5 - Labor standards provisions applicable to contracts covering
federally financed and assisted construction (also labor standards provisions
applicable to non-construction contracts subject to the Contract Work Hours and
Safety Standards Act).'
k. 41 CFR Part 60 - Office of Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor(Federal and federally assisted
contracting requirements).1
I. 49 CFR Part 18 - Uniform administrative requirements for grants and cooperative
agreements to state and local governments.3
m. 49 CFR Part 20 - New restrictions on lobbying.
n. 49 CFR Part 21 —Nondiscrimination in federally-assisted programs of the
Department of Transportation - effectuation of Title VI of the Civil Rights Act of
1964.
o. 49 CFR Part 23 - Participation by Disadvantage Business Enterprise in Airport
Concessions.
Airport Sponsor Assurances 3/2014 Page 3 of 20
136
p. 49 CFR Part 24 — Unifo Relocation Assistance and Real Property Acquisition
for Federal and Federally Assisted Programs.' 2
q. 49 CFR Part 26—Participation by Disadvantaged Business Enterprises in
Department of Transportation Programs.
r. 49 CFR Part 27—Nondiscrimination on the Basis of Handicap in Programs and
Activities Receiving or Benefiting from Federal Financial Assistance.'
s. 49 CFR Part 28—Enforcement of Nondiscrimination on the Basis of Handicap in
Programs or Activities conducted by the Department of Transportation.
t. 49 CFR Part 30 - Denial of public works contracts to suppliers of goods and
services of countries that deny procurement market access to U.S. contractors.
u. 49 CFR Part 32—Governmentwide Requirements for Drug-Free Workplace
(Financial Assistance)
v. 49 CFR Part 37 —Transportation Services for Individuals with Disabilities
(ADA).
w. 49 CFR Part 41 - Seismic safety of Federal and federally assisted or regulated
new building construction.
Specific Assurances
Specific assurances required to be included in grant agreements by any of the above
laws, regulations or circulars are incorporated by reference in this grant agreement.
Footnotes to Assurance C.1.
1 These laws do not apply to airport planning sponsors.
2
These laws do not apply to private sponsors.
3
49 CFR Part 18 and 2 CFR Part 200 contain requirements for State and Local
Governments receiving Federal assistance. Any requirement levied upon State
and Local Governments by this regulation and circular shall also be applicable
to private sponsors receiving Federal assistance under Title 49, United States
Code.
4
On December 26, 2013 at 78 FR 78590, the Office of Management and Budget
(OMB) issued the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200. 2 CFR Part 200
replaces and combines the former Uniform Administrative Requirements for
Grants (OMB Circular A-102 and Circular A-110 or 2 CFR Part 215 or
Circular) as well as the Cost Principles (Circulars A-21 or 2 CFR part 220;
Circular A-87 or 2 CFR part 225; and A-122, 2 CFR part 230). Additionally it
replaces Circular A-133 guidance on the Single Annual Audit. In accordance
with 2 CFR section 200.110, the standards set forth in Part 200 which affect
administration of Federal awards issued by Federal agencies become effective
once implemented by Federal agencies or when any future amendment to this
Part becomes final. Federal agencies, including the Department of
Transportation, must implement the policies and procedures applicable to
Federal awards by promulgating a regulation to be effective by December 26,
2014 unless different provisions are required by statute or approved by OMB.
Airport Sponsor Assurances 3/20 14 Page 4 of 20
137
5 Cost principles established in 2 CFR part 200 subpart E must be used as
guidelines for determining the eligibility of specific types of expenses.
6
Audit requirements established in 2 CFR part 200 subpart F are the guidelines
for audits.
2. Responsibility and Authority of the Sponsor.
a. Public Agency Sponsor:
It has legal authority to apply for this grant, and to finance and carry out the proposed
project; that a resolution, motion or similar action has been duly adopted or passed as
an official act of the applicant's governing body authorizing the filing of the
application, including all understandings and assurances contained therein, and
directing and authorizing the person identified as the official representative of the
applicant to act in connection with the application and to provide such additional
information as may be required.
b. Private Sponsor:
It has legal authority to apply for this grant and to finance and carry out the proposed
project and comply with all terms, conditions, and assurances of this grant agreement.
It shall designate an official representative and shall in writing direct and authorize
that person to file this application, including all understandings and assurances
contained therein; to act in connection with this application; and to provide such
additional information as may be required.
3. Sponsor Fund Availability.
It has sufficient funds available for that portion of the project costs which are not to
be paid by the United States. It has sufficient funds available to assure operation and
maintenance of items funded under this grant agreement which it will own or control.
4. Good Title.
a. It, a public agency or the Federal government, holds good title, satisfactory to the
Secretary, to the landing area of the airport or site thereof, or will give assurance
satisfactory to the Secretary that good title will be acquired.
b. For noise compatibility program projects to be carried out on the property of the
sponsor, it holds good title satisfactory to the Secretary to that portion of the
property upon which Federal funds will be expended or will give assurance to the
Secretary that good title will be obtained.
5. Preserving Rights and Powers.
a. It will not take or permit any action which would operate to deprive it of any of
the rights and powers necessary to perform any or all of the terms, conditions, and
assurances in this grant agreement without the written approval of the Secretary,
and will act promptly to acquire, extinguish or modify any outstanding rights or
claims of right of others which would interfere with such performance by the
sponsor. This shall be done in a manner acceptable to the Secretary.
Airport Sponsor Assurances 3/2014 Page 5 of 20
1 38
b. It will not sell, lease, encumber, or otherwise transfer or dispose of any part of its
title or other interests in the property shown on Exhibit A to this application or,
for a noise compatibility program project, that portion of the property upon which
Federal funds have been expended, for the duration of the terms, conditions, and
assurances in this grant agreement without approval by the Secretary. If the
transferee is found by the Secretary to be eligible under Title 49, United States
Code, to assume the obligations of this grant agreement and to have the power,
authority, and financial resources to carry out all such obligations, the sponsor
•
shall insert in the contract or document transferring or disposing of the sponsor's
interest, and make binding upon the transferee all of the terms, conditions, and
assurances contained in this grant agreement.
c. For all noise compatibility program projects which are to be carried out by
another unit of local government or are on property owned by a unit of local
government other than the sponsor, it will enter into an agreement with that
government. Except as otherwise specified by the Secretary, that agreement shall
obligate that government to the same terms, conditions, and assurances that would
be applicable to it if it applied directly to the FAA for a grant to undertake the
noise compatibility program project. That agreement and changes thereto must be
satisfactory to the Secretary. It will take steps to enforce this agreement against
the local government if there is substantial non-compliance with the terms of the
agreement.
d. For noise compatibility program projects to be carried out on privately owned
property, it will enter into an agreement with the owner of that property which
includes provisions specified by the Secretary. It will take steps to enforce this
agreement against the property owner whenever there is substantial non-
compliance with the terms of the agreement.
e. If the sponsor is a private sponsor, it will take steps satisfactory to the Secretary to
ensure that the airport will continue to function as a public-use airport in
accordance with these assurances for the duration of these assurances.
f. If an arrangement is made for management and operation of the airport by any
agency or person other than the sponsor or an employee of the sponsor, the
sponsor will reserve sufficient rights and authority to insure that the airport will
be operated and maintained in accordance Title 49, United States Code, the
regulations and the terms, conditions and assurances in this grant agreement and
shall insure that such arrangement also requires compliance therewith.
g. Sponsors of commercial service airports will not permit or enter into any
arrangement that results in permission for the owner or tenant of a property used
as a residence, or zoned for residential use, to taxi an aircraft between that
property and any location on airport. Sponsors of general aviation airports
entering into any arrangement that results in permission for the owner of
residential real property adjacent to or near the airport must comply with the
requirements of Sec. 136 of Public Law 112-95 and the sponsor assurances.
Airport Sponsor Assuranccs 3/20 I 4 Page 6 of 20
139
6. Consistency with Local Plans.
The project is reasonably consistent with plans (existing at the time of submission of
this application)of public agencies that are authorized by the State in which the
project is located to plan for the development of the area surrounding the airport.
7. Consideration of Local Interest.
It has given fair consideration to the interest of communities in or near where the
project may be located.
8. Consultation with Users.
In making a decision to undertake any airport development project under Title 49,
United States Code, it has undertaken reasonable consultations with affected parties
using the airport at which project is proposed.
9. Public Hearings.
In projects involving the location of an airport, an airport runway, or a major runway
extension, it has afforded the opportunity for public hearings for the purpose of
considering the economic, social, and environmental effects of the airport or runway
location and its consistency with goals and objectives of such planning as has been
carried out by the community and it shall, when requested by the Secretary, submit a
copy of the transcript of such hearings to the Secretary. Further, for such projects, it
has on its management board either voting representation from the communities
where the project is located or has advised the communities that they have the right to
petition the Secretary concerning a proposed project.
10. Metropolitan Planning Organization.
In projects involving the location of an airport, an airport runway, or a major runway
extension at a medium or large hub airport, the sponsor has made available to and has
provided upon request to the metropolitan planning organization in the area in which
the airport is located, if any, a copy of the proposed amendment to the airport layout
plan to depict the project and a copy of any airport master plan in which the project is
described or depicted.
II. Pavement Preventive Maintenance.
With respect to a project approved after January 1, 1995, for the replacement or
reconstruction of pavement at the airport, it assures or certifies that it has
implemented an effective airport pavement maintenance-management program and it
assures that it will use such program for the useful life of any pavement constructed,
reconstructed or repaired with Federal financial assistance at the airport. It will
provide such reports on pavement condition and pavement management programs as
the Secretary determines may be useful.
12. Terminal Development Prerequisites.
For projects which include terminal development at a public use airport, as defined in
Title 49, it has, on the date of submittal of the project grant application, all the safety
equipment required for certification of such airport under section 44706 of Title 49,
United States Code, and all the security equipment required by rule or regulation, and
Airport Sponsor Assurances 3/2014 Page 7 of 20
140
has provided for access to the passenger enplaning and deplaning area of such airport
to passengers enplaning and deplaning from aircraft other than air carrier aircraft.
13. Accounting System, Audit, and Record Keeping Requirements.
a. It shall keep all project accounts and records which fully disclose the amount and
disposition by the recipient of the proceeds of this grant, the total cost of the
project in connection with which this grant is given or used, and the amount or
nature of that portion of the cost of the project supplied by other sources, and such
other financial records pertinent to the project. The accounts and records shall be
kept in accordance with an accounting system that will facilitate an effective audit
in accordance with the Single Audit Act of 1984.
b. It shall make available to the Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, for the purpose of audit and
examination, any books, documents, papers, and records of the recipient that are
pertinent to this grant. The Secretary may require that an appropriate audit be
conducted by a recipient. In any case in which an independent audit is made of the
accounts of a sponsor relating to the disposition of the proceeds of a grant or
relating to the project in connection with which this grant was given or used, it
shall file a certified copy of such audit with the Comptroller General of the United
States not later than six (6) months following the close of the fiscal year for which
the audit was made.
14. Minimum Wage Rates.
It shall include, in all contracts in excess of$2,000 for work on any projects funded
under this grant agreement which involve labor, provisions establishing minimum
rates of wages, to be predetermined by the Secretary of Labor, in accordance with the
Davis-Bacon Act, as amended (40 U.S.C. 276a-276a-5), which contractors shall pay
to skilled and unskilled labor, and such minimum rates shall be stated in the invitation
for bids and shall be included in proposals or bids for the work.
15. Veteran's Preference.
It shall include in all contracts for work on any project funded under this grant
agreement which involve labor, such provisions as are necessary to insure that, in the
employment of labor(except in executive, administrative, and supervisory positions),
preference shall be given to Vietnam era veterans, Persian Gulf veterans,
Afghanistan-Iraq war veterans, disabled veterans, and small business concerns owned
and controlled by disabled veterans as defined in Section 47112 of Title 49, United
States Code. However, this preference shall apply only where the individuals are
available and qualified to perform the work to which the employment relates.
16. Conformity to Plans and Specifications.
It will execute the project subject to plans, specifications, and schedules approved by
the Secretary. Such plans, specifications, and schedules shall be submitted to the
Secretary prior to commencement of site preparation, construction, or other
performance under this grant agreement, and, upon approval of the Secretary, shall be
incorporated into this grant agreement. Any modification to the approved plans,
Airport Sponsor Assurances 3/20 14 Page 8 of 20
1 41
specifications, and schedules shall also be subject to approval of the Secretary, and
incorporated into this grant agreement.
17. Construction Inspection and Approval.
It will provide and maintain competent technical supervision at the construction site
throughout the project to assure that the work conforms to the plans, specifications,
and schedules approved by the Secretary for the project. It shall subject the
construction work on any project contained in an approved project application to
inspection and approval by the Secretary and such work shall be in accordance with
regulations and procedures prescribed by the Secretary. Such regulations and
procedures shall require such cost and progress reporting by the sponsor or sponsors
of such project as the Secretary shall deem necessary.
18. Planning Projects.
In carrying out planning projects:
a. It will execute the project in accordance with the approved program narrative
contained in the project application or with the modifications similarly approved.
b. It will furnish the Secretary with such periodic reports as required pertaining to
the planning project and planning work activities.
c. It will include in all published material prepared in connection with the planning
project a notice that the material was prepared under a grant provided by the
United States.
d. It will make such material available for examination by the public, and agrees that
no material prepared with funds under this project shall be subject to copyright in
the United States or any other country.
e. It will give the Secretary unrestricted authority to publish, disclose, distribute, and
otherwise use any of the material prepared in connection with this grant,
f. It will grant the Secretary the right to disapprove the sponsor's employment of
specific consultants and their subcontractors to do all or any part of this project as
well as the right to disapprove the proposed scope and cost of professional
services.
g. It will grant the Secretary the right to disapprove the use of the sponsor's
employees to do all or any part of the project.
h. It understands and agrees that the Secretary's approval of this project grant or the
Secretary's approval of any planning material developed as part of this grant does
not constitute or imply any assurance or commitment on the part of the Secretary
to approve any pending or future application for a Federal airport grant.
19. Operation and Maintenance.
a. The airport and all facilities which are necessary to serve the aeronautical users of
the airport, other than facilities owned or controlled by the United States, shall be
operated at all times in a safe and serviceable condition and in accordance with
the minimum standards as may be required or prescribed by applicable Federal,
Airport Sponsor Assurances 3/2014 Page 9 of 20
1 42
state and local agencies for maintenance and operation. It will not cause or permit
any activity or action thereon which would interfere with its use for airport
purposes. It will suitably operate and maintain the airport and all facilities thereon
or connected therewith, with due regard to climatic and flood conditions. Any
proposal to temporarily close the airport for non-aeronautical purposes must first
be approved by the Secretary. In furtherance of this assurance, the sponsor will
have in effect arrangements for-
!) Operating the airport's aeronautical facilities whenever required;
2) Promptly marking and lighting hazards resulting from airport conditions,
including temporary conditions; and
3) Promptly notifying airmen of any condition affecting aeronautical use of the
airport. Nothing contained herein shall be construed to require that the airport
be operated for aeronautical use during temporary periods when snow, flood
or other climatic conditions interfere with such operation and maintenance.
Further, nothing herein shall be construed as requiring the maintenance,
repair, restoration, or replacement of any structure or facility which is
substantially damaged or destroyed due to an act of God or other condition or
circumstance beyond the control of the sponsor.
b. It will suitably operate and maintain noise compatibility program items that it
owns or controls upon which Federal funds have been expended.
20. Hazard Removal and Mitigation.
It will take appropriate action to assure that such terminal airspace as is required to
protect instrument and visual operations to the airport (including established
minimum flight altitudes) will be adequately cleared and protected by removing,
lowering, relocating, marking, or lighting or otherwise mitigating existing airport
hazards and by preventing the establishment or creation of future airport hazards.
21 Compatible Land Use.
It will take appropriate action, to the extent reasonable, including the adoption of
zoning laws, to restrict the use of land adjacent to or in the immediate vicinity of the
airport to activities and purposes compatible with normal airport operations, including
landing and takeoff of aircraft. In addition, if the project is for noise compatibility
program implementation, it will not cause or permit any change in land use, within its
jurisdiction, that will reduce its compatibility, with respect to the airport, of the noise
compatibility program measures upon which Federal funds have been expended.
22. Economic Nondiscrimination.
a. It will make the airport available as an airport for public use on reasonable terms
and without unjust discrimination to all types, kinds and classes of aeronautical
activities, including commercial aeronautical activities offering services to the
public at the airport.
b. In any agreement, contract, lease, or other arrangement under which a right or
privilege at the airport is granted to any person, firm, or corporation to conduct or
Airport Sponsor Assurances 3/2014 Page 10 of 20
143
to engage in any aeronautical activity for furnishing services to the public at the
airport, the sponsor will insert and enforce provisions requiring the contractor to-
1) furnish said services on a reasonable, and not unjustly discriminatory, basis to
all users thereof, and
2) charge reasonable, and not unjustly discriminatory, prices for each unit or
service, provided that the contractor may be allowed to make reasonable and
nondiscriminatory discounts, rebates, or other similar types of price reductions
to volume purchasers.
c. Each fixed-based operator at the airport shall be subject to the same rates, fees,
rentals, and other charges as are uniformly applicable to all other fixed-based
operators making the same or similar uses of such airport and utilizing the same
or similar facilities.
d. Each air carrier using such airport shall have the right to service itself or to use
any fixed-based operator that is authorized or permitted by the airport to serve any
air carrier at such airport.
e. Each air carrier using such airport (whether as a tenant, non-tenant, or subtenant
of another air carrier tenant) shall be subject to such nondiscriminatory and
substantially comparable rules, regulations, conditions, rates, fees, rentals, and
other charges with respect to facilities directly and substantially related to
providing air transportation as are applicable to all such air carriers which make
similar use of such airport and utilize similar facilities, subject to reasonable
classifications such as tenants or non-tenants and signatory carriers and non-
signatory carriers. Classification or status as tenant or signatory shall not be
unreasonably withheld by any airport provided an air carrier assumes obligations
substantially similar to those already imposed on air carriers in such classification
or status.
f. It will not exercise or grant any right or privilege which operates to prevent any
person, firm, or corporation operating aircraft on the airport from performing any
services on its own aircraft with its own employees [including, but not limited to
maintenance, repair, and fueling] that it may choose to perform.
g. In the event the sponsor itself exercises any of the rights and privileges referred to
in this assurance, the services involved will be provided on the same conditions as
would apply to the furnishing of such services by commercial aeronautical service
providers authorized by the sponsor under these provisions.
h. The sponsor may establish such reasonable, and not unjustly discriminatory,
conditions to be met by all users of the airport as may be necessary for the safe
and efficient operation of the airport.
i. The sponsor may prohibit or limit any given type, kind or class of aeronautical
use of the airport if such action is necessary for the safe operation of the airport or
necessary to serve the civil aviation needs of the public.
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144
23. Exclusive Rights.
It will permit no exclusive right for the use of the airport by any person providing, or
intending to provide, aeronautical services to the public. For purposes of this
paragraph, the providing of the services at an airport by a single fixed-based operator
shall not be construed as an exclusive right if both of the following apply:
a. It would be unreasonably costly, burdensome, or impractical for more than one
fixed-based operator to provide such services, and
b. If allowing more than one fixed-based operator to provide such services would
require the reduction of space leased pursuant to an existing agreement between
such single fixed based operator and such airport. It further agrees that it will not,
either directly or indirectly, grant or permit any person, firm, or corporation, the
exclusive right at the airport to conduct any aeronautical activities, including, but
not limited to charter flights, pilot training, aircraft rental and sightseeing, aerial
photography, crop dusting, aerial advertising and surveying, air carrier operations,
aircraft sales and services, sale of aviation petroleum products whether or not
conducted in conjunction with other aeronautical activity, repair and maintenance
of aircraft, sale of aircraft parts, and any other activities which because of their
direct relationship to the operation of aircraft can be regarded as an aeronautical
activity, and that it will terminate any exclusive right to conduct an aeronautical
activity now existing at such an airport before the grant of any assistance under
Title 49, United States Code.
24. Fee and Rental Structure.
It will maintain a fee and rental structure for the facilities and services at the airport
which will make the airport as self-sustaining as possible under the circumstances
existing at the particular airport, taking into account such factors as the volume of
traffic and economy of collection. No part of the Federal share of an airport
development, airport planning or noise compatibility project for which a grant is
made under Title 49, United States Code, the Airport and Airway Improvement Act
of 1982, the Federal Airport Act or the Airport and Airway Development Act of 1970
shall be included in the rate basis in establishing fees, rates, and charges for users of
that airport.
25. Airport Revenues.
a. All revenues generated by the airport and any local taxes on aviation fuel
established after December 30, 1987, will be expended by it for the capital or
operating costs of the airport; the local airport system; or other local facilities
which are owned or operated by the owner or operator of the airport and which
are directly and substantially related to the actual air transportation of passengers
or property; or for noise mitigation purposes on or off the airport. The following
exceptions apply to this paragraph:
I) If covenants or assurances in debt obligations issued before September 3,
1982, by the owner or operator of the airport, or provisions enacted before
September 3, 1982, in governing statutes controlling the owner or operator's
financing, provide for the use of the revenues from any of the airport owner or
Airport Sponsor Assurances 3/2014 Page 12 of 20
1 45
operator's facilities, including the airport, to support not only the airport but
also the airport owner or operator's general debt obligations or other facilities,
then this limitation on the use of all revenues generated by the airport(and, in
the case of a public airport, local taxes on aviation fuel) shall not apply.
2) If the Secretary approves the sale of a privately owned airport to a public
sponsor and provides funding for any portion of the public sponsor's
acquisition of land, this limitation on the use of all revenues generated by the
sale shall not apply to certain proceeds from the sale. This is conditioned on
repayment to the Secretary by the private owner of an amount equal to the
remaining unamortized portion (amortized over a 20-year period)of any
airport improvement grant made to the private owner for any purpose other
than land acquisition on or after October 1, 1996, plus an amount equal to the
federal share of the current fair market value of any land acquired with an
airport improvement grant made to that airport on or after October 1, 1996.
3) Certain revenue derived from or generated by mineral extraction, production,
lease, or other means at a general aviation airport(as defined at Section 47102
of title 49 United States Code), if the FAA determines the airport sponsor
meets the requirements set forth in Sec. 813 of Public Law 112-95.
b. As part of the annual audit required under the Single Audit Act of 1984, the
sponsor will direct that the audit will review, and the resulting audit report will
provide an opinion concerning, the use of airport revenue and taxes in paragraph
(a), and indicating whether funds paid or transferred to the owner or operator are
paid or transferred in a manner consistent with Title 49, United States Code and
any other applicable provision of law, including any regulation promulgated by
the Secretary or Administrator.
c. Any civil penalties or other sanctions will be imposed for violation of this
assurance in accordance with the provisions of Section 47107 of Title 49, United
States Code.
26. Reports and Inspections.
It will:
a. submit to the Secretary such annual or special financial and operations reports as
the Secretary may reasonably request and make such reports available to the
public; make available to the public at reasonable times and places a report of the
airport budget in a format prescribed by the Secretary;
b. for airport development projects, make the airport and all airport records and
documents affecting the airport, including deeds, leases, operation and use
agreements, regulations and other instruments, available for inspection by any
duly authorized agent of the Secretary upon reasonable request;
c. for noise compatibility program projects, make records and documents relating to
the project and continued compliance with the terms, conditions, and assurances
of this grant agreement including deeds, leases, agreements, regulations, and other
instruments, available for inspection by any duly authorized agent of the Secretary
upon reasonable request; and
Airport Sponsor Assurances 3/2014 Page 13 of 20
146
d. in a format and time prescribed by the Secretary, provide to the Secretary and
make available to the public following each of its fiscal years, an annual report
listing in detail:
1) all amounts paid by the airport to any other unit of government and the
purposes for which each such payment was made; and
2) all services and property provided by the airport to other units of government
and the amount of compensation received for provision of each such service
and property.
27. Use by Government Aircraft.
It will make available all of the facilities of the airport developed with Federal
financial assistance and all those usable for landing and takeoff of aircraft to the
United States for use by Government aircraft in common with other aircraft at all
times without charge, except, if the use by Government aircraft is substantial, charge
may be made for a reasonable share, proportional to such use, for the cost of
operating and maintaining the facilities used. Unless otherwise determined by the
Secretary, or otherwise agreed to by the sponsor and the using agency, substantial use
of an airport by Government aircraft will be considered to exist when operations of
such aircraft are in excess of those which, in the opinion of the Secretary, would
unduly interfere with use of the landing areas by other authorized aircraft, or during
any calendar month that
a. Five (5) or more Government aircraft are regularly based at the airport or on land
adjacent thereto; or
b. The total number of movements (counting each landing as a movement) of
Government aircraft is 300 or more, or the gross accumulative weight of
Government aircraft using the airport(the total movement of Government aircraft
multiplied by gross weights of such aircraft) is in excess of five million pounds.
28. Land for Federal Facilities.
It will furnish without cost to the Federal Government for use in connection with any
air traffic control or air navigation activities, or weather-reporting and communication
activities related to air traffic control, any areas of land or water, or estate therein, or
rights in buildings of the sponsor as the Secretary considers necessary or desirable for
construction, operation, and maintenance at Federal expense of space or facilities for
such purposes. Such areas or any portion thereof will be made available as provided
herein within four months after receipt of a written request from the Secretary.
29. Airport Layout Plan.
a. It will keep up to date at all times an airport layout plan of the airport showing
1) boundaries of the airport and all proposed additions thereto, together with the
boundaries of all offsite areas owned or controlled by the sponsor for airport
purposes and proposed additions thereto;
2) the location and nature of all existing and proposed airport facilities and
structures (such as runways, taxiways, aprons, terminal buildings, hangars and
Airport Sponsor Assurances 3/2014 Page 14 of 20
147
roads), including all proposed extensions and reductions of existing airport
facilities;
3) the location of all existing and proposed nonaviation areas and of all existing
improvements thereon; and
4) all proposed and existing access points used to taxi aircraft across the airport's
property boundary. Such airport layout plans and each amendment, revision,
or modification thereof, shall be subject to the approval of the Secretary which
approval shall be evidenced by the signature of a duly authorized
representative of the Secretary on the face of the airport layout plan. The
sponsor will not make or permit any changes or alterations in the airport or
any of its facilities which are not in conformity with the airport layout plan as
approved by the Secretary and which might, in the opinion of the Secretary,
adversely affect the safety, utility or efficiency of the airport.
b. If a change or alteration in the airport or the facilities is made which the Secretary
determines adversely affects the safety, utility, or efficiency of any federally
owned, leased, or funded property on or off the airport and which is not in
conformity with the airport layout plan as approved by the Secretary, the owner or
operator will, if requested, by the Secretary (1) eliminate such adverse effect in a
manner approved by the Secretary; or(2) bear all costs of relocating such
property (or replacement thereof) to a site acceptable to the Secretary and all costs
of restoring such property (or replacement thereof) to the level of safety, utility,
efficiency, and cost of operation existing before the unapproved change in the
airport or its facilities except in the case of a relocation or replacement of an
existing airport facility due to a change in the Secretary's design standards beyond
the control of the airport sponsor.
30. Civil Rights.
It will promptly take any measures necessary to ensure that no person in the United
States shall, on the grounds of race, creed, color, national origin, sex, age, or
disability be excluded from participation in, be denied the benefits of, or be otherwise
subjected to discrimination in any activity conducted with, or benefiting from, funds
received from this grant.
a. Using the definitions of activity, facility and program as found and defined in §§
21.23 (b) and 21.23 (e)of 49 CFR § 21, the sponsor will facilitate all programs,
operate all facilities, or conduct all programs in compliance with all non-
discrimination requirements imposed by, or pursuant to these assurances.
b. Applicability
1) Programs and Activities. If the sponsor has received a grant (or other federal
assistance) for any of the sponsor's program or activities, these requirements
extend to all of the sponsor's programs and activities.
2) Facilities. Where it receives a grant or other federal financial assistance to
construct, expand, renovate, remodel, alter or acquire a facility, or part of a
facility, the assurance extends to the entire facility and facilities operated in
connection therewith.
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148
3) Real Property. Where the sponsor receives a grant or other Federal financial
assistance in the form of, or for the acquisition of real property or an interest
in real property, the assurance will extend to rights to space on, over, or under
such property.
c. Duration.
The sponsor agrees that it is obligated to this assurance for the period during
which Federal financial assistance is extended to the program, except where the
Federal financial assistance is to provide, or is in the form of, personal property,
•
or real property, or interest therein, or structures or improvements thereon, in
which case the assurance obligates the sponsor, or any transferee for the longer of
the following periods:
I) So long as the airport is used as an airport, or for another purpose involving
the provision of similar services or benefits; or
2) So long as the sponsor retains ownership or possession of the property.
d. Required Solicitation Language. It will include the following notification in all
solicitations for bids, Requests For Proposals for work, or material under this
grant agreement and in all proposals for agreements, including airport
concessions, regardless of funding source:
"The (Name of Sponsor), in accordance with the provisions of Title VI of the
Civil Rights Act of 1964 (78 Stat. 252, 42 U.S.C. §§ 2000d to 2000d-4)and the
Regulations, hereby notifies all bidders that it will affirmatively ensure that any
contract entered into pursuant to this advertisement, disadvantaged business
enterprises and airport concession disadvantaged business enterprises will be
afforded full and fair opportunity to submit bids in response to this invitation and
will not be discriminated against on the grounds of race, color, or national origin
in consideration for an award."
e. Required Contract Provisions.
1) It will insert the non-discrimination contract clauses requiring compliance
with the acts and regulations relative to non-discrimination in Federally-
assisted programs of the DOT, and incorporating the acts and regulations into
the contracts by reference in every contract or agreement subject to the non-
discrimination in Federally-assisted programs of the DOT acts and
regulations.
2) It will include a list of the pertinent non-discrimination authorities in every
•
contract that is subject to the non-discrimination acts and regulations.
•
3) It will insert non-discrimination contract clauses as a covenant running with
the land, in any deed from the United States effecting or recording a transfer
of real property, structures, use, or improvements thereon or interest therein to
a sponsor.
4) It will insert non-discrimination contract clauses prohibiting discrimination on
the basis of race, color, national origin, creed, sex, age, or handicap as a
Airport Sponsor Assurances 3/2014 Page 16 of 20
1 49
covenant running with the land, in any future deeds, leases, license, permits,
or similar instruments entered into by the sponsor with other parties:
a) For the subsequent transfer of real property acquired or improved under
the applicable activity, project, or program; and
b) For the construction or use of, or access to, space on, over, or under real
property acquired or improved under the applicable activity, project, or
program.
f. It will provide for such methods of administration for the program as are found by
the Secretary to give reasonable guarantee that it, other recipients, sub-recipients,
sub-grantees, contractors, subcontractors, consultants, transferees, successors in
interest, and other participants of Federal financial assistance under such program
will comply with all requirements imposed or pursuant to the acts, the regulations,
and this assurance.
g. It agrees that the United States has a right to seek judicial enforcement with
regard to any matter arising under the acts, the regulations, and this assurance.
31. Disposal of Land.
a. For land purchased under a grant for airport noise compatibility purposes,
including land serving as a noise buffer, it will dispose of the land, when the land
is no longer needed for such purposes, at fair market value, at the earliest
practicable time. That portion of the proceeds of such disposition which is
proportionate to the United States' share of acquisition of such land will be, at the
discretion of the Secretary, (I) reinvested in another project at the airport, or(2)
transferred to another eligible airport as prescribed by the Secretary. The
Secretary shall give preference to the following, in descending order, (1)
reinvestment in an approved noise compatibility project, (2) reinvestment in an
approved project that is eligible for grant funding under Section 47117(e) of title
49 United States Code, (3) reinvestment in an approved airport development
project that is eligible for grant funding under Sections 47114, 47115, or 47117 of
title 49 United States Code, (4)transferred to an eligible sponsor of another public
airport to be reinvested in an approved noise compatibility project at that airport,
and (5) paid to the Secretary for deposit in the Airport and Airway Trust Fund. If
land acquired under a grant for noise compatibility purposes is leased at fair
market value and consistent with noise buffering purposes, the lease will not be
considered a disposal of the land. Revenues derived from such a lease may be
used for an approved airport development project that would otherwise be eligible
for grant funding or any permitted use of airport revenue.
b. For land purchased under a grant for airport development purposes (other than
noise compatibility), it will, when the land is no longer needed for airport
purposes, dispose of such land at fair market value or make available to the
Secretary an amount equal to the United States' proportionate share of the fair
market value of the land. That portion of the proceeds of such disposition which
is proportionate to the United States' share of the cost of acquisition of such land
will, (I) upon application to the Secretary, be reinvested or transferred to another
Airport Sponsor Assurances 3/2014 Page 17 of 20
150
eligible airport as prescribed by the Secretary. The Secretary shall give
preference to the following, in descending order: (1) reinvestment in an approved
noise compatibility project, (2)reinvestment in an approved project that is eligible
for grant funding under Section 47117(e)of title 49 United States Code, (3)
reinvestment in an approved airport development project that is eligible for grant
funding under Sections 47114, 47115, or 47117 of title 49 United States Code, (4)
transferred to an eligible sponsor of another public airport to be reinvested in an
approved noise compatibility project at that airport, and (5) paid to the Secretary
for deposit in the Airport and Airway Trust Fund.
c. Land shall be considered to be needed for airport purposes under this assurance if
(1) it may be needed for aeronautical purposes (including runway protection
zones) or serve as noise buffer land, and (2)the revenue from interim uses of such
land contributes to the financial self-sufficiency of the airport. Further, land
purchased with a grant received by an airport operator or owner before December
31, 1987, will be considered to be needed for airport purposes if the Secretary or
Federal agency making such grant before December 31, 1987, was notified by the
operator or owner of the uses of such land, did not object to such use, and the land
continues to be used for that purpose, such use having commenced no later than
December 15, 1989.
d. Disposition of such land under(a) (b) or(c) will be subject to the retention or
reservation of any interest or right therein necessary to ensure that such land will
only be used for purposes which are compatible with noise levels associated with
operation of the airport.
32. Engineering and Design Services.
It will award each contract, or sub-contract for program management, construction
management, planning studies, feasibility studies, architectural services, preliminary
engineering, design, engineering, surveying, mapping or related services with respect
to the project in the same manner as a contract for architectural and engineering
services is negotiated under Title IX of the Federal Property and Administrative
Services Act of 1949 or an equivalent qualifications-based requirement prescribed for
or by the sponsor of the airport.
33. Foreign Market Restrictions.
It will not allow funds provided under this grant to be used to fund any project which
uses any product or service of a foreign country during the period in which such
foreign country is listed by the United States Trade Representative as denying fair
and equitable market opportunities for products and suppliers of the United States in
procurement and construction.
34. Policies, Standards, and Specifications.
It will carry out the project in accordance with policies, standards, and specifications
approved by the Secretary including but not limited to the advisory circulars listed in
the Current FAA Advisory Circulars for ALP projects, dated 04/18/2019 (the latest
approved version as of this grant offer) and included in this grant, and in accordance
Airport Sponsor Assurances 3/2014 Page 18 of 20
151
with applicable state policies, standards, and specifications approved by the
Secretary.
35. Relocation and Real Property Acquisition.
a. It will be guided in acquiring real property, to the greatest extent practicable under
State law, by the land acquisition policies in Subpart B of 49 CFR Part 24 and
will pay or reimburse property owners for necessary expenses as specified in
Subpart B.
b. It will provide a relocation assistance program offering the services described in
Subpart C and fair and reasonable relocation payments and assistance to displaced
persons as required in Subpart D and E of 49 CFR Part 24.
c. It will make available within a reasonable period of time prior to displacement,
comparable replacement dwellings to displaced persons in accordance with
Subpart E of 49 CFR Part 24.
36. Access By Intercity Buses.
The airport owner or operator will permit, to the maximum extent practicable,
intercity buses or other modes of transportation to have access to the airport;
however, it has no obligation to fund special facilities for intercity buses or for other
modes of transportation.
37. Disadvantaged Business Enterprises.
The sponsor shall not discriminate on the basis of race, color, national origin or sex in
the award and performance of any DOT-assisted contract covered by 49 CFR Part 26,
or in the award and performance of any concession activity contract covered by 49
CFR Part 23. In addition, the sponsor shall not discriminate on the basis of race,
color, national origin or sex in the administration of its DBE and ACDBE programs
or the requirements of 49 CFR Parts 23 and 26. The sponsor shall take all necessary
and reasonable steps under 49 CFR Parts 23 and 26 to ensure nondiscrimination in the
award and administration of DOT-assisted contracts, and/or concession
contracts. The sponsor's DBE and ACDBE programs, as required by 49 CFR Parts
26 and 23, and as approved by DOT, are incorporated by reference in this
agreement. Implementation of these programs is a legal obligation and failure to
carry out its terms shall be treated as a violation of this agreement. Upon notification
to the sponsor of its failure to carry out its approved program, the Department may
impose sanctions as provided for under Parts 26 and 23 and may, in appropriate cases,
refer the matter for enforcement under 18 U.S.C. 1001 and/or the Program Fraud
Civil Remedies Act of 1936 (31 U.S.C. 3801).
38. Hangar Construction.
If the airport owner or operator and a person who owns an aircraft agree that a hangar
is to he constructed at the airport for the aircraft at the aircraft owner's expense, the
airport owner or operator will grant to the aircraft owner for the hangar a long term
lease that is subject to such terms and conditions on the hangar as the airport owner or
operator may impose.
Airport Sponsor Assurances 3/2014 Page 19 of 20
152
39. Competitive Access.
a. If the airport owner or operator of a medium or large hub airport(as defined in
section 47102 of title 49, U.S.C.) has been unable to accommodate one or more
requests by an air carrier for access to gates or other facilities at that airport in
order to allow the air carrier to provide service to the airport or to expand service
at the airport, the airport owner or operator shall transmit a report to the Secretary
that-
I) Describes the requests;
2) Provides an explanation as to why the requests could not be accommodated;
and
3) Provides a time frame within which, if any, the airport will be able to
accommodate the requests.
b. Such report shall be due on either February 1 or August 1 of each year if the
airport has been unable to accommodate the request(s) in the six month period
prior to the applicable due date.
Airport Sponsor Assurances 3/2014 Page 20 of 20
153
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$132,426.00 Iffi � 7.3�T�O0 �r.xaroo
SPONSOR VERIFICATION: 'Date (see instruction sheet o,attached comments for more information) -
For each and every Nov. 'O7-Date of approved ALP with project shown —
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projeuasapp|icab|e 11/27/1fi'nateuf environmental determination(noo'FOms|'catEx)
N/4 -Date ofland acquisition or signed purchase agreement
N64 -Date of pavement maintenance program
N/A -Date of Benefit Cost xno|vms(acx)asrequired
spomsnn'sS|GmArunc: DATE:
PRINTED NAME: Robert Peterson TITLE: Airport Director
PHONE NUMBER-, (509) 575-8149 EMAIL: nzb.petaroon(a-)-yekimomirtennina|.00rn
FAA USE ONLY
154
INSTRUCTIONS FOR COMPLETING
CAPITAL IMPROVEMENT PLAN DATA SHEET
A Capital Improvement Plan(CIP)Data Sheet must be submitted for each major work item that is requesting Federal assistance over
the next 5 years. Submittal of this information is necessary to effectively administer the Airport Improvement Program.
HEADER INFORMATION-Include the name of the airport,the LOCID,the local priority of the requested work,the project description
and the desired Federal fiscal year(October 1st to September 30th)that you desire the project.
SKETCH-Color-coded sketch that depicts and identifies the scope of the proposed project. An aerial photo can be used as long as it
shows the proposed project information.
JUSTIFICATION-Answers the questions of what it is,why is it needed and what is the benefit. This is a very important part of your
Capital Improvement Plan. The information is required to accurately determine the eligibility of your project and its priority for
funding. Projects without adequate justification cannot be added to the CIP. To help you prepare solid justification we have
compiled the following list of suggestions,which you can use to support your assessment of the need for this project. Be sure to list
all reasons and needs for your project and include a detailed description of existing conditions.Use extra pages if needed.
• For pavement rehabilitation include the age of the pavement,distresses,Pavement Condition Index
(PCI)Rating(may be able to obtain this info from ODA),or any other factor that would affect pavement life.
Include type of pavement(apron,runway)and dimensions(linear feet and width or square footage). Also
include what you have done to maintain the pavement over its lifetime and the date of the last major
rehabilitation(i.e.overlays,sealcoats,etc.)
New taxiways/taxilanes—what will this taxiway/taxilane serve? Does it serve a hangar area? Is it a
parallel taxiway? What width are you proposing? If you propose a width that is wider than FAA standards,
indicate how that additional pavement will be funded.
For Apron Expansion indicate the current size of the apron and what you plan to add. Indicate why you
need more apron space and how the apron area will be used(tie down area,etc).
For fencing projects—indicate the height of the fence and lineal footage. Also,explain why the fence is
needed(i.e.deer fencing,security,etc)
• Land acquisition explain what the land is needed for—approach protection? Development such as a
new hangar area? Also include if it is fee or easement. Include parcel numbers and acreage of those parcels.
Please state if residences or businesses will be acquired.
• For Arrival/Departure Building,provide what type of facility you currently have and what you plan to
build(square footage,types of rooms)
COST ESTIMATE-The estimate of total cost including the Federal,State and Local shares. For first year projects,attach a detailed
cost estimate showing unit costs;aggregate in square yards(S.Y.),concrete paving in square yards(S.Y.)and asphaltic paving in tons.
Separate the costs for land acquired in fee and land acquired in easement. Note if the project is dependent on other sources of
funding(i.e.other agency grants)
SPONSOR VERIFICATION-The verification that the project is properly planned and is ready to"go"within the first year of the CIP for
applicable projects. Except for equipment acquisition,proposed development and land acquisition must be shown on an approved
ALP, have cleared environmental processing,and the land already acquired or have a signed purchase agreement. These
requirements must be completed before a project can be considered for upcoming year funding. For the 2nd and 3rd years of the CIP
program,the sponsor should be working towards satisfying these requirements. Date each item verifying that all project
requirements are satisfied(check marks are not acceptable).
155
CERTIFICATION REGARDING LOBBYING
Certification for Contracts,Grants,Loans,and Cooperative Agreements
The undersigned certifies,m the best of his v,her knowledge and belief,that:
(1)No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any
person for influencing or attempting to influence an officer or employee of an agency,a Member of
Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with
the awarding of any rouom|contmct,the making of any Federal g,ant,the making of any Feoom||oun,the
entering into of any cooperative agreement,and the extension,continuation,renewal,amendment,or
modification v,any Federal contract,grant,loan,v,cooperative agreement.
(2)If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an
officer or employee of Congress,or an employee of a Member of Congress in connection with this Federal
contract,grant,loan,or cooperative agreement,the undersigned shall complete and submit Standard
Form-LLL,"Disclosure of Lobbying Activities,"in accordance with its instructions.
CV The undersigned shall require that the language m this certification m»included in the award documents
for all subawards at all tiers(including subcontracts,subgrants,and contracts under grants,loans,and
cooperative agreements)and that all subrecipients shall certify and disclose accordingly.This certification
is a material representation of fact upon which reliance was placed when this transaction was made or
entered into,Submission of this certification is a prerequisite for making or entering into this transaction
imposed oy section 1nax.title u1.u)u.Code.Any person who fails m file the required certification shall ue
subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states,to the best o,his n,her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencing or aftempting to influence an officer
or employee of any agency,a Member of Congress,an officer or employee of Congress,or an employee of
a Member of Congress in connection with this commitment providing for the United States to insure or
guarantee a loan,the undersigned shall complete and submit Standard Form-LLL,"Disclosure of Lobbying
Activities,"in accordance with its instructions,Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352,title 31,U,S.Code,Any person who fails to file the
required statement shall be subject to a civil penalty of not less than$10,000 and not more than$100,000
for each such failure.
~APPLICANT'S ORGAN
City of Ydk Ma
PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Prefix: First Name: Cl i i t Middle Name:E::::::��l
Last Name: Suffix:
SIGNATURE: DATE�