HomeMy WebLinkAbout2019 Rehabilitate Electrical Building ELIZABETH FIELD AIRPORT (OB8)
FISHERS ISLAND
FY 019
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RehabilitateFishers Island Ferry District
Electrical Building
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Airport Grant Pre-Application Checklist
(COMPLETE ONE CHECKLIST PER GRANT)
Airport Name: Fishers Island Elizabeth Field Airport Date Prepared: 01/25/2019
SAM CAGE code #: 39TN9 SAM Expiration Date: 09/04/2019
Project Description: Rehabilitate Electrical Building (Construction)
❑ We do not plan on having a project this fiscal year. The FAA is authorized to carry our
entitlements into the next fiscal year. (If checked,sign below, and return to ADO.)
Items Required with Preapplication
Document Yes No NIA Comments
Attached
1. Project Schedule (NOTE FAA DUE DATES) ❑X ❑ ❑ ❑
2. Standard Form 424, Form 5100-100 (parts 114V for airport development
grants), Form 5100-101 (parts 114V for planning grants) (Includes project cost ❑ ❑ ❑
breakdown and sketch)
3. Project Narrative and Justification (for Planning or Environmental Projects El El 1:1include Scope of Work)
4. Environmental Documentation (Is the complete environmental documentation
matching the potential application project description included?) (Attached or ❑ ❑ ❑
previously submitted to ADO)
5. Construction Safety Phasing Plan/Airspace ❑ ❑ ❑
6. Exhibit A(SOP available) (attached or previously submitted to ADO) ❑ ❑ ❑
7. Title Certificate or Long Term Lease Agreement (at the request of ADO) ❑ ❑ ❑X ❑
Note: If you cannot complete any of the above documents with this submittal, explain in the space provided on
page 2 and provide the expected submittal date, but no later than the date specified in the Federal Register.
Scott A. Russell
Sponsor's Designated Official Representative (Official with authority to sign Grant Agreement) (Type or Print)
Date:
Sponsor's Designated Official Representative (Signature)
The purpose of this checklist is to identify some of the requirements and considerations associated with
requesting Airport Improvement Program (AIP) funds. Airport Sponsors should read and consider each of the
items carefully.
Some of the items can be answered by simply checking the "Yes" and "No" boxes while others require
providing additional information as part of the airport's request for AIP funds.
Signatures are required, including in required attached forms. Updated October 2016
Electronic submittal using Portable Document Format(PDF)is preferred. Page 1 of 2
Common Key Requirements or Considerations
Clear Approaches Per 49 USC § 47107(a)(9).
The sponsor must take appropriate action to ensure that terminal airspace required to protect instrument and
visual operations to the airport (including operations at established minimum flight altitudes) will be cleared and
protected by mitigating existing, and preventing future, airport hazards. (see 5010-Airport Master Record)
Bid Protest Procedures.
The sponsor requirements for bid protests and appeals is contained in 49 CFR § 18.36(b)(12)
Reimbursable Agreement.
The cost for reimbursable agreements between the sponsor and a federal agency is allowable if the cost is
necessary for the project and the other federal agencies statutes allow this action. For instance, 49 USC §
106(1)(16) allows the FAA to enter into reimbursable agreements in order to carry out the functions of the FAA.
An example of this is a reimbursable agreement between a sponsor and the FAA Air Traffic Organization
(ATO) for the purpose of having the ATO relocate an FAA-owned navigational aid that is required by an AIP
funded project.
Non-Fed Coordination.
If any type of NAVAID (PAPI, PLASI, VASI, MALS, MALSR, ILS, etc.) is to be installed or relocated as part of
the project, the FAA Non-Fed Coordinator must be notified and appropriate airspace studies completed. The
airspace studies must be completed before the work can be included in a Federal aid project. These studies
can take up to a year to complete.
Required Forms (as applicable).
Agreement for Transfer of Entitlements (FAA Form 5100-110); NAVAID Forms (PAPIs, AWOS, REILs);
Modification of Airport Design Standards, Buy American Approval, Certificate of Economic Necessity, SRE
Calculation, AIP Revenue-Generating Facility Eligibility Evaluation Form and attachments. Please contact your
Program Manager if you cannot find the above forms on the Airports web site.
ADDITIONAL INFORMATION:
FONSI in route from 5-Year EA
Signatures are required, including in required attached forms. Updated October 2016
Electronic submittal using Portable Document Format(PDF)is preferred. Page 2 of 2
AIRPORT PROJECT SCHEDULE
LOCATION: Elizabeth Field Airport PROJECT NO: 3-36-0029- -2019
Rehabilitate Electrical l�uildin Construction
DATE
No. ITEMmm
COMMENTS(if appropriate)
1. Submission of Environmental Document 11/30/18- 08/31/2017 FONSI issued 2/15/18
1/112019
Provide Airspace(For new structures only) N/A
3. Verify Project is on ALP (*Update to ALP) N/A
4. Submission of a Benefit-Cost Analysis N/A
5. Selection of Sponsor's Engineer(within 5 year term 06/01/2017
or project included in associated RFQ)
6. Provide DBE plan and/or revisions to AEA-9
(See DBE and ACDBE Reporting Requirements for N/A
Airport Grants)
7. Provide Preapplication Package to ADO 1/31/2019 01/31/2019
8. Provide Final Notice of Intent to Use Funds(via 4/15/2019 04/15/2019
Preapplication Package)
9. Professional Services Agreement 05/18/2019
10. Submit Preliminary Engineers Design Report N/A
(Verify rehabilitation method or pavement section)
11. Request deviations to FAA design standards form N/A
with supporting documents
12. Submit project safety phasing plan for FAA N/A
approval
13. 90% Complete Plans and Specs(Part 139) N/A
(45 days prior to advertising bids)
14 90% Complete Plans and Specs(Other)
N/A
(30 days prior to advertising bids)
15. Submit all transfer agreements to FAA office N/A
16. Obtain wage rates N/A
17. Advertise for bids N/A
18 Bid Opening N/A
19. Bid Tab Submitted N/A
20. Application Submitted (Submit by date required by
FAA) 6/15/2019 06/15/2019
21. Acceptance of Grant Offer 09/17/2019
22. Award of Contract N/A
23. Const. Management Plan N/A
24. Preconstruction Meeting/Notice to Proceed N/A
25. Construction Start N/A
26. Construction Completion N/A
27 NAVAIDS Commissioned N/A
28. Exhibit A revised N/A
29. 5010 updated N/A
30. ALP revised/Construction As-Builts N/A
31. AGIS Updated N/A
32. Project Closeout Report 09/30/2020
Signatures are required, including in required attached forms. Updated October 2016
Electronic submittal using Portable Document Format(PDF)is preferred.
OMB Number:4040-0004
Expiration Date:10/31/2019
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)
Changed/Corrected Application ❑Revision
'3.Date Received: 4 Applicant Identifier
FOB
5a.Federal Entity Identifier: 5b.Federal Award Identifier:
3-36-0029- - 2019
State Use Only:
6.Date Received by State: 7.State Application Identifier: 0913.
8.APPLICANT INFORMATION:
'a Legal Name Town of Southold
•b.Employer/Taxpayer Identification Number(EIN/TIN): •c.Organizational DUNS:
11-6003307 1977363870000
d.Address:
•Streetl: Town of Southold
Street2' Town Hall PO Box 1179
•City: Southold
County/Parish:
•State. NY: New York
Province:
'Country: USA: UNITED STATES
•Zip/Postal Code: 11971-000
e.Organizational Unit:
Department Name Division Name:
f.Name and contact information of person to be contacted on matters involving this application:
Prefix. Mr. 'First Name: Gordon
Middle Name:
`Last Name: Murphy
Suffix
Title. Manager
Organizational Affiliation
Fishers Island Ferry District
•Telephone Number: 631-788-7463 Fax Number:
`Email gmurphy@fiferry.com
Application for Federal Assistance SF-424
*9.Type of Applicant 1:Select Applicant Type:
D: Special District Government
Type of Applicant 2:Select Applicant Type*
Type of Applicant 3:Select Applicant Type:
*Other(specify):
*10.Name of Federal Agency:
Federal Aviation Adminitration
11.Catalog of Federal Domestic Assistance Number:
20.106
CFDA Title.
*12.Funding Opportunity Number:
L3-36-0029-_-_-2019
'Title:
Rehabilitate Electrical Building (Construction)
13.Competition Identification Number:
Title:
14.Areas Affected by Project(Cities,Counties,States,etc.):
15. Project Map.pdf Add Attachment Delete Attachment View Attachment
*15.Descriptive Title of Applicant's Project:
Rehabilitate Electrical Building (Construction)
Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments View Attachments
Application for Federal Assistance SF-424
16.Congressional Districts Of:
'a.Applicant E== •b.Program/Project E=
Attach an additional list of Program/Protect Congressional Districts if needed.
Add Attachment Delete Attachment View Attachment
17.Proposed Project:
'a.Start Date: 09/01/2018 'b.End Date. 3/30/2019
18.Estimated Funding(S):
.a Federal $229,500.00
•b Applicant
'c.State 12,750.0• 0
d.Local 12,750.00
•e.Other
*f Program Income
.g TOTAL $255,000.00
'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 01/31/2019
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 I 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 internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix. Mr. `First Name: Scott
Middle Name. A.
*Last Name: Russell
Suffix:
'Title: Town Supervisor
'Telephone Number: 631-765-1889 Fax Number: 631-765-1823
*Email: scott.russell@town.southold.ny.us
`Signature of Authorized Representative: 'Date Signed:
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.. Project Areas
' _- -• - _ Runway 12-30 Rehabilitation
L ` - Runway 7-25 Rehabilitation
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Airport Entrance Road
ANImprovements
Terminal Building Construction
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Private Hangar Development
E �
Private Hangar Development Entrance Improvemanb
E Project Area=3 9 ac
Project Area=0.17 ac
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2 Project Area=6.3 ac
9 Obstruction Removal When printed at 11'x1 "
9 Project Area=0.16 ac Date 9/15/2016
Obstruction Removal O
Project Area=0.68 ac Runway 7-25 Rehabilitation
2 Project Area=2.5 ac
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US Department of Transportation OMB CONTROL NUMBER 2120-0569
Federal Aviation Administration EXPIRATION DATE:8/31/2019
Application for Federal Assistance (Development and Equipment Projects)
PART II — PROJECT APPROVAL INFORMATION
Part II -SECTION A
The term "Sponsor" refers to the applicant name provided in box 8 of the associated SF-424 form.
Item 1.
Does Sponsor maintain an active registration in the System for Award Management 0 Yes El No
(www.SAM.gov)?
Item 2.
Can Sponsor commence the work identified in the application in the fiscal year the 0 Yes El No [:] N/A
grant is made or within six months after the grant is made, whichever is later?
Item 3.
Are there any foreseeable events that would delay completion of the project? If yes, ❑Yes ❑X No ❑ N/A
provide attachment to this form that lists the events.
Item 4.
Will the project(s) covered by this request have impacts or effects on the
environment that require mitigating measures? If yes, attach a summary listing of ❑Yes 0 No ❑ N/A
mitigating measures to this application and identify the name and date of the
environmental document(s).
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 ❑Yes ❑X No ❑N/A
identify other funding sources by checking all applicable boxes.
❑ The project is included in an approved PFC application.
If included in an approved PFC application,
does the application only address AIP matching share? ❑Yes ❑No
❑ The project is included in another Federal Assistance program. Its CFDA number is below.
Item 6.
Will the requested Federal assistance include Sponsor indirect costs as described in ❑Yes 0 No ❑N/A
2 CFR Appendix VII to Part 200, States and Local Government and Indian Tribe
Indirect Cost Proposals?
If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate
the Sponsor proposes to apply:
❑ De Minimis rate of 10% as permitted by 2 CFR§ 200.414.
❑ Negotiated Rate equal to % as approved by (the Cognizant Agency)
on (Date) (2 CFR part 200, appendix VII).
Note: Refer to the instructions for limitations of application associated with claiming Sponsor indirect costs.
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 1 of 7
OMB CONTROL NUMBER.2120-0569
OMB EXPIRATION DATE:8/31/2019
PART II -SECTION B
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 SF-424 form.
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 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 Authorized Representative shall 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 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 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 2 of 7
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:
Present and future land use is compatible with the airport. No significant impact on land use in vicinity of 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:
None
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:
None
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.
The project is consistent with existing plans.
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)).
Primary users of the airport are aware of the project.
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
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE:8/31/2019
PART II—SECTION C (Continued)
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 as follows:
None
10. Land —(a)The sponsor holds 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 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]
None
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 Project, 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]
(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 as Exhibit"A". [1]
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 on the property map.
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 4 of 7
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE 8/31/2019
PART III - BUDGET INFORMATION - CONSTRUCTION
SECTION A—GENERAL
1. Federal Domestic Assistance Catalog Number: 20.106
2. Functional or Other Breakout: AIP - Rehabilitate Electrical Building (Construction)
SECTION B—CALCULATION OF FEDERAL GRANT
Latest Approved Adjustment
Amount +or(-)Amount Total
Cost Classification Amount
(Use only for (Use only for
Required
revisions revisions)
1. Administration expense 2,000
2. Preliminary expense
3. Land, structures, right-of-way
4. Architectural engineering basic fees
5. Other Architectural engineering fees
6. Project inspection fees 41,000
7. Land development
8. Relocation Expenses
9. Relocation payments to Individuals and Businesses
10. Demolition and removal
11. Construction and project improvement $212,000
12. Equipment
13. Miscellaneous
14. Subtotal(Lines 1 through 13) 255,000
15. Estimated Income(if applicable)
16. Net Project Amount(Line 14 minus 15)
17. Less: Ineligible Exclusions(Section C, line 23 g.)
18. Subtotal(Lines 16 through 17) 255,000
19. Federal Share requested of Line 18 229,500
20. Grantee share 12,750
21. Other shares 12,750
22. TOTAL PROJECT(Lines 19, 20&21) 255,000
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 5 of 7
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) 12,750
d. Bonds
e. Tax Levies
f. Non-Cash
g. Other(Explain):
h. TOTAL-Grantee share 12,750
25. Other Shares Amount
a. State 12,750
b. Other
c. TOTAL-Other Shares 12,750
26.TOTAL NON-FEDERAL FINANCING 25,500
SECTION E— REMARKS
(Attach sheets if additional space is required)
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 6 of 7
OMB CONTROL NUMBER:2120-0569
OMB EXPIRATION DATE:8/31/2019
PART IV— PROGRAM NARRATIVE
(Suggested Format)
PROJECT: Rehabilitate Electrical Building (Construction)
AIRPORT: Elizabeth Field Airport
1. Objective:
The proposed project involves replacing airfield lighting equipment(regulators), installing shelving to elevate the airfield lighting
equipment and raise it out of frequent flood elevations, address lighting and mechanical/HVAC system to prevent accelerated
corrosion due to the ocean air and salty environment, and address repairs to previous flood damage(interior lighting repairs,
painting, etc.). Exterior renovations would include replacement of the main entry door and repairing damaged building fascia. There
would be no change in the building use, no change in the building footprint, nor will there be any ground disturbance as part of this
work.
2. Benefits Anticipated:
The existing airfield electrical vault is over 20 years old, and has been subjected to frequent storms and flooding.Along with the
salt-air environment,the elements are rapidly deteriorating the airfield lighting equipment. The Airport was devastated during
Superstorm Sandy(2012),with floodwaters breaching the vault and exposing the lighting equipment to saltwater. The regulators
had temporarily failed, requiring the airport to close due to inoperable lights, until they were repaired.As the airport isn't monitored
24-7, providing a safe, reliable lighting system and lighting equipment will improve the building by addressing much-needed repairs
and mitigating impacts to airfield lighting equipment during flooding events. Improving the flooding resistance will increase the
service life as well as enhance the overall level of safety at the airport.
3. Approach: (See approved Scope of Work in Final Application)
4. Geographic Location:
Elizabeth Field Airport is located on the western side of Fishers Island. Fishers Island is located at the eastern end of Long Island
Sound, 2 miles off the southeastern coast of Connecticut.
5. If Applicable, Provide Additional Information:
6.Sponsor's Representative: (include address&telephone number)
Scott Russell, Telephone: 631-765-1889, Email: scott.russell@town.southold.ny.us
Address: Town of Southold, PO Box 1179, Southold, New York 11971
FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 7 of 7
Project Cost Breakdown
Airport: Elizabeth Field Aiport
Project Description: Rehabilitate Electrical Building (Construction)
Construction or Engineering/
Brief Item Description Land Cost Land Incidental Admin. Cost Total Cost Federal Share Non-Federal
90% 10%
Rehab. Electrical Bldg.
(Construction) $212,000 $41,000 $2,000 $255,000 $229,500 $25,500
Totals $212,000 $41,000 $2,000 $255,0001 $229,500 $25,500
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