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2017 Airport Pavement Management Study
ELIZABETH FIELD AIRPORT (0B8) FISHERS ISLAND - fr GRANT APPLICATION ,. 'low IIIIMt f, 1 ' Town of Southold Fishers Island Ferry District Airport Pavement Management Study of SOIJ UN 00PREPARED BY COMPANIES" ARP SOP No. 6.00 Effective Date: 10/1/2015 AIP Grant Application Checklist AIRPORT NAME: Elizabeth Field Airport DATE: 6/12/2017 SYSTEM FOR AWARD MANAGEMENT(SAM) CAGE CODE#: 39TN9 SYSTEM FOR AWARD MANAGEMENT(SAM) EXPIRATION DATE: 10/11/2017 This checklist(and attached instructions)is a tool to assist a grantee(airport sponsor)in identifying the requirements and considerations associated with preparing an Airport Improvement Program (AIP)grant application package for submittal ,to the FAA.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. Ref Yes No N/A Comments Attached 1. Standard Form 424 (signed) © , 2. Project Cost Breakdown (attached) 0 , © 0 i 3. Project Sketch (at the request of the ADO) Ix El © 0 4. Project Narrative (attached or within Form 5100-11/101 Parr IV) El 0 5 Form 5100-100 (parts II - IV) (airport development grants) 0 n Form 5100-101 (parts II - IV) (planning grants) 6. Bid Tabulations/Negotiated Amounts (attached or previously submitted to the ADO) _ 0 r❑- 0 El 7. Exhibit A (attached orpreviously submitted to the ADO) El ®, Q 0 8. Title Certificate or Long Term Lease Agreement (at the request of the ADO) 13 n Ix. 0 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 F�Continuation *Other(Specify) ❑ Changed/Corrected Application ❑Revision *3 Date Received 4 Applicant Identifier FOB8 5a Federal Entity Identifier 5b Federal Award Identifier 3-36-0029- - 2017 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 Streetl 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 Assistant 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: 3-36-0029-20-2017 *Title Airport Pavement Management Study 13.Competition Identification Number: Title. 14.Areas Affected by Project(Cities,Counties,States,etc.): Oa8 APMS - General Plan.pdf Add Attachment I Delete:Attachment, •'*View•Attachment. *15.Descriptive Title of Applicant's Project: Airport Pavement Management Study Attach supporting documents as specified in agency instructions p: Add°Attachments, R PDelete Attachments= Vi mw Attachments Application for Federal Assistance SF-424 16.Congressional Districts Of: "a.Applicant Ny 2 'b Program/Project NY 2 Attach an additional list of Program/Project Congressional Districts if needed. j -Add Attachmerit Delete Attachment View Attachment , 17.Proposed Project: *a Start Date. 09/01/2017 'b End Date 02/02/2018 18.Estimated Funding($): *a Federal 65,250.00 *b Applicant 0.00 •c State 3,625.00 •d Local 3,625.00 *e Other 0.00 *f Program Income 0.00 'g TOTAL 72,500.00 *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 ❑ 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 1 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. 1 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) ® **IAGREE **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 _ Project Cost Breakdown Airport: Elizabeth Field Aiport Project Description: Airport Pavement Management Study Construction or Engineering/ Brief Item Description Land Cost Land Incidental Admin. Cost Total Cost Federal Share Non-Federal 90% 10% APMS $70,000 $2,500 $72,500 $65,250 $7,250 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Totals $0 $70,000 $2,500 $72,500 $65,250 $7,250 Administrative Cost Summary Airport Pavement Management Study Project&Grant Administration* No. of Hrs Hrly Rate Total Gordon Murphy- Manager, FIFD 8 $50.00 $400.00 Diane Hansen,Admin Asst. 16 $30.00 $480.00 IFE 1 $1,500.00 $1,500.00 Postage 1 $100.00 $100.00 Total $2,480.00 TOTAL: $2,480.00 * Project Administration Costs includes consultant and manufacturer coordination, deliverable reviews and grant management. CBS ARCHITECTURAL/ENGINEERING COMPANIES COST SUMMARY SCHEDULE "B" STUDY & REPORT PHASE PROJECT NAME Airport Pavement Management System(APMS) DATE 24-Mar-17 PROJ DESCRIPTION Pavement Management Study A/E C&S ENGINEERS,INC PROJECT NO 211 CLIENT Town of Southold C&S CONTACT T J Horth CLIENT MANAGER Gordon S Murphy,Asst Manager I. ESTIMATE OF DIRECT SALARY COSTS: MAXIMUM AVERAGE RATE OF PAY RATE OF PAY ESTIMATED ESTIMATED TITLE ($/HR) ($/HR) @ HOURS COST A SERVICE GROUP/ASSOCIATE MANAGER $8900 $7610 X 0 = $000 B DEPARTMENT MANAGER $7700 $6550 X 0 = $000 C MANAGING ENGINEER $7020 $6060 X 56 = $3,39400 D CHIEF/PRINCIPAL ENGINEER $6450 $5200 X 8 = $41600 E SENIOR PROJECT ENGINEER $5230 $4460 X 90 = $4,01400 F PROJECT ENGINEER/ENV SCIENTIST $4970 $3930 X 0 = $000 G ENGINEER $3800 $3330 X 260 = $8,65800 H STAFF ENGINEER $3210 $2760 X 0 = $000 1 SENIOR DESIGNER $4050 $3850 X 60 = $2,31000 J DESIGNER $2940 $2570 X 0 = $000 K CADD OPERATOR/DESIGN TECHNICIAN $2960 $21 90 X 0 = $000 L ADMINISTRATIVE ASSISTANT $2710 $2250 X 20 = $45000 M INTERN $1800 $1500 X 0 = $000 N GRANTS ADMINISTRATOR $3870 $3025 X 30 = $90800 O ASSISTANT GRANTS ADMINISTRATOR $2520 $2450 X 0 = $000 TOTAL ESTIMATED DIRECT SALARY COST $20,15000 II. OVERHEAD EXPENSES&PAYROLL BURDEN PER SCHEDULE"C"- (AGREED OVERHEAD EXPRESSED AS A PERCENTAGE OF DIRECT SALARY COST) 16300% $32,84500 Ill. SUBTOTAL OF ITEMS I&II: $52,99500 IV. ESTIMATE OF DIRECT EXPENSES: A TRAVEL,BY AUTO 4 TRIPS @ 640 MILES/TRIP @ $0535 = $1,36960 B PER DIEM 4 DAYS @ 2 PERSONS @ $19400 = $1,55200 C MISCELLANEOUS = $15415 TOTAL ESTIMATE OF DIRECT EXPENSES $3,07575 V. FIXED FEE(PROFIT,LUMP SUM): A LABOR PLUS OVERHEAD 15% (OF III) $7,94925 B DIRECT EXPENSES 0% (OF IV) $000 TOTAL FIXED FEE $7,94925 B-1 VI. SUBCONTRACTS: A ESTIMATE OF SUBSURFACE INVESTIGATION&TESTS 1 MOBILZATION/DEMOBILIZATION LUMP SUM = $2,50000 2 PAVEMENT CORES 10 EACH @ $5000 = $50000 3 CONTINUOUS SAMPLING 30 LF @ $1800 = $54000 4 OBSERVATION WELL 0 LF @ $1500 = $000 5 TEST PITS 4 EACH @ $25000 = $1,00000 6 FIELD CBR 0 EACH @ $25000 = $000 7 FIELD DENSITY TESTS 0 EACH @ $3500 = $000 8 MECHANICAL ANALYSIS 4 EACH @ $3500 = $14000 9 LABORATORY PROCTORS 4 EACH @ $10000 = $40000 10 SOAKED LAB CBR(ASTM D1883,PAR 8 1 1) 4 EACH @ $15000 = $60000 11 SOAKED LAB CBR(ASTM D1883,PAR 8 1 2) 0 EACH @ $25000 = $000 12 SOAKED LAB CBR(ASTM D1883,PAR 8 2) 0 EACH @ $35000 = $000 13 ATTERBERG LIMITS 0 EACH @ $5500 = $000 14 NATURAL MOISTURE CONTENT 10 EACH @ $600 = $6000 15 HYDROMETER ANALYSIS 4 EACH @ $6000 = $24000 TOTAL ESTIMATED SUBSURFACE INVESTIGATION&TESTS $5,98000 VII. TOTALS: A MAXIMUM TOTAL COST FOR DESIGN SERVICES,AGREEMENT TOTAL&FAA ELIGIBLE: $70,000.00 B-2 US Department of Transportation OMB CONTROL NUMBER:2120-0569 14W Federal Aviation Administration EXPIRATION DATE 4/30/2017 Application for Federal Assistance (Planning Projects) Part II - Project Approval Information Section A—Statutory Requirements The term "Sponsor" refers to the applicant name as provided in box 8 of the associated SF-424 form. Item 1 ❑X Yes ❑No Does Sponsor maintain an active registration in the System for Award Management (www.SAM.gov)? Item 2 ❑X Yes ❑No ❑N/A 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? 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 Is the project covered by another Federal assistance program?If yes, please identify other ❑Yes X❑No ❑N/A funding sources by the Catalog of Federal Domestic Assistance(CFDA) number. CFDA: Item 5 Will the requested Federal assistance include Sponsor indirect costs as described in 2 CFR ❑Yes ❑X No ❑N/A 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 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION Page 1 of 4 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 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION Page 2 of 4 Part III — Budget Information Section A—Budget Summary Federal New or Revised Budget Grant Program Catalog No (a) (o Federal Non-Federal Total (c) (d) (e) 1.Airport Improvement Program 20-106 $ 65,250 $ 7,250 $ 72,500 2. 3.TOTALS $ 65,250 $ 7,250 $ 72,500 Section B—Budget Categories (All Grant Programs) Airport Improvement Program Other Program (1) (2) 4.Object Class Categories Amount Adjustment Amount Adjustment Total +or(-)Amount +or(-)Amount (Use only for (Use only for revisions) revisions) a.Administrative expense $ 2,500 $ $ $ $ b.Airport Planning 70,000 c. Environmental Planning d. Noise Compatibility Planning e.Subtotal 72,500 f. Program Income g. TOTALS (line a minus line f) $ 72,50T0 $ $ $ $ Section C—Non-Federal Resources Grant Program Applicant State Other Sources Total (a) (b) (c) (d) (e) 5. $ 3,625 $ 3,625 $ $ 7,250 6. 7.TOTALS j $ $ $ $ Section D—Forecasted Cash Needs Source of funds Total for Project 15i Year 2nd Year 3`d Year 4th Year 8. Federal $ 65,250 $ 65,250 $ $ $ 9. Non-Federal 7,250 7,250 10.TOTAL $ 72,500 $ 72,500 $ $ $ Section E—Other Budget Information 11 Other Remarks. (attach sheets if necessary) FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION Page 3 of 4 Part IV - Program Narrative (Suggested Format) PROJECT: Airport Pavement Management Study AIRPORT: Elizabeth Field Airport 1. Objective: This project involves preparation of an APMS report by conducting a network level pavement condition index(PCI)study for all airfield pavements to determine the existing pavement condition. The report will include researching the pavement history, conducting a pavement condition survey, and developing recommendations for maintenance and rehabilitation of airfield pavements. 2. Benefits Anticipated: To meet FAA requirements, an APMS needs to be completed prior to receiving funds for any pavement repair projects. The APMS will provide an objective evaluation of the pavement based on existing conditions, and the future condition based on historical deterioration models. The evaluation will provide a basis for determining future maintenance and rehabilitation needs.The APMS report will enable the airport to prioritize capital improvement projects more efficiently and make better use of available funding. 3. Approach: (See approved Scope of Work in Final Application) 4. Geographic Location: Elizabeth Field Airport is located on the,west end of Fishers Island.The island is located 8 miles from the southerly coast of Conn. 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 5100-101 (4116)SUPERSEDES PREVIOUS EDITION Page 4 of 4 US Department of Transportation OMB CONTROL NUMBER- 2120-0569 Federal Aviation Administration EXPIRATION DATE 8/31/2019 Construction Project Final Acceptance Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Fishers Island Elizabeth Field Airport Project Number: 3-36-0029- -2017 Description of Work: Airport Pavement Management Study 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 of 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 "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). ❑X Yes ❑ No ❑N/A 2. 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(AC) 150/5370-12); b. Contract requirements (2 CFR part 200 and FAA Order 5100.38); and c. Construction safety and phasing plan measures (AC 150/5370-2). []Yes ❑ No ❑X N/A 3. All acceptance tests specified in the project specifications were or will be performed and documented. (AC 150/5370-12). [:]Yes ❑ No 0 N/A FAA Form 5100-129(1/17)SUPERSEDES PREVIOUS EDITION page 1 of 3 4. Sponsor has taken or will take appropriate corrective action for any test result outside of allowable tolerances(AC 150/5370-12). ❑Yes ❑ No ❑X N/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 150/5370-10). ❑Yes ❑ No 0 N/A 6. Sponsor has notified, or will promptly notify the Federal Aviation Administration (FAA) of the following occurrences: a. 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 part 5); and c. Violations of or complaints addressing conformance with Equal Employment Opportunity or Disadvantaged Business Enterprise requirements (41 CFR Chapter 60 and 49 CFR part 26). ❑Yes ❑ No Q 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(29 CFR Part 5). ❑Yes ❑ No 0 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: a 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§26.29); c. Release of applicable retainage upon satisfactory performance of work(49 CFR§26.29); and d. Verification that payments to DBEs represent work the DBE performed by carrying out a commercially useful function (49 CFR§26.55). ❑Yes ❑ No 0 N/A 9. 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 (Order 5100.38); b. Necessary actions to correct punch list items identified during final inspection are complete (Order 5100.38); and c. Preparation of a record of final inspection and distribution to parties to the contract (Order 5100.38); ❑Yes ❑ No ❑X 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 ❑ No 0 N/A FAA Form 5100-129(1/17)SUPERSEDES PREVIOUS EDITION page 2 of 3 11. The construction of all buildings have complied or will comply with the seismic construction requirements of 49 CFR§41.120. ❑Yes ❑ No 0 N/A 12. For development projects, sponsor has taken or will take the following close-out actions: a. Submit to the FAA a final test and quality assurance report summarizing acceptance test results, as applicable (Grant Condition); b. Complete all environmental requirements as established within the project environmental determination (Oder 5100.38); and c. Prepare and retain as-built plans (Order 5100.38). ❑Yes ❑ No 0 N/A 13. Sponsor has revised or will revise their airport layout plan (ALP)that reflects improvements made and has submitted or will submit an updated ALP to the FAA no later than 90 days from the period of performance end date. (49 USC §47107 and Order 5100.38). ❑Yes ❑ No ❑X N/A Attach documentation clarifying any above item marked with "No" response. Sponsor'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. Executed on this day of , Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott Russell Title of Sponsor's Authorized Official: Town Supervisor J ILAI-P A Signature of Sponsor's Authorized Official: LAWWR 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 § 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-129(1/17)SUPERSEDES PREVIOUS EDITION page 3 of 3 U S.Department of Transportation OMB CONTROL NUMBER:2120-0569 r/ Federal Aviation Administration EXPIRATION DATE: 8/31/2019 Drug-Free Workplace Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Fishers Island Elizabeth Field Airport Project Number: 3-36-0029- -2017 Description of Work: Airport Pavement Management Study 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 on the drug-free workplace within federal grant programs are described in 2 CFR part 182. Sponsors are required to certify they will be, or will continue to provide, a drug-free workplace in accordance with the regulation. The AIP project grant agreement contains specific assurances on the Drug-Free Workplace Act of 1988. 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 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 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 (2 CFR § 182.205). ❑x Yes ❑ No ❑ N/A 2. An ongoing drug-free awareness program (2 CFR§ 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 sponsor's policy of maintaining a drug-free workplace; c. Any available drug counseling, rehabilitation, and employee assistance programs; and d. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. ❑x Yes ❑ No ❑ N/A FAA Form 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3 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§ 182.210). 0 Yes ❑ No ❑ N/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(2 CFR§ 182.205(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. p Yes ❑ No ❑ 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 (2 CFR§ 182.225). Employers of convicted employees must provide notice, including position title of the employee, to the FAA(2 CFR§ 182.300). P9 Yes ❑ No ❑ N/A 6. One of the following actions (2 CFR § 182.225(b))will be taken within 30 calendar days of receiving a notice under item 4b above with respect to any employee who is so convicted: a. 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. p Yes ❑ No ❑ N/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 6 above (2 CFR§ 182.200). p Yes ❑ No ❑ N/A Site(s) of performance of work(2 CFR§ 182.230): Location 1 Name of Location: Elizabeth Field Airport Address: 500 Airport Road, Fishers Island, NY 06390 Location 2 (if applicable) Name of Location: Address: Location 3 (if applicable) Name of Location: Address: FAA Form 5100-130 (1/17)SUPERSEDES PREVIOUS EDITION Page 2 of 3 Attach documentation clarifying any above item marked with a "No" response. Sponsor'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. Executed on this day of , Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official. Scott Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's Authorized Official: IoA IV 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 § 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 U.S Department of Transportation OMB CONTROL NUMBER:2120-0569 Federal Aviation Administration EXPIRATION DATE 8/31/2019 Equipment and Construction Contracts Airport Improvement Sponsor Certification Sponsor: Town of Southold Airport: Fishers Island Elizabeth Field Airport Project Number: 3-36-0029- -2017 Description of Work: Airport Pavement Management Study 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 procurement standards for equipment and construction contracts within Federal grant programs are described in 2 CFR§§200.317-200.326. Labor and Civil Rights Standards applicable to the AIP are established by the Department of Labor(www.dol.gov)AIP Grant Assurance C.1—General Federal Requirements identifies all applicable Federal Laws, regulations, executive orders, policies, guidelines and requirements for assistance under the AIP 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 or an equipment project. 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 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§ 200.318). ❑x Yes ❑ No ❑ N/A FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 4 2. 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). ❑x Yes ❑ No ❑ 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 VI of the Civil Rights Act and 49 CFR Part 26 for Disadvantaged Business Enterprises in all contracts and subcontracts. ❑ Yes [-] No ❑x 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 (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 (49 CFR§26.37(b)); and c. Provides for a running tally of payments made to DBE firms and a means for comparing actual attainments (i.e. payments)to original commitments (49 CFR§ 26.37(c)). ❑Yes ❑ No ❑x 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 a sufficient response time to solicit an adequate number of interested contractors or vendors; 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; c. Publicly opened at a time and place prescribed in the invitation for bids; and d. Prepared in a manner that result in a firm fixed price contract award to the lowest responsive and responsible bidder. ❑Yes ❑ No ❑x N/A 6. For projects the Sponsor proposes to use the competitive proposal procurement method (2 CFR § 200.320(d)), Sponsor has requested or will request FAA approval prior to proceeding with a competitive proposal procurement by submitting to the FAA the following: a. 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 c. Listing of evaluation factors along with relative importance of the factors. ❑Yes ❑ No ❑x N/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 200,Appendix II). ❑ Yes ❑ No ❑x N/A FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 2 of 4 8. Concurrence was or will be obtained from the Federal Aviation Administration (FAA) prior to contract award under any of the following circumstances (Order 5100.38D): a. Only one qualified person/firm submits a responsive bid; b. Award is to be made to other than the lowest responsible bidder; and c. Life cycle costing is a factor in selecting the lowest responsive bidder. ❑ Yes ❑ No p N/A 9. All construction and equipment installation contracts contain or will contain provisions for: a. Access to Records (§ 200.336) b. Buy American Preferences (Title 49 U.S.C. § 50101) c. Civil Rights-General Provisions and Title VI Assurances(41 CFR part 60) d. Federal Fair Labor Standards (29 U.S.0 §201, et seq) e. Occupational Safety and Health Act requirements (20 CFR part 1920) f. Seismic Safety—building construction (49 CFR part 41) g. State Energy Conservation Requirements-as applicable(2 CFR part 200, Appendix II) h. U.S. Trade Restriction (49 CFR part 30) i. Veterans Preference(49 USC §47112(c)) ❑ Yes ❑ No ❑x N/A 10. All construction and equipment installation contracts exceeding $2,000 contain or will contain the provisions established by: a. Davis-Bacon and Related Acts (29 CFR part 5) b. Copeland "Anti-Kickback"Act(29 CFR parts 3 and 5) ❑ Yes ❑ No ❑x N/A 11. All construction and equipment installation contracts exceeding $3,000 contain or will contain a contract provision that discourages distracted driving (E.O. 13513). ❑ Yes ❑ No 0 N/A 12. All contracts exceeding $10,000 contain or will contain the following provisions as applicable: a. Construction and equipment installation projects-Applicable clauses from 41 CFR Part 60 for compliance with Executive Orders 11246 and 11375 on Equal Employment Opportunity; b. Construction and equipment installation -Contract Clause prohibiting segregated facilities in accordance with 41 CFR part 60-1.8; c. Requirement to maximize use of products containing recovered materials in accordance with 2 CFR§200.322 and 40 CFR part 247; and d. Provisions that address termination for cause and termination for convenience (2 CFR Part 200,Appendix II). ❑ Yes ❑ No ❑x N/A FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 4 13. All contracts and subcontracts exceeding $25,000: Measures are in place or will be in place(e.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 (2 CFR parts 180 and 1200). ❑ Yes ❑ No ❑x N/A 14. Contracts exceeding the simplified acquisition threshold (currently$150,000) include or will include provisions, as applicable, that address the following: a. Construction and equipment installation contracts-a bid guarantee of 5%, a performance bond of 100%, and a payment bond of 100% (2 CFR§ 200.325); b. Construction and equipment installation contracts- requirements of the Contract Work Hours and Safety Standards Act(40 USC 3701-3708, Sections 103 and 107); c. Restrictions on Lobbying and Influencing (2 CFR part 200, Appendix 11); 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 §200,Appendix II); and e. All Contracts-Applicable standards and requirements issued under Section 306 of the Clean Air Act(42 USC 7401-7671 q), Section 508 of the Clean Water Act(33 USC 1251- 1387, and Executive Order 11738 ❑ Yes ❑ No ❑x N/A Attach documentation clarifying any above item marked with "No" response. Sponsor'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. Executed on this day of , Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott Russell Title of Sponsor's Authorized Official. Town Supervisor Signature of Sponsor's 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§ 1001 (False Statements) and could subject me to fines, imprisonment, or both. FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 4 of 4 � U S.Department of Transportation OMB CONTROL NUMBER:2120-0569 v Federal Aviation Administration EXPIRATION DATE- 8/31/2019 Project Plans and Specifications Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Fishers Island Elizabeth Field Airport Project Number: 3-36-0029- -2017 Description of Work: Airport Pavement Management Study 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). Labor and civil rights standards applicable to AIP are established by the Department of Labor(www.dol.gov/). AIP Grant Assurance C.1—General Federal Requirements identifies applicable federal laws, regulations, executive orders, policies, guidelines and requirements for assistance under AIP. A list of current advisory circulars with specific standards for procurement, design or construction of airports, 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 (N/A), this list includes mayor 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 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 circulars, or FAA-accepted state standard, is necessary other than those explicitly approved by the Federal Aviation Administration (FAA) (14 USC §47105). P9 Yes ❑ 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 (2 CFR§200.319). p Yes ❑ No ❑N/A FAA Form 5100-132(1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3 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 USC§47107). ❑x Yes ❑ No ❑ N/A 4. Development and features that are ineligible or unallowable for AIP funding have been or will be omitted from the plans and specifications (FAA Order 5100.38, par. 3-43). ❑ Yes ❑ No 0 N/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-5). ❑ Yes ❑ No 0 N/A 6. The specification does not impose or will not impose geographical preference in their procurement requirements (2 CFR §200.319(b)and FAA Order 5100.38, Table U-5). ❑ Yes ❑ No 0 N/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§319(d)). ❑ Yes ❑ No 0 N/A 8. Solicitations with bid alternates include or will include explicit information that establish a basis for award of contract that is free of arbitrary decisions by the sponsor(2 CFR§200.319(a)(7)). ❑ Yes ❑ No 0 N/A 9. Concurrence was or will be obtained from the FAA if Sponsor incorporates a value engineering clause into the contract(FAA Order 5100.38, par. 3-57). ❑ Yes ❑ No 0 N/A 10. The plans and specifications incorporate or will incorporate applicable requirements and recommendations set forth in the federally approved environmental finding (49 USC§47106(c)). 0 Yes ❑ No ❑ N/A 11. The design of all buildings comply or will comply with the seismic design requirements of 49 CFR §41.120. (FAA Order 5100.38d, par. 3-92) ❑ Yes ❑ No 0 N/A 12 The project specification include or will include process control and acceptance tests required for the project by as per the applicable standard: a. Construction and installation as contained in Advisory Circular(AC) 150/5370-10. []Yes ❑ No 0 N/A FAA Form 5100-132(1/17)SUPERSEDES PREVIOUS EDITION Page 2 of 3 b. Snow Removal Equipment as contained in AC 150/5220-20. ❑Yes ❑ No ❑x N/A c. Aircraft Rescue and Fire Fighting (ARFF)vehicles as contained in AC 150/5220-10. ❑Yes [] No p N/A 13. For construction activities within or near aircraft operational areas(AOA): a. The Sponsor has or will prepare a construction safety and phasing plan (CSPP) conforming to Advisory Circular 150/5370-2. b. Compliance with CSPP safety provisions has been or will be incorporated into the plans and specifications as a contractor requirement. c. Sponsor will not initiate work until receiving FAA's concurrence with the CSPP (FAA Order 5100.38, Par. 5-29). ❑ Yes ❑ No ❑x N/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 (49 USC§47110(b)(1) and FAA Order 5100.38d, par. 3-100). ❑ Yes ❑ No ❑x N/A Attach documentation clarifying any above item marked with "No" response. Sponsor'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. Executed on this day of Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's 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 § 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-132(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 US Department of Transportation OMB CONTROL NUMBER:2120-0569 Federal Aviation Administration EXPIRATION DATE. 8/31/2019 Selection of Consultants Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Fishers Island Elizabeth Field-Airport Project Number: 3-36-0029- -2017 Description of Work: Airport Pavement Management Study 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 in 2 CFR§§200.317-200.326. 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 mayor 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 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§200.318(k)). ❑x Yes ❑No ❑N/A 2. Sponsor procurement actions ensure or will ensure full and open competition that does not unduly limit competition (2 CFR§200.319). ❑x Yes ❑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 of a request-for- qualifications (RFQ)from competing for the advertised services (2 CFR§ 200.319). ®Yes ❑No ❑ N/A FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3 4. The advertisement describes or will describe specific project statements-of-work that provide clear detail of required services without unduly restricting competition (2 CFR§200.319). ❑x Yes ❑No ❑N/A 5. Sponsor has publicized or will publicize a RFQ that: a. Solicits 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)). ❑x Yes ❑No ❑N/A 6. Sponsor has based or will base selection on qualifications, experience, and disadvantaged business enterprise participation with price not being a selection factor(2 CFR§200.320(d)). ❑x Yes ❑No ❑N/A 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 (2 CFR§180.300). ❑x Yes ❑No ❑N/A 8. A/E services covering multiple projects: Sponsor has agreed to or will agree to: a. Refrain from initiating work covered by this procurement beyond five years from the date of selection (AC 150/5100-14); and b. Retain the right to conduct new procurement actions for projects identified or not identified in the RFQ (AC 150/5100-14). ❑x Yes ❑No ❑N/A 9. 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 RFQ (2 CFR§200.323). ❑x Yes ❑No ❑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). p Yes ❑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(1)). M Yes ❑No ❑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 II) p Yes ❑No ❑N/A FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 2 of 3 13. For contracts that apply a time-and-material payment provision (also known as hourly rates, specific rates of compensation, and labor rates), the Sponsor has established or will establish: a. Justification that there is no other suitable contract method for the services (2 CFR §200.3180)); b. A ceiling price that the consultant exceeds at their risk (2 CFR§200.3180)); and c. A high degree of oversight that assures consultant is performing work in an efficient manner with effective cost controls in place 2 CFR§200.3180)). ❑x Yes ❑No ❑N/A 14. Sponsor is not using or will not use the prohibited cost-plus-percentage-of-cost(CPPC)contract method. (2 CFR§200.323(d)). ❑x Yes ❑No ❑N/A Attach documentation clarifying any above item marked with "no" response. Sponsor'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. 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§ 1001 (False Statements) and could subject me to fines, imprisonment, or both. Executed on this day of , Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott Russell Title of Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's Authorized Official: w/d4ra&402.-, I declare under penalty of perjury that the foregoing is true and correct. I undersand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 U S.Department of Transportation OMB CONTROL NUMBER 2120-0569 Federal Aviation Administration EXPIRATION DATE: 8/31/2019 Certification and Disclosure Regarding Potential Conflicts of Interest Airport Improvement Program Sponsor Certification Sponsor: Town of Southold Airport: Fishers Island Elizabeth Field Airport Project Number: 3-36-0029- -2017 Description of Work: Airport Pavement Management Study Application Title 2 CFR§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 in the firm selected for award: a) The employee, officer or agent, b) Any member of his immediate family, c) His or her partner, or d) An organization which employs, or is 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 (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 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 CFR §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. ❑x Yes ❑ No FAA Form 5100-135(2/17)SUPERSEDES PREVIOUS EDITION Page 1 of 2 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 to sub-agreements (2 CFR§200.318(c)). ❑D Yes ❑ No 3. The sponsor or sub-recipient certifies that is has disclosed and will disclose to the FAA any known potential conflict of interest(2 CFR§ 1200.112). ❑x Yes ❑ No Attach documentation clarifying any above item marked with "no" response. Sponsor's Certification 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" is correct and complete. Executed on this day of Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott Russell Title of P Sponsor's Authorized Official: Town Supervisor Signature of Sponsor's 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§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-135(2/17)SUPERSEDES PREVIOUS EDITION Page 2 of 2 Obstacle Action Plan Worksheet' - - 1 Obstacle Reference Number is a locally generated number or FAA Digital Obstacle File(DOF)number uniquely identifying the obstacle 2 Obstacle Type describe the type of obstacle 3 Latitude enter the latitude(for example N342218.32 for N34o 22'18.32") 4 Longitude enter the longitude(for example W983211.11 for W98o 32'11.11") 5 AMSL Elevation(ft.) enter the Above Mean Sea Level(AMSL)elevation of the obstacle at its highest point 6 Height AGL(ft.) enter the Above Ground Level(AGL)height of the obstacle measured from the ground at the base of the obstacle 7 Surface Penetrated enter either the word approach or departure surface 8 Penetration Amount enter the amount the obstacle penetrates the surface in in feet 9 Reference Runway enter the runway designation for the runway the surface protects , Obstacle Disposition Plan 1 Obstacle Reference Number is a locally generated number or FAA Digital Obstacle File(DOF)number uniquely identifying the obstacle 2 Obstacle Type describe the type of obstacle 3 Obstacle located on or off airport Identify if the airport is"ON" of"OFF"airport property 4 Sponsored Controlled Identify if the the obstacle is under sponsor control ("YES"under sponsor control or"NO"not under sponsor control 5 Proposed Mitigation enter the proposed disposition of the obstacle 6 Proposed Disposition Date lenter the date as in the MM/DD/YY format. Propbsed Maintenance Plan 1 Runway Designator Enter the runway designator the maintenance plan supports 2 Proposed Maintenance Action Describe your plans to maintain the runway surfaces clear of obstacles Airport Contact Information Airport Name: Elizabeth Field Airport Location Identifier: OB8 Sponsor: Town of Southold & Fishers Island Ferry District Street Address: PO Box 607 Street Address 2: City: Fishers Island State: New York Zip Code+4: 06390 Telephone Number: (631) 788-7463 Email Address: gmurphy@fiferry.com ObstacleAct_ion Plan AMSL Obstacle Obstacle Type Latitude Longitude Elevation(ft.) Height Surface Penetrated Penetration Amount Reference Runway Reference Number ( �) AGL(ft.) (ft. RUNWAY 7-25 7-1 rock and dirt berm 41 15 02.00 72 02 08.29 8.0 unknown Part 77 Approach 10 Runway 7-25 7-2 clump of phragmites 41 15 03.04 72 02 10.18 8.0 unknown Part 77 Approach 91 Runway 7-25 7-4 group of trees on dirt mound 41 15 02.62 72 02 12.27 8.0 unknown Part 77 Approach 181 Runway 7-25 7-6 bush 41 15 03 20 72 02 12.00 9.0 unknown Part 77 Transitional 12.8 Runway 7-25 7-7 bush 41 15 03.51 72 02 11.65 9.0 unknown Part 77 Transitional 2.7 Runway 7-25 7/25-1 rock and dirt berm 41 15 02 17 72 02 06.83 80 unknown Part 77 Primary 6.7 Runway 7-25 7/25-2 rock and dirt berm 41 15 02.63 72 02 04.48 8.0 unknown Part 77 Transitional 3.1 Runway 7-25 7/25-4 terminal building roof peak 41 15 13.66 72 0147.99 8.0 unknown Part 77 Transitional 5.7 Runway 7-25 7/25-5 utility pole 41 15 14.98 72 0147.61 8.0 unknown Part 77 Transitional 11 Runway 7-25 25-1 top light 41 15 14.76 72 0142.99 10.0 unknown Part 77 Approach 7.4 Runway 7-25 25-2 lookout tower 41 15 15.37 72 0143 52 12.0 unknown Part 77 Transitional 1.9 Runway 7-25 RUNWAY 12-30 12-1 41 ft diameter phragmites 42 15 11.71 72 02 12.91 5.0 unknown Part 77 Approach 9 Runway 12-30 30-1 boulder sea wall 275'long 41 15 03.36 72 0137.08 5.0 unknown Part 77 Approach 3.3 Runway 12-30 30-3 brush area 41 15 05.15 72 0133.91 5.0 unknown Part 77 Approach 0.4 Runway 12-30 12/30-6 marker light 41 15 05.85 72 0151.35 5.0 unknown Part 77 Primary 3 Runway 12-30 12/30-7 windsock pole 41 15 08.33 72 0148.03 5.0 unknown Part 77 Primary 21.5 Runway 12-30 12/30-8 sand dune 300'long 41 15 04.44 72 0147.15 5.0 unknown Part 77 Primary 8.6 Runway 12-30 12/30-9 berm 41 15 04 04 72 0142.61 5.0 unknown Part 77 Primary 2.6 Runway 12-30 12/30-10 boulder sea wall 50'long 41 15 22.13 72 21 19.62 6.0 unknown Part 77 Primary 6.6 Runway 12-30 12/30-11 marker light 41 15 03.82 72 0140.71 6.0 unknown Part 77 Primary 7.7 Runway 12-30 12/30-12 boulder sea wall 275'long 41 15 03.54 72 0138.64 8.0 unknown Part 77 Primary 5.1 Runway 12-30 12/30-13 sand dune with phragmites 41 15 05.82 72 0137.88 8.0 unknown Part 77 Primary 0.2 Runway 12-30 12/30-14 sand dune with phragmites 41 15 05.23 72 0136 52 8.0 unknown Part 77 Approach 2.8 1 Runway 12-30 Obstacle Disposition Plan Obstacle Reference Obstacle located Under Sponsor Number Obstacle Type ON or OFF Airport Control Proposed Disposition of the Obstacle Proposed Disposition Completion Date RUNWAY 7-25 7-1 rock and dirt berm On Yes Light 2019 7-2 clump of phragmites On Yes Remove 2019 7-4 group of trees on dirt mound On Yes Remove 2019 7-6 bush On Yes Remove 2019 7-7 bush On Yes Remove 2019 7/25-1 rock and dirt berm On Yes Remove Obstruction Status unknow,additional study needed 7/25-2 rock and dirt berm On Yes Remove Obstruction Status unknow,additional study needed 7/25-4 terminal building roof peak On Yes Remove Obstruction Status unknow,additional study needed 7/25-5 utility pole On Yes relocate/bury Obstruction Status unknow,additional study needed 25-1 top light On Yes none Obstruction Status unknow,additional study needed 25-2 lookout tower On Yes none Obstruction Status unknow,additional study needed RUNWAY 12-30 12-1 41 ft diameter phragmites On Yes Remove 2019 30-1 boulder sea wall 275'long On Yes No Action No Action 30-3 brush area On Yes Remove Obstruction Status unknow,additional study needed 12/30-6 marker light On Yes None Obstruction Status unknow,additional study needed 12/30-7 windsock pole On Yes No Action No Action 12/30-8 sand dune 300'long On Yes Remove Obstruction Status unknow,additional study needed 12/30-9 berm On Yes No Action Obstruction Status unknow,additional study needed 12/30-10 boulder sea wall 50'long On Yes No Action Obstruction Status unknow,additional study needed 12/30-11 marker light On Yes No Action Obstruction Status unknow,additional study needed 12/30-12 boulder sea wall 275'long On Yes No Action Obstruction Status unknow,additional study needed 12/30-13 sand dune with phragmites On Yes Remove Obstruction Status unknow,additional study needed 12/30-14 sand dune with phragmites On Yes Remove Obstruction Status unknow,additional study needed Proposed Maintenance Plan Runway Designator Proposed Maintenance Action Obstructions listed were identified by third party aerial survey dated February 2010 The obstacles have been provided in table format on sheet 4("Airspace Plan and Obstruction Data")of the Airport Layout Plan Update,dated October 2010 The obstacles have been visually verified based on damage sustained during a 2012 hurricane event,and the obstruction data table updated accordingly Currently the Airport is in non-compliance with FAR Part 77 20 1 Approach,Part 77 Primary and 7 1 Transitional surfaces Removal or modification of these obstructions is necessary to meet FAR Part 77 approach and transitional requirements and to increase the overall safety of operations at the Airport If obstructions are not mitigated,the Airport will remain in noncompliance with federal regulations for maintaining FAR Part 77 surfaces clear of obstructions - Runway 12-30 On-Airport Obstruction Removal efforts will require removal(clearing and grubbing)of approximately 0 91 acres of vegetation(phragmites,brush,trees)and grading approximately 0 41 acres of turf(dirt berm/mound),grading in Runway 7-25 this area will include removal of approximately 200 cubic yards of excavated material(sod),following sod removal,top soil,seeding with native seed mix and mulching within grading limits will be completed The existign boulder sea walls at the RW 7 and RW 30 ends regwer an additional investigation to determine the extent of mitigation required The Sponsor intends to utilize the current obstruction data and pursue a design-phase grant in FY2018 to confirm obstacles and develop a detailed mitigation plan for addressing the on-airport obstructions The anticipated schedule for the design phase of obstruction removal is FY 2018-2019 and construction in FY 2021-2022 The Sponsor intends to pursue FAA AIP grant assistance to fund the construction phase of obstruction mitigation projects in FY2019 Once terrain and tree removal operations are completed,the areas will be graded and seeded in an effort to allow for future maintenance by the Sponsor Obstructions that are proposed to be lighted shall be coordinated with all stakeholders -------ADDRESSES t ANY;State,Reviewin A4pncies ALBANY,RENSSELAER, SCHENECTADY, BROOME, CHENANGO, CORTLAND, SARATOGA DELAWARE, OTSEGO, SCHOHARIE,TIOGA, TOMPKINS Mr. Rocky Ferraro,AICP Executive Director Mr.Erik Miller,Director Capital District Regional Planning Commission Southern Tier East Planning Board One Park Place Suite 102 375 State St. Albany,NY 12205 Binghamton,NY 13901-2385 Tel. (518)453-0850 Tel. (607)724-1327 x212 Fax(518) 453-0856 Fax(607)724-1194 Email: Rocky�a)cdrpc.org Email: emillerksteny.org *Will accept electronic project proposals Director.stenvAgmail.com *Will accept electronic project proposals CHAUTAUQUA,CATTARAUGUS,ALLEGANY CHEMUNG, SCHUYLER,STEUBEN Ms. Sarah Phearsdorg Ms. Marcia Weber Southern Tier West RPB Southern Tier Central 4039 Route 219, Suite 200 Regional Planning Bd. Salamanca, NY 14779-9625 8 Denison Parkway East, Suite 310 Tel. (716)945-5301 Corning,NY 14830 Email: sphearsdorfe(iDsoutherntierwest.org Tel. (607)962-5092 *Will accept electronic project proposals Fax(607)962-3400 Email: weberAlstny.rr.com *Will accept electronic project proposals COLUMBIA DUTCHESS Waive right to review all proposed projects Waive right to review all proposed projects ERIE,NIAGARA FRANKLIN Waive right to review all proposed projects Waive right to review all proposed projects FULTON GENESSE,LIVINGSTON,MONROE, ONTARIO, ORLEANS, SENECA, Waive right to review all proposed projects WAYNE,YATES,WYOMING Ms. Rudeen Armstrong Genesee/FingerLakes Regional Planning Cncl. City Place,50 West Main Street, Suite 8107 Rochester, NY 14614 Tel. (585) 454-0190 Fax(585) 454-0191 - *Will not accept electronic project proposals *Only reviewing proposals that are specific to Brownfields and Waste Water GREENE JEFFERSON Waive right to review,all proposed projects Mr.Donald CanField Jefferson County Planning Dept. 175 Arsenal St. Watertown,NY 13601 Tel. (315)785-3144 Fax(315)785-5092 Email:`don 00o.i efferson.ny.us *Will not accept electronic project proposals LEWIS MONTGOMERY Waive right to review all proposed projects Waive right to review all proposed projects NASSAU NEW YORK CITY and NEW YORK STATE DEPARTMENT OF Waive right to review all proposed projects ENVIRONMENTAL CONSERVATION Waive right to review all proposed projects ORANGE OSWEGO, ONONDAGA,MADISON, CAYUGA Mr. David Church Ms. Carol Faucher or David ]Bonar Orange County Planning Dept. Central New York Regional 124 Main St. Planning Board Goshen,NY 10924 126 N. Salina Street Tel. (845) 615-3840 Syracuse,NY 13202-1050 Fax(845) 291-2533 Tel. (315)422-8276 Email: Dchurch@orangecountygov.com Fax(315)422-9051 *Will accept electronic project proposals Email: mailAcnyrpdb.ors *Will not accept electronic project'proposals PUTNAM ROCKLAND Waive right to review all proposed projects Ms.Arlene Miller Rockland County Department of Planning Robert Yeager Health Center,Building T 50 Sanatorium Road Pomona, NY 10970 Tel. (845)364-3434 Fax(914) 638-5686 Email: Millera(a,co.rockland.ny.us *Will accept electronic project proposals ST.LAWRENCE `SUFFOLK---- Waive right to review all proposed projects Waiye"right to_review all p,`r"oposed.projects;' SULLIVAN ULSTER Waive right to review all proposed projects Mr. Dennis Doyle Ulster County Planning Board Box 1800 244 Fair St. Kingston, NY 12401 Tel. (845)340-3339 Fax(845)340-3429 Email: planningAco.ulster.ny.us WESTCHESTER HERKIMER, ONEIDA Mr. Edward Buroughs Waive right to review all proposed projects Commissioner of Planning Westchester County Department of Planning 148 Martine Avenue,Room 432 White Plains,NY 10601-4704 Tel. (914)995-4402 Email: EEB6Awestchestergov.com *Will accept electronic project proposals CLINTON,ESSEX,HAMILTON,WARREN, *Only reviewing proposals with a threshold of WASHINGTON $200,000. Waive right to review all proposed projects 1 2 3 4 -------------------------------]! CONNECTICUT 1 RHODE ISIANO I PROVED 6Y T—of S— APvaovEn 6r FFOEwu AvwnONAOmwISTRanONA NC On E C �swawu ��En�meers,Inc olvlslox oFOEao'wWlcsPo�Anox ® I Nae FPutrmFt+TD _- Prams a1s4 APPROVED Br ! su6mmEo er Fa�Ot ss mwwm mm FISHERS ISIANO °ATE DATE ' ELIZABETH D p FIELD -LOCKISLAND LONG ISLAND SOUND AIRPORT t Ws!sr(t960 ti��a ,HO'b RSX a N. �4 1 ols ® As 9 OFFFE-11-Cr E iW ItIE5T-.E LONG ISLAND / Eo _ / 9 ATLANTIC OCEAN LOCATION MAP 1 � FFRren FSsox ./ R D� 6CHoaL ®® wMTRAN9 40 axG © J0 20 .0 'SNN. FISHERS fsuND t0 C � R��p ©p a7W3//. nmCCPoS5 a0n° Pype6��i�tlp4 1-T °EVELOPMm PROJECT PHASING x P-1(Em°mmnm) r ry lel A,Seaemetbr SYry CIP wp NCrack Repay(Oe 1.BY.-( I 3 ISO we lObsarabm Sralem(AWOS) a w o r Zfoi _ �9'� \_R,✓_ 1-3 2 � AFRO! Runway 3D llueslwld RelmaumeRSA Mprevamenja ,.•£m•weH POINr����"��'!�_G__f 32 �� ,�E INrdp Z � /A�//� oea��saaOREmoa maalaea cmawcp I pga5 ..�A// / Temlmal APmne Aula Parkin IRNN 251030 mE 1) _ g Rego` (-1118 Cmswm n z-z /Il;� ", `�✓ \ � Dealpn a cm,wm Tarvara 5-m 2s IP 12 j 9�w F __ CON 20NE gg /II 1 1 iPELL !` ` GPS ApPmack Oevelmmenl S s U a ZO IAPPROAGN SIOPF _N'! OF'q�� NNI-fU 9.•\ \ Q / 1 $ppr 6 ,,,,,� ', (20142016) n S G wO _ 2<-w`O at Q Rwvmy 0vetlay(Oespn a Conalrvcl) b FA�RP�� MEaiEeµel°ary€__`\\ "•r°-\: PU2 cesip"a6e�gmlemea cwlav lRlw]mtn \ p OOV RgEl� lots 2026)ew Temmu �ow • _ISTyyp 14O'x2 - IL 1 .\\ 1,4 j$ --1 BudNng(Design 6 Cmswcll a�" PJ Dem (msienflcbna1rvc11 I i ry U6H rap) / `$` _- "��1•W R Y // sk Eals6n9 Te�min3 S.lding / U // ' / ( 1 _ NWAYOATA -,v// t� \\\Y ,i 1.5 2p' PRwCNSL°PE Raowav°ata ealw" E,Iw"9 Rx w o O B COn9TLINE. P" Ltb BLOC 1-13SOUNO 'S-1(eAI 16% 016% 3 GB eGanga °29 21 aN. o IS 5W THRESHOLD SITING SURFACE PENETRATION Rumvay enMn�SU xis 6°z LL u] ZQ ROCK AND DIRT BERM TO BE REMOVED Ruaway v4mn76 176 J (OBSTRUCTION NO 725-1 SEE SHEETS 4 AND 6) THRESHOLD SITING SURFACE PENETRATION Djsplacetl Tnre,lwld• wa/rva F=- O y BOULDER SEAWALL TO BE RELOCATED ble Runway LenelN z3a5 W PLAN (OBSTRUCTIONNO 12130-12 SEESHEETS4AND5) m 3 U1 seA3e 1 30veNm 00,) IQJ O W 2 300 0 300 fi00FF �IpuaiNwewilx el W LL 300 THRESHOLD SITING SURFACE PENETRATIONSpmmI Sudc1 e sl a mtrzOl TREES TO BE REMOVED Appmacn Miamama• walla Nail. (OBSTRUCTION NOS]i AND T 5,SEE SHEETS 4 AND 6) is 1 PAPI PAPF2m 2=— 2 REILa PA PFz2 REILa,PAW Mt..mAppmecO Aid, REILa OPS N/Bllaa walla -- N De eonal PaL)(NgO 63�aPORi DATA 41 50BN 4tP°r1506 tlN Wcmrcee Code(ARC) sllA1 MmIIY OI1smB1W wMIRLa Q LEGENon ! mrry Liebji S QIs Clu-, -- Rumv Cen1eN en Pn Psatl_ 1 A Bd B d p ASA_____ �nway sa2lY Awes asA RSA_____ �Im w�6 uc 0a�gmn romiry wamalamren Z O aura Object Free Area IROFA) _WF___ ILmnuOe s ry (A 16 BI)afl lusnery IA 1 fl B-1) } __BOR____ raver Obslecle Free inns ROFZI _-_BoP4_-- 72 01 S4 W ]2015d•W F,. LenpN 500 Fumrry Pmlecubn TmelRPA I Mean Mazd. l Temlrerelme ofYbjjem Mmtb 8O4 F umrsy O4eclFree Aree(a0FA) ll Z FM _�FA___ TazI- b--Area OFA - -- Ilgkletl vnndra h.H y RumvaY H Ajmm lrawjPm IAv)wpe�senare�p�nnwmun __]3A_____ Takm s __Js9 _ z50' 7 man om�ior reguarea mrevuMu m" ---daL----- Bwldmg Reslncl. (.F1) �-- _ A1mM Telmma1V NAVAJOS mAWOS�mI �Samry-FSA1 -o �p m AAe��m � n -- a� - - ; MagnebC°admlm .•w pmBeymdRww ;p g Oa 8 awnlck muldma erwryarteaunaeiery w N PNn ARP Deism Megrrebc Vadabm 060 660 Wtljb z5O' 25O �yyy�y"��'oBy1p�,8100 Baltlinga I NPIAS Sence Leel 11GA 1GA Okajrcle Free Lne(OFA 250 r d _--_ -_,_ ONtba Itlinga ®- ! Swla Sewce Lem G4 GA i FAR Pad]]Caregwy °Jaual NPI/asual xaum equal taus QI Pm nV Llrc IM Coa:repe Cm,swind Cammnml Rumra dCmwinatea(NAD 83) w,uml c - Ou P uy net(12 MPMPMr]125 124t 1509 a3•N 61.150943'N ]41.15039PN741-1-97 N d aQ FACII-1-TAfiLE Ralmad ----- - I [Z'.-MME MPM 0.AN 1b30 12 72 02°8]5 W 12 72 OT 09]5•W 7 72 OZ u4 51 W 7 72 W0451 W Eaimjn Pm o Fence Au—t-(12MPM Ovn- 7D a1 15NM M N 41.15 N-WN Q am aaebs ' 35% nB33B1 1 xn•o136 smw 302T O10]9Yw zs I I IN g R cijiry Nama mliry Namara a0o I ekrerce Code Lar tu4e aeMSLP 3aM5tn - _ Tree mne _ - ratan larrmmes ImnJyNb-Ilfed0-11 pLmaxy�Bn-.Awna(l-I-LI Na ]9152 dHFtTREFEPENCE NO ---- - i �eHbng Eje� �;>9 3 &RE�I3 OFfi c°vmsm® SCHEDULE A SCOPE OF WORK Project Title: Airport Pavement Management System Airport Name: Elizabeth Field Airport Services Provided: Airport Pavement Management Program AIRPORT PAVEMENT MANAGEMENT SYSTEM UPDATE PHASE The Airport Pavement Management System Update Phase is intended to create an Airport Pavement Management System(APMS)for the Elizabeth Field Airport.The CONSULTANT will conduct a pavement surface condition survey, and shall input this data into a Pavement Management Program(PMP) database. All airside pavements will be included in the survey: ,t S .. iFF Y,f hd'-'rte O 1 16 Google The specific services to be provided or furnished for this Phase of the Project are the following: 1. Record Drawing Review • Acquire and review record documents (such as plans, specifications, reports, and studies) to become familiar with data that is available for the airport including construction dates, the type of major/minor rehabilitation that has taken place since original construction including dates,as the original construction and the date the last maj or/minor rehabilitation methods were conducted are critical to the accuracy of the PMP software's predictions of future condition. 2. Preliminary Elizabeth Field Airport PMP Layout • Preparation of current site drawings in which the Elizabeth Field Airport pavement network will be divided into the proper branches based on pavement use (i.e. runway/taxiway/apron), and finally into different sections that are dependent on the pavement type, age and structure. • The Elizabeth Field Airport pavement network/branches/sections will then be broken down to typical sample units of 5,000 SF f 1,000 SF for asphalt. A standard random sampling technique (network level), in accordance with ASTM D 5340, which utilizes statistical means to accurately predict the Pavement Condition Index (PCI) of the Elizabeth Field A-1 04/10 Airport's pavement network in preparation for the field visit to examine the pavement condition. 3. Site Visit • The condition survey will be a network-level management study performed by experienced C&S staff in accordance with ASTM D 5340 and FAA Advisory Circulars 150/5380-6C & 150/5380-713. • The random sample sections previously determined will be surveyed for pavement distresses,along with any additional sample section(s)the C&S representatives feel should be included into calculation as the condition of that sections varies from the average condition of that pavement section.These distresses for each sample unit will be measured and categorized in accordance with ASTM D 5340 for input into the PMP software. • Photographs will be taken to document the typical distress types. 4. Input of Information into PMP Software and Output • Distress data for each branch and section of the Elizabeth Field Airport Pavement network will be entered into the PMP software database. This will be done while the C&S representatives are on-site so that any areas that need to be re-checked can be performed prior to the team leaving. • Modify the PMP software costs for maintenance and repairs based on previous local experience, maintenance practices, costs and the actual use of the pavements. This will produce the following information: o Local Maintenance Policies—What should be done and when o Local costs for planned Maintenance and Repair methods, in accordance with the most up to date Elizabeth Field Airport ACIP. o Cost curve graphs that relate the cost per square foot to PCI for future years again looking at the most up to date Elizabeth Field Airport ACIP.From this information, it can be discussed with the Owner whether the ACIP order should be modified. o Priority Table—Owner's priorities vs.the pavement condition and needs? o Prediction Model for the asphalt pavements and differing areas, i.e. Runway, Taxiways and Aprons. • Updating airfield mapping showing the different pavement sections as well as the sections that were actually randomly sampled for use in future PMP studies so that the same areas can be studied for more precise comparison of pavement"aging"/damage. • Color coded mapping will be provided illustrating the current PCI values utilizing the standard seven color layout. 5. Final Report Preparation, • The final report will document the methodology used for the PMP study, inspection data, analyses, and examination of the existing ACIP in comparison to the PCI study. • The report will have a listing of the pavement network, sections and sample units. • Drawings will show the pavement sections and sample units and a color coded drawing(s) will present the current PCI results. • The final report will also show the methodology for the maintenance and repair activities, assumed local costs and comparison to existing Elizabeth Field Airport ACIP. • Five(5)color copies of the report will be turned over to the Owner as well as one(1)copy for the Federal Aviation Administration(FAA). A-2 04/10 • The Final Report shall include the following: o Branch Listing Report which provides the complete list of the Elizabeth Field Airport's pavement network including branches and data — branch numbers, branch names,branch use,branch area and the number of sections in each branch. There is also a drawing that accompanies this report and shows this visually as well as labels the sections that were randomly sampled. o PCI Report which provides the PCI value for each branch runway, taxiway, apron) as well as a weighted average PCI for each type of pavement use (i.e. average PCI of runway pavements,taxiway pavements and apron pavements)This will also have a corresponding drawing that will show the current PCI values utilizing the standard seven color layout. o Inspection Report which includes a summary of each sample section surveyed as well as photographs of the current condition of the pavement for each of the sample units. o Future PCI Condition Report which provides the future conditions for the pavement extrapolated in accordance with the Airport's current ACIP. o Work Plan Report which provides estimates for the cost of the future work by extrapolating the pavement condition of the entire pavement section that is planned for rehabilitation over the length of the Airport's current ACIP. ASSUMPTIONS: The conditions or considerations in developing the scope and fee for the project described above include: 1. No right-of-way or other deed research is included in this proposal. 2. As-built drawings are available and will be provided prior to field visit. 3. Access to the site for inspection/survey can be performed during day hours. 4. Cost estimates will be based on bid price from recent projects at the airport. 5. Soil sampling for contaminants will not be required for this project. END OF SCHEDULE A A-3 04/10 r 1 2 3 4 CONNECTICUT RHOCEISLANO I lrwesq—) 11;�E lneem,lIc NOR—� ~NORM •N°�Y�1412 S ptl cy\ FISHERS ISLAND F° '® `ELIZABET D P FIELD S—ISLAND QF SOU LONG ISLAND SOUND AIRPORT �p�a lyo6 LONG ISLAND asxERs IsuxO WE1M1W AVE ATLANTIC OCEAN / _ ® ILYENEELPOND LOCATION MAP FIYMIMN1FEa 6TARON 1HER011AN ./ D)TENMICOOMO _ ED AMC=— EL GEND o —1 02 Mao ,lam ,\ e® a nn G F PROPEOTY UNE A $ _— REI RU"Ar MOTEcnoxNezo 201ApvROACNSLOPE_-^'!- NOTES BEOBww+IceeeanlwT To \\\ � EsxErERRmxoRAUEwwNwTxoFtvu _;r� LaxclnroE 7 .• _____--_�a'O�_�____ _- REM1 \\ j � APP RA�nt41EI WT2'Ot58• 1o0p 4 uBSMON// : _-OOatpp`LP`uNiE�- ® Mt 1195 WI2.O1SS B // ��\ .'�:'" �� �� - Y--� RMNWAYPR RW 2s Ex0 Nat 161] wrsro�i 0us• In Z $� -LONOISIM'�XE NEW YORK STATE PLANE COOROI VE—TEM In = MPR TE ��P to Y Ge��E a0a¢ONf O COAS ixE / `+/ BLOCK IStANO5WN0 1 AREA=101ACRES(TIILE IN FEE SIMPLE) W 0 0 c zo1. 4 THISMAPwAso REOOAlmonooWMExTEosWRCFs LL O ]Z� ±P� y 1qp TWOiGTE A1IACN.LL BWIIDMYBYRVEY ,Z y R,�igPc' ANO UFT OEA�TEAB MCf�AOF TIRE unv sHpyPNACCUMTE � $ O W S PLANE-E EIWQOx SERr F—RN.P w LL wvECEM8ER 2008 WAS Ism TOMPREPARE MIS PROPERTY MM 000 0 100 BOOR �ensol%m. W ILQ EKINn Desrsl � .RSA--_-- --Sete F.Nam _.BRP FAt a Pw mIDne(ROF -- Pglb�mRe RPA d A–_ oven FreOArea oFAt O �_Lu s _ __Jse____ sarery aee S �A -�-__RSB i ReaNcllon m /O IL PAO FORIA Al�pwt Peknmu P- LAND O \N LAND ACQUISITION TABLE ZR ARP AmM ee lae 1 d R ACOWSRION &CE ACtLPAGE ® ONereVUd s LL 2 POEL UNREOSRla' �� sHEETREFEoRFNfENO _ _____ Gro�N FleatKn Coniine O SHEET 0 OF 0 1 2 3 4 C pAhtg 3 - 36 -0029 -020 - 2017 Law U.S.Department SPONSOR of Transportation Federal Aviation Administration GRANTAGREEMENT PART I—OFFER Date of Offer July 21, 2017 Airport/Planning Area Elizabeth Field AIP Grant Number 3-36-0029-020-2017 DUNS Number 197736387 TO: Town of Southold (herein called the"Sponsor") FROM: The United States of America(acting through the Federal Aviation Administration, herein called the "FAA")` WHEREAS,the Sponsor has submitted to the FAA a Project Application dated,for a grant of Federal funds for a project at or associated with the Elizabeth Field Airport,which is included as part of this Grant Agreement; and WHEREAS,the FAA has approved a project for the Elizabeth Field Airport(herein called the "Project") consisting of the following: Prepare an Airport Pavement Study. which is more fully described in the Project Application. NOW THEREFORE,According to the applicable provisions of the former Federal Aviation Act of 1958, as amended and recodified,49 U.S.C. §40101, et seq.,and the former Airport and Airway Improvement Act of 1982(AAIA), as amended and recodified,49 U.S.C. §47101,et seq., (herein the AAIA grant statute is referred to as"the Act"),the representations contained in the Project Application, and in consideration of (a)the Sponsor's adoption and ratification of the Grant Assurances dated March 2014,and the Sponsor's acceptance of this Offer; and, (b)the benefits to accrue to the United States and the public from the accomplishment of the Project and compliance with the Grant Assurances and conditions as herein provided. THE FEDERAL AVIATION ADMINISTRATION, FOR AND ON BEHALF OF THE UNITED STATES, HEREBY OFFERS AND AGREES to pay ninety(90) percent of the allowable costs incurred accomplishing the Project as the United States share of the Project. This Offer is made on and SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS: CONDITIONS 1. Maximum Obligation.The maximum obligation of the United States payable under this Offer is$65,250. The following amounts represent a breakdown of the maximum obligation for the purpose of establishing 1 3 -36 -0029 - 020 - 2017 obligation of the United States under the provisions of 49 U.S.C. §47108(b): $65,250 for planning $0 airport development or noise program implementation; and, $0 for land acquisition. 2. Period of Performance.The period of performance begins on the date the Sponsor formally accepts this agreement. Unless explicitly stated otherwise in an amendment from the FAA,the end date of the period of performance is 4 years (1,460 calendar days)from the date of formal grant acceptance by the Sponsor. The Sponsor may only charge allowable costs for obligations incurred prior to the end date of the period of performance (2 CFR§200.309). Unless the FAA authorizes a written extension,the sponsor must submit all project closeout documentation and liquidate (pay off) all obligations incurred under this award no later than 90 calendar days after the end date of the period of performance (2 CFR§200.343). The period of performance end date does not relieve or reduce Sponsor obligations and assurances that extend beyond the closeout of a grant agreement. 3. Ineligible or Unallowable Costs.The Sponsor must not include any costs in the project that the FAA has determined to be ineligible or unallowable. 4. Indirect Costs-Sponsor.Sponsor may charge indirect costs under this award by applying the indirect cost rate identified in the project application as accepted by the FAA,to allowable costs for Sponsor direct salaries and wages. 5. Determining the Final Federal Share of Costs.The United States'share of allowable project costs will be made in accordance with the regulations, policies, and procedures of the Secretary. Final determination of the United States'share will be based upon the final audit of the total amount of allowable project costs and settlement will be made for any upward or downward adjustments to the Federal share of costs. 6. Completing the Project Without Delay and in Conformance with Requirements.The Sponsor must carry out and complete the project without undue delays and in accordance with this agreement, and the regulations, policies,and procedures of the Secretary.The Sponsor also agrees to comply with the assurances which are part of this agreement. 7. Amendments or Withdrawals before Grant Acceptance.The FAA reserves the right to amend or withdraw this offer at any time prior to its acceptance by the Sponsor. 8. Offer Expiration Date.This offer will expire and the United States will not be obligated to pay any part of the costs of the project unless this offer has been accepted by the Sponsor on or before August 21,2017, or such subsequent date as may be prescribed in writing by the FAA. 9. Improper Use of Federal Funds.The Sponsor must take all steps, including litigation if necessary,to recover Federal funds spent fraudulently,wastefully,or in violation of Federal antitrust statutes,or misused in any other manner for any project upon which Federal funds have been expended. For the purposes of this grant agreement,the term "Federal funds" means funds however used or dispersed by the Sponsor,that were originally paid pursuant to this or any other Federal grant agreement.The Sponsor must obtain the approval of the Secretary as to any determination of the amount of the Federal share of such funds.The Sponsor must return the recovered Federal share, including funds recovered by settlement,order,or judgment,to the Secretary.The Sponsor must furnish to the Secretary, upon request, all documents and records pertaining to the determination of the amount of the Federal share or to any settlement, litigation, negotiation, or other efforts taken to recover such funds.All settlements or other final positions of the Sponsor, in court or otherwise, involving the recovery of such Federal share require advance approval by the Secretary. 2 3 -36-0029 - 020 - 2017 10. United States Not Liable for Damage or Injury.The United States is not responsible or liable for damage to property or injury to persons which may arise from,or be incident to,compliance with this grant agreement. 11. System for Award Management(SAM)Registration And Universal Identifier. A. Requirement for System for Award Management(SAM): Unless the Sponsor is exempted from this requirement under 2 CFR 25.110,the Sponsor must maintain the currency of its information in the SAM until the Sponsor submits the final financial report required under this grant, or receives the final payment,whichever is later.This requires that the Sponsor review and update the information at least annually after the initial registration and more frequently if required by changes in information or another award term.Additional information about registration procedures may be found at the SAM website(currently at http://www.sam.gov). B. Data Universal Numbering System: DUNS number means the nine-digit number established and assigned by Dun and Bradstreet, Inc. (D & B)to uniquely identify business entities.A DUNS number may be obtained from D& B by telephone (currently 866-705-5771)or on the web (currently at http://fedgov.dnb.com/webform). 12. Electronic Grant Payment(s). Unless otherwise directed by the FAA,the Sponsor must make each payment request under this agreement electronically via the Delphi einvoicing System for Department of Transportation (DOT) Financial Assistance Awardees. 13. Informal Letter Amendment of AIP Proiects. If,during the life of the project,the FAA determines that the maximum grant obligation of the United States exceeds the expected needs of the Sponsor by$25,000 or five percent(5%),whichever is greater,the FAA can issue a letter amendment to the Sponsor unilaterally reducing the maximum obligation. The FAA can also issue a letter to the Sponsor increasing the maximum obligation if there is an overrun in the total actual eligible and allowable project costs to cover the amount of the overrun provided it will not exceed the statutory limitations for grant amendments.The FAA's authority to increase the maximum obligation does not apply to the"planning" component of condition No. 1. The FAA can also issue an informal letter amendment that modifies the grant description to correct administrative errors or to delete work items if the FAA finds it advantageous and in the best interests of the United States. An informal letter amendment has the same force and effect as a formal grant amendment. 14. Air and Water Quality.The Sponsor is required to comply with all applicable air and water quality standards for all projects in this grant. If the Sponsor fails to comply with this requirement,the FAA may suspend, cancel,or terminate this agreement. 15. Financial Reporting and Payment Requirements.The Sponsor will comply with all federal financial reporting requirements and payment requirements, including submittal of timely and accurate reports. 16. Buy American. Unless otherwise approved in advance by the FAA,the Sponsor will not acquire or permit any contractor or subcontractor to acquire any steel or manufactured products produced outside the United States to be used for any project for which funds are provided under this grant.The Sponsor will include a provision implementing Buy American in every contract. 17. Maximum Obligation Increase For Nonprimary Airports.ln accordance with 49 U.S.C. §47108(b), as amended,the maximum obligation of the United States, as stated in Condition No. 1 of this Grant Offer: A. May not be increased for a planning project; B. May be increased by not more than 15 percent for development projects; 3 3 -36 -0029 -020 - 2017 C. May be increased by not more than 15 percent or by an amount not to exceed 25 percent of the total increase in allowable costs attributable to the acquisition of land or interests in land,whichever is greater, based on current credible appraisals or a court award in a condemnation proceeding. 18. Suspension or Debarment.When entering into a "covered transaction" as defined by 2 CFR§180.200,the Sponsor must: A. Verify the non-federal entity is eligible to participate in this Federal program by: 1. Checking the excluded parties list system (EPLS) as maintained within the System for Award Management(SAM)to determine if the non-federal entity is excluded or disqualified; or 2. Collecting a certification statement from the non-federal entity attesting they are not excluded or disqualified from participating; or 3. Adding a clause or condition to covered transactions attesting individual or firm are not excluded or disqualified from participating. B. Require prime contractors to comply with 2 CFR§180.330 when entering into lower-tier transactions (e.g.Sub-contracts). C. Immediately disclose to the FAA whenever the Sponsor(1) learns they have entered into a covered transaction with an ineligible entity or(2)suspends or debars a contractor, person, or entity. 19. Ban on Textine While Driving. A. In accordance with Executive Order 13513, Federal Leadership on Reducing Text Messaging While Driving,October 1,2009,and DOT Order 3902.10,Text Messaging While Driving, December 30, 2009, the Sponsor is encouraged to: 1. Adopt and enforce workplace safety policies to decrease crashes caused by distracted drivers including policies to ban text messaging while driving when performing any work for,or on behalf of,the Federal government, including work relating to a grant or subgrant. 2. Conduct workplace safety initiatives in a manner commensurate with the size of the business, such as: a. Establishment of new rules and programs or re-evaluation of existing programs to prohibit text messaging while driving; and b. Education, awareness,and other outreach to employees about the safety risks associated with texting while driving. B. The Sponsor must insert the substance of this clause on banning texting while driving in all subgrants, contracts and subcontracts. 20. AIP Funded Work Included in a PFC Application. Within 90 days of acceptance of this award,Sponsor must submit to the Federal Aviation Administration an amendment to any approved Passenger Facility Charge (PFC)application that contains an approved PFC project also covered under this grant award.The airport sponsor may not make any expenditure under this award until project work addressed under this award is removed from an approved PFC application by amendment. 21. Exhibit"A" Property Map.The Exhibit"A" Property Map dated October 2010, is incorporated herein by reference or is submitted with the project application and made part of this grant agreement. 22. Employee Protection from Reprisal. A. Prohibition of Reprisals- 4 'r 3 - 36 - 0029 -020 - 2017 1. In accordance with 41 U.S.C. §4712,an employee of a grantee or subgrantee may not be discharged,demoted,or otherwise discriminated against as a reprisal for disclosing to a person or body described in sub-paragraph (A)(2), information that the employee reasonably believes is evidence of: i. Gross mismanagement of a Federal grant; ii. Gross waste of Federal funds; iii. An abuse of authority relating to implementation or use of Federal funds; iv. A substantial and specific danger to public health or safety; or V. A violation of law, rule,or regulation related to a Federal grant. 2. Persons and bodies covered:The persons and bodies to which a disclosure by an employee is covered are as follows: L A member of Congress or a representative of a committee of Congress; ii. An Inspector General; iii. The Government Accountability Office; iv. A Federal office or employee responsible for oversight of a grant program; V. A court or grand jury; vi. A management office of the grantee or subgrantee; or vii. A Federal or State regulatory enforcement agency. 3. Submission of Complaint—A person who believes that they have been subjected to a reprisal prohibited by paragraph A of this grant term may submit a complaint regarding the reprisal to the Office of Inspector General (OIG)for the U.S. Department of Transportation. 4. Time Limitation for Submittal of a Complaint-A complaint may not be brought under this subsection more than three years after the date on which the alleged reprisal took place. 5. Required Actions of the Inspector General—Actions, limitations and exceptions of the Inspector General's office are established under 41 U.S.C. §4712(b) 6. Assumption of Rights to Civil Remedy- Upon receipt of an explanation of a decision not to conduct or continue an investigation by the Office of Inspector General,the person submitting a complaint assumes the right to a civil remedy under4l U.S.C. §4712(c). 23. DBE Plan.The Sponsor understands and agrees that the FAA will not make nor be obligated to make any payments on this grant until the Sponsor has received approval of its DBE Plan from the FAA Office of Civil Rights. 24. Environmental.The environmental approval for this project was issued on 3/22/2017. 25. Protection of Runway Protection Zone-Airport Property.The Sponsor agrees to prevent the erection or creation of any structure, place of public assembly,or other use in the runway protection zone,as depicted on the Exhibit"A": Property Map,except for NAVAIDS that are fixed by their functional purposes or any other structure permitted by the FAA.The Sponsor further agrees that any existing structures or uses within the Runway Protection Zone will be cleared or discontinued by the Sponsor unless approved by the FAA. 26. Consultant Contract and Cost Analysis.The Sponsor understands and agrees that no reimbursement will be made on the consultant contract portion of this grant until the FAA has received the consultant contract,the Sponsor's analysis of costs, and the independent fee estimate. 27. Preliminary Scope of Work.This Grant is made and accepted upon the basis of a preliminary scope of work.The parties agree that within 30 days from the date of acceptance of this Grant Offer,the Sponsor will furnish a final scope of work to the FAA and that no work will commence, nor will there be any contract signed for accomplishment of such work, until the final scope of work has been approved by the 5 3 - 36 -0029 -020 - 2017 FAA.The Sponsor and the FAA further agree that any reference to the scope of work made in the Grant Offer or in the project application is in respect to the final scope of work. 28. Unsigned Negotiated Agreement. It is understood and agreed by the parties hereto,that this Grant is being issued on the basis of a preliminary agreement. It is further understood and agreed that the Federal Aviation Administration (FAA)will not concur with the issuance of a Notice to Proceed or approved any federal payments until the executed Negotiated Agreement has been submitted to and approved in writing by the New York Airport District Office (NYADO). 6 'm 3 -36 - 0029 -020 - 2017 The Sponsor's acceptance of this Offer and ratification and adoption of the Project Application incorporated herein shall be evidenced by execution of this instrument by the Sponsor, as hereinafter provided,and this Offer and Acceptance shall comprise a Grant Agreement, as provided by the Act, constituting the contractual obligations and rights of the United States and the Sponsor with respect to the accomplishment of the Project and compliance with the assurances and conditions as provided herein. Such Grant Agreement shall become effective upon the Sponsor's acceptance of this Offer. UNITED STATES OF AMERICA FEDERAL AVIATION ADMINISTRATION (Signature) for Evelyn Martinez (Typed Name) Manager, New York Airports District Office. (Title of FAA Official) 7 � b 3 -36 -0029 - 020 - 2017 z PART II-ACCEPTANCE The Sponsor does hereby ratify and adopt all assurances,statements, representations,warranties, covenants, and agreements contained in the Project Application and incorporated materials referred to in the foregoing Offer,and does hereby accept this Offer and by such acceptance agrees to comply with all of the terms and conditions in this Offer and in the Project Application. I declare under penalty of perjury that the ef ' 'rooregoing is true and correct. Executed this af day of IW�J , 61 -' off--" Town of Southold ------- -------- ------------------ ------- ame of Sponsor) C/� (Signature of Sponsor's Authorized Official) _� BY: vC�U,PE ___ J 1 V – �_— (Typed Name of Sponsor's Authorized Official) Title: _ J_L , b� (T� e of Sponsor's Authorized Official CERTIFICATE OF SPONSOR'S ATTORNEY acting as Attorney for the Sponsor do hereby certify: That in my opinion the Sponsor is empowered to enter into the foregoing Grant Agreement under the laws of the State of Further, I have examined the foregoing Grant Agreement and the actions taken by said Sponsor and ponsor's official representative has been duly authorized and that the execution thereof is in all respects due and proper and in accordance with the laws of the said State and the Act. In addition,for grants involving projects to be carried out on property not owned by the Sponsor,there are no legal impediments that will prevent full performance by the Sponsor. Further, it is my opinion that the said Grant Agreement constitutes a legal and binding obligation of the Sponsor in accordance with the terms thereof. Dated at S (location)this 9_day of �S� C)L I By: (Signature of Sponsor's Attorney) 'Knowingly and willfully providing false information to the Federal government is a violation of 18 U.S.C. Section 1001 (False Statements) and could subject you to fines, imprisonment, or both. 8 � r 3 -36 -0029 - 020- 2017 ASSURANCES AIRPORT SPONSORS A. General. a. 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. b. 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. c. 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. 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 Exclusive Rights and 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: 9 March,2014 3 -36-0029 -020- 2017 FEDERAL LEGISLATION a. Title 49, U.S.C., subtitle VII,as amended. b. Davis-Bacon Act-40 U.S.C. 276(a),et seal C. Federal Fair Labor Standards Act-29 U.S.C. 201,et seq. d. Hatch Act—5 U.S.C. 1501,et seg.2 e. Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Title 42 U.S.C.4601,et seg.12 f. National Historic Preservation Act of 1966-Section 106- 16 U.S.C.470(f).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 seg. L 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 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 Vlof 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.' 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.' w. Wild and Scenic Rivers Act, P.L.90-542, as amended. x. Single Audit Act of 1984-31 U.S.C. 7501, et seg.2 y. Drug-Free Workplace Act of 1988-41 U.S.C. 702 through 706. 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 10 March,2014 3 -36 -0029 -020- 2017 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 Part180-OMBGuidelines 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).' 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. p. 49 CFR Part 24—Uniform Relocation Assistance and Real Property Acquisition for Federal and Federally Assisted Programs.12 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.' 11 March,2014 1 1 3 -36-0029 -020 - 2017 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.I. 1 These laws do not apply to airport planning sponsors. Z 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. 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: 12 March,2014 3 - 36 -0029 -020 - 2017 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. 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. 13 March,2014 3 - 36-0029 -020 - 2017 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. 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 14 March,2014 3 -36 -0029 -020- 2017 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 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 thi's 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 15 March,2014 3 -36 -0029 -020- 2017 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, 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 16 March,2014 3 -36 -0029 -020 - 2017 required or prescribed by applicable Federal, 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 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, 17 March,2014 3 - 36 -0029 -020 - 2017 provided that the contractor may be allowed to make reasonable and nondiscriminatory discounts, rebates, or other similar types of price reductions to volume purchasers. a.) 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. b.)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. c.) 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. d.)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. e.)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. f.) 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. g.)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. 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 18 March,2014 s r 3 - 36 - 0029 - 020 - 2017 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 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. a.) 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 19 March,2014 3 - 36 -0029 -020- 2017 manner consistent with Title 49, United States Code and any other applicable provision of law, including any regulation promulgated by the Secretary or Administrator. b.)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 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. by gross weights of such aircraft) is in excess of five million pounds 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. 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 20 March,2014 3 - 36 -0029 -020 - 2017 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 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. a.) 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 21 March,2014 3 -36 -0029 -020- 2017 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. 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(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 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 22 March,2014 3 -36 - 0029 -020 - 2017 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 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 23 March,2014 3 - 36 -0029 -020- 2017 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 AIP projects, dated January 24, 2017 and included in this grant, and in accordance 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 24 March,2014 3 - 36 -0029 - 020 - 2017 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. 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. I I I 25 March,2014 3 -36 -0029 - 020 - 2017 l AV/qT FAA ya oa Airports Is RPS\ Current FAA Advisory Circulars Required for Use in AIP Funded and PFC Approved Projects Updated: 1/24/2017 View the most current versions of these ACs and any associated changes at: http://www.faa.gov/airports/resources/advisory circularsand http://www.faa.gov/regulations policies/advisory circulars/ NUMBER TITLE 70/7460-11- Obstruction Marking and Lighting Change 1 150/5020-1 Noise Control and Compatibility Planning for Airports 150/5070-613 Changes 1-2 Airport Master Plans 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 150/5200-31C Airport Emergency Plan Changes 1-2 150/5210-5D Painting, Marking, and Lighting of Vehicles Used on an Airport 150/5210-71) Aircraft Rescue and Fire Fighting Communications 150/5210-13C Airport Water Rescue Plans and Equipment 150/5210-14B Aircraft Rescue Fire Fighting Equipment,Tools and Clothing 150/5210-15A Aircraft Rescue and Firefighting Station Building Design 26 FAA Advisory Circular Required for Use AIP Funded and PFC Approved Projects Updated:1/24/2017 3 - 36-0029 -020- 2017 NUMBER , TITLE., 150/5210-18A Systems for Interactive Training of Airport Personnel 150/5210-19A Driver's Enhanced Vision System (DEVS) 150/5220-10E Guide Specification for Aircraft Rescue and Fire Fighting(ARFF)Vehicles 150/5220-16D Automated Weather Observing Systems(AWOS)for Non-Federal Applications r 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 150/5220-21C Aircraft Boarding Equipment 150/5220-22B Engineered Materials Arresting Systems(EMAS)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-B) Changes 1-2 Out Squitter Equipment 150/5300-76 FAA Policy on Facility Relocations Occasioned by Airport Improvements of Changes 150/5300-13A Airport Design Change 1 150/5300-14C 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 150/5300-18B General Guidance and Specifications for Submission of Aeronautical Surveys to Change 1 NGS: Field Data Collection and Geographic Information System (GIS)Standards 150/5320-51) Airport Drainage Design 150/5320-6F Airport Pavement Design and Evaluation 27 FAA Advisory Circular Required for Use AIP Funded and PFC Approved Projects Updated:1/24/2017 3 - 36 - 0029 - 020 - 2017 NUMBER TITLE., 150/5320-12C Measurement, Construction, and Maintenance of Skid Resistant Airport Changes 1-8 Pavement Surfaces 150/5320-15A Management of Airport Industrial Waste 150/5235-413 Runway Length Requirements for Airport Design 150/5335-5C Standardized Method of Reporting Airport Pavement Strength-PCN 150/5340-1L Standards for Airport Markings 150/5340-51) Segmented Circle Airport Marker System 150/5340-18F Standards for Airport Sign Systems 150/5340-26C Maintenance of Airport Visual Aid Facilities 150/5340-30H Design and Installation Details for Airport Visual Aids 150%5345-3G Specification for L-821, Panels for the Control of Airport Lighting i 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 Retro reflective Markers 150/5345-42H Specification for Airport Light Bases,Transformer Housings,Junction Boxes, and Accessories 150/5345-43H Specification for Obstruction Lighting Equipment 150/5345-44K Specification for Runway and Taxiway Signs 150/5345-45C Low-Impact Resistant(LIR)Structures 28 FAA Advisory Circular Required for Use AIP Funded and PFC Approved Projects Updated:1/24/2017 3 - 36 -0029 -020- 2017 NUMBER. TITLE 150/5345-46E Specification for Runway and Taxiway Light Fixtures 150/5345-47C Specification for Series to Series Isolation Transformers for Airport Lighting Systems 150/5345-49C 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 150/5360-13 Planning and Design Guidelines for Airport Terminal Facilities Change 1 150/5360-14 Access to Airports By Individuals With Disabilities 150/5370-21' Operational Safety on Airports During Construction 150/5370-10G Standards for Specifying Construction of Airports 150/5370-11B 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 150/5395-1A Seaplane Bases 29 FAA Advisory Circular Required for Use AIP Funded and PFC Approved Projects Updated:1/24/2017 3 - 36 - 0029 -020 - 2017 THE FOLLOWING ADDITIONAL APPLY TO AIP PROJECTS ONLY Updated:01/24/2017 NUMBER - . TITLE. 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 1-6 Assisted Projects 150/5300-15A Use of Value Engineering for Engineering 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 150/5380-76 Airport Pavement Management Program 150/5380-9 Guidelines and Procedures for Measuring Airfield Pavement Roughness I 30 FAA Advisory Circular Required for Use AIP Funded and PFC Approved Projects Updated-1/24/2017