Loading...
07/16/2019 06F Federal Aviation Administration Grant; Yakima Air Terminal-McAllister Field Capital Improvements ti i..asxntntj kd ir:QE,L0*.),"41#1 aY ae.. x°'naa.x,,4n 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 ^� �^� Use ^ J���� ~�U����}8�~ FAA ��^°��U���D��� .=U��K�"����� .�~..�K�U���=° xv�� ~°���� UK� �"�v Funded � ����� Approved Projects ��= " ° = =������� "" � 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 r:::::::..::w::.r::::.r::::....::.. r:::::::r::r:::....::................ r:.�w.r::::::::::::r::::::::.:r......:.wY:.w::::::::. r::.::::::. :.w::.rr:.r:::::.r:::::::::::..........:::::::::. w......... ::.r::::.r.r::::::�::::...::::::. w:.w::::.r:.::w::::::::::::::. r.wY.r:.r:...:::.r.....w:::::...::::::::::::::::::r:.w. .�. :::.�:::..:: ::�:.rw::w::...:r��:.. ::::::.�:. r:::::::::.w::::::::...:.... r... ..w....... r r......r...................w.�.......:::......r::::::::::...::.:::.�.r:::::::...r::.:::::::::.r:. ... .:.r:..r.......r.�::....rr::.::::.:.rw::.�:::::::.w:..rwY.r:.r:.r:.wY::::::.r:r:.r::::.r.w w:::::r::r::r::r �: ::...::::.w:.r ::: .....fir r r.rw:r:::.::::::::.�:.r:::::::::::::.:::::::.r::::.r.r::r::::::::.r.r:::::.w...:::::::.r::. ::::.....:.r:::. ::.:.�:::.r::::. �:::. .�..r:.::::::::.�:.�:. :.r:.�.�r::::.rr..fr:.r: . :.r:::::.�:::r ::r::: r. r:: w.� . .rrr::. :::w::: t , r... ...r:r:::::..r: r:::::r:...:::::t :::::r:::::::::::::r:::.r:::::.wrrE w::: Y. : .......rr:::w...jg w:rrr:.w.:.r:::. .r:.w.r:t .�:. It .... rr: rw:.w::::::::.r:::::.r....:::.w::.r::.rr. �. .�.r:: :.r:::::.w:.r.•r:. r::..r::.r:::.r:�::::r::�:.�.w.�. :. r:::.rr. :. � ... . .w...::.�:.r::::::::::.r r::::::::.r::.r:::•t �.r.....�.. r.�. .w...�........r... .�r ..r............r....r......r..............�.......�....w.r..r......w.....r...r.rr......r..r..r.... �..�. .....�....w.w.. ..wY.......� .r..w..::. .rw.r:::.r::::.w r::.w... ....r ..r. .w::::.wr r... w�...�.�rr.......w...r.wY..w.. .�.r.... �r. .�. r...................r .....w.r...r.......w....r.........r......r..............r.. �:.r:::.�r .w:::.rw...::::::::................ :.r:::::::.w:...:.......rr r.�. .. ..r....rw...�......r.............�.w�..r..... .r..... ......�.........f.........rrr::.:..:::.:::::r:.::::::.:.�:.w::.r::..::::r.::::::......::.::: :.:.�:w:::r::::r::.:.r:::::.. :::.r.::::.r:.. ...�::::::::::.�:::.. :.r:.r::..r::. v r........r........... r� .........w r.�..r.rw...�...r......r......... w.r.........................r..r....�::::::::r....::.r:::..::.::.:::::::::.:::.:...�::.�:.::.�:.. :::.r.:::::.r..�r::::::::::::::::::::.:.r:. .�.. �:. .:. .:.....:..:...::.r::.r::::::::::::::..::...r:::..::::::•.. 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 """""""""mn-nvnVVI.MF.W.kn..m..EA-vwa. nvg-x-SF.Z.Eotvfow.ovztumt.,,st:...;...k.t.gE.eq.m,vo..t.syad 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. Airport Sponsor Assurances 3/2014 Page 2 of 20 59 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. Airport Sponsor Assurances 3/2014 Page 3 of 20 60 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. Airport Sponsor Assurances 3/2014 Page 4 of 20 61 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 62 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. Airport Sponsor Assurances 3/2014 Page 6 of 20 63 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 Airport Sponsor Assurances 3/2014 Page 7 of 20 64 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 3/2014 Page 8 of 20 65 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, Airport Sponsor Assurances 3/2014 Page 9 of 20 66 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 Airport Sponsor Assurances 3/2014 Page 10 of 20 67 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. Airport Sponsor Assurances 3/2014 Page 11 of 20 68 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 Airport Sponsor Assurances 3/2014 Page 12 of 20 69 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 70 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 Airport Sponsor Assurances 3/2014 Page 14 of 20 71 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 f,: rr....:. ::......w............w.w...n r.:. r::r...:r::::.;....r:r..:::;::....r:::::..r..::::...::.. wr w r.....,. g.w:::r...w:::::::::...:::�:.r. .::::sw:...wss:::sssr:r:::rs::::::: :�:sss:::::r:;::::::::::::mm..� r........ r....r.......r..r..r r..�. ...�::w:::.......r.�:.� r .....r:..:v::::.w:�:w ..w:::....... .. :r:......:.... ... .... ...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:::::::::�.;.;;: r......r.....w..:::w:.r::::::...:::.w:::.wY.:.r::::.....rr:.rr.:..::::::.�::ss:::::::;;;:...::.:::w::::ssss:s::::.:s::r:::::.w.... .... ....�..... ..� .. ....r... r. .w.r .. .w............r.. . . ... r.. r.... w ...... ...r....r....r........�......r........ ........... wr .... ......:r:::::..r:.rw .... ::::: .:..............:.r: r::r.................::::.r::::r..r v.....� r r.....r.. ........ .rr. r ... ... ..w.. ......w......r.. ......... ...............................�:::::w.....:::..�.......:::.r.rw:.�::::..::::.:::::.....:....::......:..:::::..:....r. :.:::r..:....................::w:.:r..::.:. 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 &A. /,,,,ydreAvi. FAA ImPAR.er, * • Airports 7 Mt IPS 149 sr it 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. Airport Sponsor Assurances 3/2014 Page 11 of 20 144 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. Airport Sponsor Assurances 3/2014 Page 15 of 20 148 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 CIP DATA SHEET Yakima Air Tannine| 'K8oA|Uobn F�� YKM 11 MIN�_W 1 00 nun�*omrpa,omen�womtenanoe and*/mLReplacement Design Only 2020 N_ ^SKETCH; N. 44. � tiff IL � � � The existing Runway 9/27 Lighting System is reaching the end of its useful life and nuqu)neo replacement. Runway Q/27will bm crack sealed and aen| coated as preventative maintenance ho . extend the life of the pavement. The auxiliary wind-cone located off Runway 0/a located in the safety area and requires relocation to meet safety area standards. � COST ESTIMATE: Aom|w|sTnAT|oN swo|mssn|mG |mspscT0m: $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 — --- 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�