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2018 Rehabilitate Electrical Building
ELIZABETH FIELD AIRPORT (0B8) FISHERS ISLAND ..- .+�+tr f'�.",., .c+ .y �y,�•.�hr,�.yi.�.+.yam, s+ei r yam. FY 2018 GRANT APPLICATION r� T ..lair ♦ a �.a1'!1 .. Town of Southold IslandFishers Ferry District Rehabilitate Electrical O r � fT�N�STRA��O PREPARED BY OOUNT I COMPANIES ARP SOP No. 6.00 Effective Date: 10/1/2015 AIP Grant Application Checklist AIRPORT NAME: Fishers Island Elizabeth Field Airport DATE: 7/2/2018 SYSTEM FOR AWARD MANAGEMENT(SAM)CAGE CODE#: 39TN9 SYSTEM FOR AWARD MANAGEMENT(SAM) EXPIRATION DATE: 09/12/2018 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) ✓ 3. Project Sketch (at the request of the ADO) ✓ 4. Project Narrative (attached or within Form 5100-111101 Part/v) ✓ 5 Form 5100-100 (parts II - IV) (airport development grants) ✓ Form 5100-101 (parts II - IV) (planning grants) 6. Bid Tabu latlons/Negotlated Amounts (attached orprewously submitted to the ADO) ✓ ' 7. Exhibit A (attached or previously submitted to the ADO) ✓ 8. Title Certificate or Long Term Lease Agreement (at the request of the ADO) • Y 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 lefter(s) ❑ Preapplication ®New ®Application ❑Continuation *Other(Specify) ❑ Changed/Corrected Application ❑Revision *3.Date Received. 4 Applicant Identifier OB8 5a Federal Entity Identifier 5b Federal Award Identifier 3-36-0029- - 2018 State Use Only: 6 Date Received by State 7 State Application Identifier. 10913._ 8.APPLICANT INFORMATION: *a Legal Name Town of Southold 'b Employer/Taxpayer Identification Number(EIN/TIN) *c.Organizational DUNS. 11-6003307 1977363870000 d.Address: *Street1 Town of Southold Street2 Town Hall PO Box 1179 'City Southold County/Pansh- 'State- NY: New York Province *Country USA: UNITED STATES *Zip/Postal Code 11971-000 e.Organizational Unit: Department Name Division Name- f.Name and contact information of person to be contacted on matters involving this application: Prefix Mr. 'First Name Gordon Middle Name *Last Name Murphy Suffix Title Manager Organizational Affiliation Fishers Island Ferry District 'Telephone Number 631-788-7463 Fax Number *Email: gmurphy@fiferry.com ' � l 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: 13-36-0029-_-_-2018 *Title" Rehabilitate Electrical Building (Design) 13.Competition Identification Number: Title 14.Areas Affected by Project(Cities,Counties,States,etc.): 71 5. Project Map.pdf Add Attachment a= (.,Delete°Attachment. View.YAftachment *15.Descriptive Title of Applicant's Project: Rehabilitate Electrical Building (Design) Attach supporting documents as specified in agency instructions n Add - Attachments kDelefe Attachrilents, ,°View,Attachments J s 1 Application for Federal Assistance SF-424 16.Congressional Districts Of: *a.Applicant E2= *b Program/Project NY 2 Attach an additional list of Program/Project Congressional Districts if needed A Attachment.:� Delete--Attachmeht . Vievv.Attachi brit - :os.. 4 17.Proposed Project: *a Start Date: 09/01/2018 *b End Date 03/31/2019 18.Estimated Funding($): *a Federal 26,505.00 *b Applicant 0.00 .c State 1,472.00 *d Local 1,473.001 *e Other 0.00 *f. Program Income 0.00 *g TOTAL 29,450.00 *19.Is Application Subject to Review By State Under Executive Order 12372 Process? ® a This application was made available to the State under the Executive Order 12372 Process for review on 01/30/2018 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 Attachment Delete Attachment 1.=V,ew Attachment 21.*By signing this application,I certify(1)to the statements contained in the list of certifications**and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) ® **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- Y Project Cost Breakdown Airport: Elizabeth Field Aiport Project Description: Rehabilitate Electrical Building(Design) Construction or Engineering/ Brief Item Description Land Cost Land Incidental Admin.Cost Total Cost Federal Share Non-Federal 90% 10% Rehab. Electrical Bldg. (Design) $18,550 $900 $19,450 $17,505 $1,945 Improve Airport—Misc. Improvements-Airfield Lighting Equipment (Design) $10,000 $0 $10,000 $9,000 $1,000 Totals $0 $28,550 $9001 $29,4501 $26,5051 $2,945 Administrative Cost Summary Rehabilitate Electrical Building (Design) Project&Grant Administration* No. of Hrs Hrly Rate Total Gordon Murphy-Manager, FIFD 7 $50.00 $350.00 Diane Hansen,Admin Asst. 14 $30.00 $420.00 Postage $130.00 $130.00 Total $900.00 TOTAL: $900.00 * Project Administration Costs includes consultant and manufacturer coordination, deliverable reviews and grant management. 1 1 U S.Department of Transportation OMB CONTROL NUMBER-2120-0569 Federal Aviation Administration EXPIRATION DATE:8/31/2019 Application for Federal Assistance (Development and Equipment Projects) PART II — PROJECT APPROVAL INFORMATION Part II -SECTION A The term "Sponsor" refers to the applicant name provided in box 8 of the associated SF-424 form. Item 1. Does Sponsor maintain an active registration in the System for Award Management 0 Yes ❑No (www.SAM.gov)? Item 2. Can Sponsor commence the work identified in the application in the fiscal year the N Yes ❑No ❑ N/A grant is made or within six months after the grant is made, whichever is later? Item 3. Are there any foreseeable events that would delay completion of the project? If yes, ❑Yes ❑X No ❑ N/A provide attachment to this form that lists the events. Item 4. Will the project(s)covered by this request have impacts or effects on the environment that require mitigating measures? If yes, attach a summary listing of ❑Yes 0 No ❑ N/A mitigating measures to this application and identify the name and date of the environmental document(s). Item 5. Is the project covered by this request included in an approved Passenger Facility Charge (PFC) application or other Federal assistance program? If yes, please ❑Yes Q No ❑N/A identify other funding sources by checking all applicable boxes. ❑ The project is included in an approved PFC application. If included in an approved PFC application, does the application only address AIP matching share? ❑Yes ❑No ❑ The project is included in another Federal Assistance program. Its CFDA number is below. Item 6. Will the requested Federal assistance include Sponsor indirect costs as described in ❑Yes 0 No ❑N/A 2 CFR Appendix VII to Part 200, States and Local Government and Indian Tribe Indirect Cost Proposals? If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate the Sponsor proposes to apply: ❑ De Minimis rate of 10% as permitted by 2 CFR§ 200.414. ❑ Negotiated Rate equal to % as approved by (the Cognizant Agency) on (Date) (2 CFR part 200, appendix VII). Note: Refer to the instructions for limitations of application associated with claiming Sponsor indirect costs. FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 1 of 7 OMB CONTROL NUMBER.2120-0569 OMB EXPIRATION DATE.8/31/2019 PART II -SECTION B Certification Regarding Lobbying The declarations made on this page are under the signature of the authorized representative as identified in box 21 of form SF-424, to which this form is attached. The term "Sponsor" refers to the applicant name provided in box 8 of the associated SF-424 form. The Authorized Representative certifies, to the best of his or her knowledge and belief,that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant,the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,the Authorized Representative shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3)The Authorized Representative shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 2 of 7 OMB CONTROL NUMBER 2120-0569 OMB EXPIRATION DATE.8/31/2019 PART II—SECTION C The Sponsor hereby represents and certifies as follows: 1. Compatible Land Use—The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity of the airport: Present and future land use is compatible with the airport. No significant impact on land use in vicinity of the airport. 2. Defaults—The Sponsor is not in default on any obligation to the United States or any agency of the United States Government relative to the development, operation, or maintenance of any airport, except as stated herewith: None 3. Possible Disabilities—There are no facts or circumstances (including the existence of effective or proposed leases, use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings)which in reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of the Grant Assurances, either by limiting its legal or financial ability or otherwise, except as follows: None 4. Consistency with Local Plans—The project is reasonably consistent with plans existing at the time of submission of this application)of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding the airport. The project is consistent with existing plans. 5. Consideration of Local Interest—It has given fair consideration to the interest of communities in or near where the project may be located. Yes 6. Consultation with Users—In making a decision to undertake an airport development project under Title 49, United States Code, it has consulted with airport users that will potentially be affected by the project(§47105(a)(2)). Primary users of the airport are aware of the project. 7. Public Hearings— In projects involving the location of an airport, an airport runway or a major runway extension, it has afforded the opportunity for public hearings for the purpose of considering the economic, social, and environmental effects of the airport or runway location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall, when requested by the Secretary, submit a copy of the transcript of such hearings to the Secretary. Further, for such projects, it has on its management board either voting representation from the communities where the project is located or has advised the communities that they have the right to petition the Secretary concerning a proposed project. N/A 8.Air and Water Quality Standards—In projects involving airport location, a major runway extension, or runway location it will provide for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located, designed, constructed, and operated so as to comply with applicable and air and water quality standards. In any case where such standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to certify shall be provided within sixty days after the project application has been received by the Secretary. N/A FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 3 of 7 OMB CONTROL NUMBER 2120-0569 OMB EXPIRATION DATE:8/31/2019 PART II—SECTION C (Continued) 9. Exclusive Rights—There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or controlled by the Sponsor except as follows: None 10. Land—(a)The sponsor holds the following property interest in the following areas of land, which are to be developed or used as part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse interests, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1] None The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such attorney or title company has determined that the Sponsor holds the above property interests. (b)The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work under the Project, the following property interest in the following areas of land on which such construction work is to be performed, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1] (c)The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the Project, the following property interest in the following areas of land which are to be developed or used as part of or in connection with the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1] State the character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of every kind and nature, including liens, easements, leases,etc.The separate areas of land need only be identified here by the area numbers shown on the property map. FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 4 of 7 OMB CONTROL NUMBER'2120-0569 OMB EXPIRATION DATE'8/31/2019 PART III - BUDGET INFORMATION - CONSTRUCTION SECTION A—GENERAL 1. Federal Domestic Assistance Catalog Number: 20.106 2. Functional or Other Breakout: AIP-Rehabilitate Electrical Building (Design) SECTION B—CALCULATION OF FEDERAL GRANT Latest Approved Adjustment Total Cost Classification Amount +or(-)Amount Amount (Use only for (Use only for Required revisions) revisions 1. Administration expense 900 2. Preliminary expense 3. Land, structures, right-of-way 4. Architectural engineering basic fees 28,550 5. Other Architectural engineering fees 6. Project inspection fees 7. Land development 8. Relocation Expenses 9. Relocation payments to Individuals and Businesses 10. Demolition and removal 11. Construction and project improvement 12. Equipment 13. Miscellaneous 14. Subtotal(Lines 1 through 13) 29,450 15. Estimated Income(if applicable) 16. Net Project Amount(Line 14 minus 15) 17 Less: Ineligible Exclusions(Section C, line 23 g.) 18. Subtotal(Lines 16 through 17) 29,450 19 Federal Share requested of Line 18 26,505 20. Grantee share 1,472 21. Other shares 1,473 22. TOTAL PROJECT(Lines 19,20&21) 29,450 FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 5 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE:8/31/2019 SECTION C—EXCLUSIONS Amount Ineligible for 23.Classification(Description of non-participating work) Participation a. b. C. d. e. f. g. Total SECTION D—PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE 24.Grantee Share—Fund Categories Amount a. Securities b. Mortgages c.Appropriations(by Applicant) 1,472 d. Bonds e.Tax Levies f. Non-Cash g. Other(Explain): h.TOTAL-Grantee share 1,472 25.Other Shares Amount a. State 1,473 b. Other c.TOTAL-Other Shares 1,473 26.TOTAL NON-FEDERAL FINANCING 2,945 SECTION E—REMARKS (Attach sheets if additional space is required) FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 6 of 7 OMB CONTROL NUMBER 2120-0569 OMB EXPIRATION DATE*8/31/2019 PART IV—PROGRAM NARRATIVE (Suggested Format) PROJECT: Rehabilitate Electrical Building (Design) AIRPORT: Elizabeth Field Airport 1. Objective: The proposed project involves replacing airfield lighting equipment(regulators), installing shelving to elevate the airfield lighting equipment and raise it out of frequent flood elevations, address lighting and mechanical/HVAC system install to prevent accelerated corrosion due to the in the salt air environment, and address repairs to previous flood damage(interior lighting repairs, painting, etc) Exterior renovations would include replacement of the main entry door and repairing damaged budding fascia There would be no change in the building use, no change in the budding footprint, nor will there be any ground disturbance as part of this work 2. Benefits Anticipated: The existing airfield electrical vault is over 20 years old, and has been subjected to frequent storms and flooding Along with the salt- air environment,the elements are rapidly deteriorating the airfield lighting equipment The Airport was devastated during Superstorm Sandy,with floodwaters breaching the vault and exposing the lighting equipment to saltwater.The regulators had temporarily failed, requiring the airport to close due to inoperable lights, until they were repaired.As the airport isn't monitored 24-7, providing a safe, reliable lighting system and lighting equipment will improve the budding by addressing much-needed repairs and mitigating impacts to airfield lighting equipment during flooding events. Improving the flooding resistance will increase the service life as well as enhance the overall level of safety at the airport. 3. Approach: (See approved Scope of Work in Final Application) 4. Geographic Location: Elizabeth Field Airport is located on the western side of Fisher's Island. Fishers Island is located at the eastern end of Long Island Sound, 2 miles off the southeastern coast of Connecticut 5. If Applicable, Provide Additional Information: 6.Sponsor's Representative: (include address&telephone number) Scott Russell, Telephone: 631-765-1889, Email: scott.russelI@town.southold.ny.us Address: Town of Southold, PO Box 1179, Southold, New York 11971 FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 7 of 7 U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-129, Construction Project Final Acceptance — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-129 US Department of Transportation OMB CONTROL NUMBER 2120-0569 4W 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- -2018 Description of Work: Rehabilitate Electrical Building (Design) 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 ❑X 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 0 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 ❑X 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 ❑ 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 Q 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 Q 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 Q 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 ❑ 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 ❑X 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 7L) 11 ) a0J� 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: 1 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. s _ FAA Form 5100-129(1117)SUPERSEDES PREVIOUS EDITION page 3 of 3 QMW U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-130, Drug-Free Workplace — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response,- including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591,Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-130 U S.Department of Transportation OMB CONTROL NUMBER:2120-0569 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- -2018 Description of Work: Rehabilitate Electrical Budding (Design) 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). l p 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 p 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). ❑x 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. ❑x 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). ❑x 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. ❑x 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). ❑x 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 �j day of Tv)y 01.®1 7 , 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 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 U.S Department of Transportation Federal Aviation Administration FAA Form 5100-131, Equipment and Construction Contracts — Airport Improvement Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591,Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-131 s # US 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- -2018 Description of Work: Rehabilitate Electrical Building (Design) 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 ❑ 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. ❑x Yes ❑ No ❑ 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). ❑x Yes ❑ No ❑ 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 fiade to other than the lowest responsible bidder; and c. Life cycle costing is a factor in selecting the lowest responsive bidder. 0 Yes ❑ No ❑ 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.C. §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 ll) h. U.S. Trade Restriction (49 CFR part 30) i. Veterans Preference (49 USC§47112(c)) ❑x Yes ❑ No ❑ 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) ❑x Yes ❑ No ❑ 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). 0 Yes ❑ No ❑ 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 ll). ❑x Yes ❑ No ❑ 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). ❑x Yes ❑ No ❑ 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 II); 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. ❑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. Executed on this Vk day of —J-u 16 1 ao I 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 Federal Aviation Administration FAA Form 5100-132, Project Plans and Specifications — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer,ASP-110. FAA Form 5100-132 US Department of Transportation OMB CONTROL NUMBER:2120-0569 •/ 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- -2018 Description of Work: Rehabilitate Electrical Building (Design) 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 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. 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). ❑x 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). ❑x 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). 0 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). ❑x Yes ❑ No ❑ 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). 0 Yes ❑ No ❑ 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). 0 Yes [] No ❑ 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)). 0 Yes ❑ No ❑ 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)). ❑x Yes ❑ No ❑ 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). 0 Yes ❑ No ❑ 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) 0 Yes ❑ No ❑ 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. 0 Yes ❑ No ❑ 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 p 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). p Yes [--] No ❑ 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). p 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. Executed on this 6 A day of Tv 1 y J @L01,g 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 U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-134, Selection of Consultants — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. i I FAA Form 5100-134 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- -2018 Description of Work: Rehabilitate Electrical Building (Design) 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 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. 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 i 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). ❑x 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)). p 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)). p 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). p 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). p 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). p 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(i)). ED 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) pYes ❑No ❑N/A FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 2 of 3 i 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 (9 day of =-u i. Name of Sponsor: Town of Southold Name of Sponsor's Authorized Official: Scott Russell Title of Sponsor's Authorized Official: Town Supervisor i 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 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 a 1 US Department of Transportation Federal Aviation Administration FAA Form 5100-135, Certification and Disclosure Regarding Potential Conflicts of Interest — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. i i i i i i 1 FAA Form 5100-135 f,r 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- -2018 Description of Work: Rehabilitate Electrical Building (Design) 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. i 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)). E9 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). p 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 (off day of �V18 c 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. i I 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 N34°22' 18.32") 4 Longitude enter the longitude(for example W983211.11 for W98°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 .---#Proposed Disposition Date enter the date as in the MM/DD/YY format. Proposed 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 t 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 Obstacle Action Plan AMSL Obstacle Obstacle Type Latitude Longitude Elevation(ft.) Height Penetration Amount Reference Number � AGL(ft.) (ft.)Surface Penetrated Reference Runway ( �) 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 9.1 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 18.1 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 8.0 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 2119.62 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 51 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 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 budding 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(soil),following soil 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 requier 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 January,31, 2018 i Sarah Lansdale, Director ' Suffolk County Planning Department H. Lee Dennison.Bidg. 11,th Floor 1'00 Veterans-Memorial Highway P.O. Box 6100 + Hauppauge, New York 11788-0099 Re: Elizabeth Field Airport—Fisher's'lsland { FY 201'8 Pre-Applications t Federal Catalog No. 20-106 File:" 211 P Enclosed please,find the following: One copy each of the Grant Pre-Applications, Airport Project Schedule, Form'424, Form 5100-100,'project description and justification, cost break down,and project sketch for your review and clearance for the following project: • Rehabilitate,Electrical Building - • Airport,Wide Obstruction Evaluation (Survey&Analysis) 11 Airport Entrance Road Improvements j Remarks i !; If you,have any questions or need additional information, please do not,hesitate to contact us. a Very truly yours, C&S ENGINEERS, INC. - Tracey L. Marks Grants Administrator ' TLM Enclosures i cc: William Duffy Scott Russell Gordon Murphy 4 r (14 lm., Legend QAirport Property Line M Project Areas - Runway 12-30 Rehabilrtabon Runway 7-25 Rehabilitation Obstruction Mitigation I�Airport Entrance Road Improvements - Terminal Building Construction r? T E t Private Hangar Development t' Y Private Hangar Development E Project Area=3 9 ac Entrance Improvements Project Area=0.77 ac a� e a Obstruction Removal Project Area=0.3G ac V_ 500 I ti Terminal Building Construction u Feet Project Area=0 J9 ac / ti Runway v 17-Ara 6.3libtion 1 Inch=500 feet Area Project =6.7 a< e Obstruction Removal When pooled at 11"x17" Project Area=0.16 ac Date 9/15/2016 Obstruction Removal Project Area=0.69 ac Runway 7-25 Rehabilitation n Proj ect Area=7.5 ac Q a ^` Elizabeth Field r' Airport 0 Town of Southold Fishers Island, New York 0 Alternative 2 Preferred Alternative s Figure 1-3 F DRAFT LUMP SUM CONSULTANT AGREEMENT FOR DESIGN OF THE AIRFIELD ELECTRIC VAULT REHABILITATION PROJECT AT ELIZABETH FIELD AIRPORT FISHERS ISLAND TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK $O(/pyolo k_ S FAA AIP NO. 3-36-0029- -2018 NYSDOT NO. 0913. TABLE OF CONTENTS ARTICLES PAGE ARTICLE 1—DESCRIPTION OF SERVICES TO BE PERFORMED.......................................................................1 ARTICLE 2—PROVISION FOR PAYMENT—TIME FOR PERFORMANCE...........................................................1 ARTICLE 3—STANDARD OF CARE,STANDARD PRACTICES,AND REQUIREMENTS.......................................2 ARTICLE 4—ENTIRE AGREEMENT................................................................................................................2 ARTICLE 5—TAXES,ROYALTIES,AND EXPENSES........................................................................................2 ARTICLE 6—CONSULTANT LIABILITY..........................................................................................................2 ARTICLE 7—LABOR LAW REQUIREMENTS...................................................................................................3 ARTICLE 8—NONDISCRIMINATION PROVISIONS ..........................................................................................3 ARTICLE 9—WORKER'S COMPENSATION AND LIABILITY INSURANCE........................................................3 ARTICLE 10—ASSIGNMENT REQUIREMENTS ...............................................................................................4 ARTICLE 11—ADDITIONAL SERVICES..........................................................................................................5 ARTICLE 12—ABANDONMENT OR AMENDMENT OF PROJECT AND TERMINATION......................................5 ARTICLE 13—SUSPENSION OF SERVICES......................................................................................................6 ARTICLE 14—INTERCHANGE OF DATA.........................................................................................................7 ARTICLE 15—DISPOSITION OF PROJECT DOCUMENTS.................................................................................7 ARTICLE 16—CODE OF ETHICS ....................................................................................................................7 ARTICLE 17INDEPENDENT CONTRACTOR.................................................................................................7 ARTICLE 18—PATENT RIGHTS AND COPYRIGHTS........................................................................................7 ARTICLE 19—NEW YORK STATE PARTICIPATION........................................................................................7• ARTICLE 20—FEDERAL PARTICIPATION.......................................................................................................8 ARTICLE21—MISCELLANEOUS....................................................................................................................8 ARTICLE 22—SUBCONSULTANTS/SUBCONTRACTORS AND VENDORS.........................................................9 ARTICLE 23—FORCE MAJEURE..................................................................................................................9 ARTICLE 24—DISPUTE RESOLUTION..........................................................................................................9 SCHEDULE A—SCOPE OF SERVICES.....................................................................................A-1 to A-5 SCHEDULE B—COST SUMMARY AND FEE SCHEDULE....................................................B-1 to B-2 SCHEDULE C—AGREED OVERHEAD...............................................................................................C-1 SCHEDULEDNOT USED........................................................................................................................ SCHEDULEE—RESOLUTION.............................................................................................................E-I SCHEDULEF—NOT USED......................................................................................................................... SCHEDULE G—CERTIFICATION OF CONSULTANT .....................................................................G-1 SCHEDULE H—AIRPORT AID PROGRAM.............................................................................H-1 to H-7 SCHEDULE I—NEW YORK STATE DOT REQUIREMENTS....................................................I-1 to I-5 G\Group\Avtatton\GRANTS\FAAAIP\211\xxl8 Rehabilitate Electrical Buddmg(Design)\Grant Apphcahon\Destgn Agreement\DRAFT OB8 Electric Vault Design-LS doe 09/04 LUMP SUM CONSULTANT AGREEMENT FOR DESIGN PROJECT: Airfield Electric Vault Rehabilitation Elizabeth Field Airport–Town of Southold This Agreement, made effective this day of , 2018, is by and between the Town of Southold,New York, municipal corporation having an address at P.O. Box 1179, Southold,New York, 11971 (hereinafter referred to as the "SPONSOR"), and C&S Engineers, Inc., a New York business corporation having its principal offices at 499 Col. Eileen Collins Boulevard, Syracuse, New York 13212 (hereinafter referred to as the"CONSULTANT"). WITNESSETH:That the SPONSOR and the CONSULTANT,for and in consideration of the mutual obligations set forth herein and other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, agree as follows: ARTICLE 1—DESCRIPTION OF SERVICES TO BE PERFORMED The SPONSOR hereby retains the CONSULTANT because of its ability and reputation, and the CONSULTANT accepts such retention,to perform for the SPONSOR the services of the Project more particularly described in Schedule(s) "A", which is attached hereto and made a part hereof(the "Basic Services"). The SPONSOR'S resolution or other authorization for retaining the CONSULTANT is attached hereto and made a part hereof as Schedule`B". ARTICLE 2—PROVISION FOR PAYMENT–TIME FOR PERFORMANCE The SPONSOR shall pay to the CONSULTANT,and the CONSULTANT shall accept,as full compensation for the performance by the CONSULTANT of the Basic Services a lump sum fee of$28,550.00,which covers salaries of employees assigned to the Project,all indirect costs,all direct expenses,and profit. The maximum fee under this Agreement cannot be exceeded for any reason,unless Additional Services are authorized and performed in accordance with the provisions of Article 11 of this Agreement. The method of computation of the CONSULTANT's lump sum fee is prescribed in Schedule(s) `B", which is attached hereto and made a part hereof. Partial payments of the lump sum fee shall be made monthly on account. The portion of the fee billed for the CONSULTANT's Basic Services will be based upon the CONSULTANT's estimate of the proportion of the total Basic Services actually completed and expenses actually incurred at the time of billing. Payment of the final invoice will be made upon the substantial completion of the Basic Services covered by the lump sum fee. If the SPONSOR fails to make any payment due the CONSULTANT for services and expenses within forty-five (45)days after receipt of the CONSULTANT'S invoice therefor,then the amounts due the CONSULTANT shall be increased at the rate of 1.5% per month from said forty-fifth (45th) day. Payments will be credited first to principal and then to interest. Additionally,the CONSULTANT may,after giving seven(7)days'notice to the SPONSOR, suspend services under this Agreement until the invoice is paid. Upon payment in full by the 1 G\Group\Aviatton\GRANTS\FAAAIP\21Iboi18 Rehabilitate Electrical Budding(Design)\Grant Appheation\Design AgreementUDRAFT OB8 Electric Vault Design-LS doe 09/04 SPONSOR,the CONSULTANT shall resume performance or furnishing of services under this Agreement,and the time schedule and compensation set forth in Schedule(s)`B"hereto shall be equitably adjusted to compensate for the period of suspension. Execution of this Agreement by the SPONSOR and the CONSULTANT constitutes the SPONSOR's written authorization to the CONSULTANT to proceed as of the above-written date with the performance of Basic Services as set forth in Schedule(s)"A". The time for completion of the Basic Services under this Agreement, subject to the provisions of Articles 12, 13, and 23 hereof, shall be as recorded in Schedule(s)"A". ARTICLE 3-STANDARD OF CARE,STANDARD PRACTICES,AND REQUIREMENTS The standard of care for all engineering and related services performed or furnished by the CONSULTANT under this Agreement shall be the care and skill ordinarily used by members of the CONSULTANT's profession practicing under similar conditions at the same time and in the same locality.Before beginning to perform or furnish any service hereunder, the CONSULTANT shall ascertain the standard practices of the SPONSOR, the New York State Department of Transportation(the"NYSDOT"),and the Federal Aviation Administration(the "FAA"),if any,for projects of a type similar to this Project.Where the CONSULTANT deems it practicable to do so,the services to be provided or furnished under this Agreement shall be performed in accordance with these standard practices as long as they are consistent with the standard of care.If any of these standard practices are inconsistent with the CONSULTANT's standard of care or are in conflict with one another,or if strict adherence to the same is impossible or undesirable, then the CONSULTANT'S services may vary or deviate from such standards. ARTICLE 4—ENTIRE AGREEMENT This Agreement,with its accompanying Schedule or Schedules,constitutes the entire agreement between the SPONSOR and the CONSULTANT with respect to its subject matter,and supersedes any prior agreement,whether written or verbal,with respect to that subject matter. This Agreement may be amended or modified only by written instrument signed by the SPONSOR and the CONSULTANT. ARTICLE 5-TAXES,ROYALTIES,AND EXPENSES The CONSULTANT shall pay all taxes,royalties,and expenses incurred by the CONSULTANT in connection with performing its services under this Agreement,unless otherwise provided in Article 2. ARTICLE 6-CONSULTANT LIABILITY To the fullest extent permitted by law, the CONSULTANT shall indemnify the SPONSOR against, and hold it harmless from, any suit, action, actual damage, and cost resulting solely from the negligent performance of services or omission of the CONSULTANT under this Agreement,up to the limits of any available insurance. Negligent performance of services,within the meaning of this Article,shall include,in addition to negligence founded upon tort, negligence based upon the CONSULTANT's failure to meet professional standards and resulting in obvious or patent errors in the services performed hereunder. Nothing in this Article or in this Agreement shall create or give to third parties any claim or right of action against the CONSULTANT or the SPONSOR beyond such as may legally exist irrespective of this Article or this Agreement. 2 G\Group\A"atwn\0RANTS\FAAAIP\211\xod 8 Rehabilitate Electrical Budding(Design)\Grant Apphcahon\Design Agreement\DRAFT 0138 Electric Vault Design-LS doe 09/04 Notwithstanding any other provision of this Agreement,and to the fullest extent permitted by law,neither the SPONSOR nor the CONSULTANT, their respective officers, directors, partners, employees, contractors or subconsultants shall be liable to the other or shall make any claim for any incidental,indirect or consequential damages arising out of or connected in any way to the Project or to this Agreement. This mutual waiver of consequential damages shall include,but is not limited to,loss of use, loss of profit,loss of business, loss of income,loss of reputation and any other consequential damages that either party may have incurred from any cause of action including negligence,strict liability,breach of contract and breach of strict or implied warranty. Both the SPONSOR and the CONSULTANT shall require similar waivers of consequential damages protecting all the entities or persons named herein in all contracts and subcontracts with others involved in this project. The provisions of this Article 6 shall survive termination or expiration of this Agreement. ARTICLE 7—LABOR LAW REQUIREMENTS The CONSULTANT,and any subconsultant or subcontractor retained by it in connection with the performance or furnishing of services under this Agreement, shall comply with the requirements of state or federal statutes, regulations,or orders applicable to the employment of employees,as set forth in Schedules"H"and"I",which are attached hereto and made a part hereof. The SPONSOR recognizes that the CONSULTANT will be required by the New York State Department of Labor (the "NYSDOL")to compensate its personnel performing field survey work in accordance with applicable state wage rates in effect at the same time services are performed. The SPONSOR understands that the CONSULTANT has no control over these labor rates and their periodic increases.Therefore,the SPONSOR agrees to compensate the CONSULTANT for field survey services included as a part of this Agreement in accordance with the NYSDOL Prevailing Rate Schedule, which is incorporated by reference into this Agreement. Furthermore, the SPONSOR shall compensate the CONSULTANT for all increases in labor costs, including applicable overhead and profit, when those increases occur by direction of the NYSDOL. Billings for, and payments by the SPONSOR of,these increases will take place routinely in accordance with the appropriate terms of this Agreement and these increases will be paid as an additional cost over and above the agreed amount. ARTICLE 8—NONDISCRIMINATION PROVISIONS During the performance of its services under this Agreement, the CONSULTANT, and any subconsultant, subcontractor, or vendor retained by it, shall comply with the nondiscrimination requirements set forth in Schedules"H"and"I"hereto, as applicable to this Project. The CONSULTANT will include the provisions of Schedules "H" and"I"in every subconsultant agreement, subcontract,or purchase order in such a manner that such provisions will be binding upon each subconsultant, subcontractor,or vendor as to operations to be performed within the State of New York.The CONSULTANT will take such action in enforcing such provisions of such subconsultant agreement,subcontract,or purchase order as the SPONSOR may direct,including sanctions or remedies for non-compliance.If the CONSULTANT becomes involved in or is threatened with litigation by a subconsultant, subcontractor, or vendor as a result of such direction by the SPONSOR,the CONSULTANT shall promptly so notify the SPONSOR's legal counsel,requesting such counsel to intervene and protect the interests of the SPONSOR. ARTICLE 9—WORKER'S COMPENSATION AND LIABILITY INSURANCE The CONSULTANT agrees to procure and maintain at its own expense, and without direct expense to the SPONSOR,until final acceptance by the SPONSOR of the services covered by this Agreement,insurance of the kinds and in the amounts hereafter provided,written by insurance companies authorized to do business in the 3 �G\Group\Aviation\GRANTS\FAAAIP\21 1\xxl 8 Rehabilitate Electrical Budding(Design)\Grant Application\Design Agreement\DRAFT 0138 Electric Vault Design-LS doe 09/04 State of New York. Before commencing the performance of services hereunder,the CONSULTANT shall furnish the SPONSOR a certificate or certificates, in form satisfactory to the SPONSOR, showing that it has complied with this Article.All policies shall provide for a 30-day notice of policy cancellation to the SPONSOR(except 10 days' notice should be provided for cancellation due to non-payment of premiums). The kinds and amounts of insurance required are as follows: A. Policy or policies covering the obligations of the CONSULTANT in accordance with the provisions of any applicable worker's compensation or disability benefits law,including for the State of New York Chapter 41,Laws of 1914,as amended,known as the Workers'Compensation Law,and amendments thereto,and Chapter 600 of the Laws of 1949,as amended,known as the Disability Benefits Law,and this Agreement shall be void and of no effect unless the CONSULTANT procures such policy or policies and maintains the same in force during the term of this Agreement. B. Policy or policies of commercial general liability insurance,with broad form endorsement covering, among other things,the CONSULTANT's obligation under Article 6 hereof,with limits of liability of not less than One Million Dollars($1,000,000)for all damages arising out of bodily injury,including death at any time resulting therefrom sustained by one(1)person in any one(1)accident;and,subject to that limit for each person;not less than Three Million Dollars($3,000,000)for all damages arising out of bodily injury, including death at any time resulting therefrom, sustained by two (2) or more persons in any one(1)accident; and not less than One Million Dollars($1,000,000)for all damages arising out of injury to or destruction of property in any one(1)accident,and,subject to that limit per accident,not less than Three Million Dollars($3,000,000)for all damages arising out of injury to or destruction of property during the policy period. 1. Liability insurance issued to and covering the liability of the CONSULTANT's subconsultants and subcontractors,having the same policy limits as those set forth above,with respect to all services or work performed by said subconsultants or subcontractors under this Agreement. 2. Protective liability insurance issued to and covering the liability of the CONSULTANT with respect to all services under this Agreement performed for the CONSULTANT by subconsultants or subcontractors. 3. Professional liability insurance issued to and covering the liability of the CONSULTANT with respect to all professional services performed by it under this Agreement. The SPONSOR,the NYSDOT, and the FAA shall be additional insureds,as their interests may appear,under the insurance coverages described in Paragraph B above,except for the coverage described in Subparagraph (3),which coverages shall be subject to all of the terms, exclusions, and conditions of the applicable policy. ARTICLE 10—ASSIGNMENT REQUIREMENTS The CONSULTANT specifically agrees that: A. It is prohibited from assigning, transferring, conveying, subletting, or otherwise disposing of this Agreement or of its right,title,or interest herein,or its power to execute this Agreement,to any other person, company, or corporation without the previous consent in writing of the SPONSOR, the Commissioner of the NYSDOT, and the FAA. B. If this provision of the Agreement is violated,the SPONSOR may terminate this Agreement for cause in accordance with the provisions of Article 12. Furthermore,the SPONSOR shall be relieved from any liability and obligation hereunder to the person,company,or corporation to whom the CONSULTANT shall assign, transfer,convey,sublet,or otherwise dispose ofthis Agreement in violation ofthe foregoing paragraph(A), 4 G\Group\Aviation\GRANTS\FAAAIP\211\xx18 Rehabilitate Electrical Budding(Design)\Grant Apphcation\Design Agreement\DRAFT OB8 Electric Vault Design-LS doc 09/04 and such transferee shall forfeit and lose all monies assigned to it under this Agreement,except so much as may be required to pay its employees. ARTICLE 11—ADDITIONAL SERVICES If authorized in writing by the SPONSOR through a Supplemental Agreement,the CONSULTANT shall furnish or obtain from others any service that is beyond the scope of Schedule(s)"A" ("Additional Services"). The scope, and time for performance, and payment from the SPONSOR to the CONSULTANT for, any Additional Services (which shall be on the basis set forth in Schedule(s) `B") shall be set forth in such Supplemental Agreement. ARTICLE 12 ABANDONMENT OR AMENDMENT OF PROJECT AND TERMINATION A. ABANDONMENT OR AMENDMENT OF THE PROJECT—The SPONSOR shall have the absolute right to abandon or to amend its Project or to change the general basis of performance at any time, and such action on its part shall in no event be deemed a breach of this Agreement. If the SPONSOR amends its Project or changes the general basis thereof, and the CONSULTANT is of the opinion that Additional Services are made necessary thereby,then the provisions of Article 11 of this Agreement with respect to Additional Services shall apply. If the SPONSOR abandons the Project,then the provisions ofparagraph B(1)(b)below shall govern payment to the CONSULTANT. B. TERMINATION The obligation to provide further services under this Agreement may be terminated: 1. For Cause: a. By either party upon thirty(30)days'prior written notice in the event of substantial failure by the other party to perform in accordance with the terms of this Agreement through no fault of the terminating party. Notwithstanding the foregoing,this Agreement will not terminate as the result of such substantial failure if the party receiving notice begins,within seven(7)days after receipt of such notice,to correct its failure to perform and proceeds diligently to cure such failure within thirty (30) days of such receipt; provided that, if and to the extent that such substantial failure cannot reasonably be cured within such thirty (30)-day period, and if the party has diligently attempted to cure the failure and thereafter continues diligently to cure the problem,then the cure period may, in the discretion of the terminating party, be extended to sixty(60) days after the receipt of notice. b. By the CONSULTANT upon seven(7)days'written notice if(a)the CONSULTANT believes that it is being requested by the SPONSOR to perform or furnish services contrary to or in conflict with the CONSULTANT's responsibilities as a licensed design professional or the standard of care set forth in Article 3 hereof; or(b)the CONSULTANT's services are delayed or suspended for more than ninety (90) days, consecutively or in the aggregate, for reasons beyond the CONSULTANT's control; or(c)the SPONSOR has abandoned, or is considered to have abandoned,the Project. 2. For convenience by the SPONSOR,effective upon the receipt of notice by the CONSULTANT. C. PAYMENTS UPON TERMINATION 1. For Cause: a. By the SPONSOR:If the SPONSOR terminates this Agreement for cause upon completion of any phase of Basic Services,then progress payments due the CONSULTANT in accordance with this Agreement for all such services performed by or furnished through the CONSULTANT and its subconsultants,subcontractors,and vendors through the completion of such phase shall constitute 5 G\Group\Aviation\GRANTS\FAAAIP\211\xx18 Rehabilitate Electrical Buddmg(Design)\Grant Application\Design Agreement\DRAFT OB8 Electric Vault Design-LS doc 09/04 total payment for such services.If the SPONSOR terminates this Agreement for cause during any phase of Basic Services, the CONSULTANT will also be paid for such services performed or furnished in accordance with this Agreement by the CONSULTANT during that phase through the date of termination on the basis specified in Schedule(s)`B".The CONSULTANT will also be paid for the charges of its subconsultants,subcontractors,or vendors who performed or furnished Basic Services to the extent that such services have been performed or furnished in accordance with this Agreement through the effective date of the termination. The SPONSOR shall also pay the CONSULTANT for all unpaid Additional Services and unpaid Reimbursable Expenses. b. By the CONSULTANT:If the CONSULTANT terminates this Agreement for cause upon completion of any phase of Basic Services,then progress payments due the CONSULTANT in accordance with this Agreement for all such services performed or furnished by the CONSULTANT and its subconsultants,subcontractors,or vendors through the completion of such phase shall constitute total payment for such services. The CONSULTANT shall also be paid for all unpaid Additional Services and unpaid Reimbursable Expenses, as well as for the CONSULTANT's reasonable expenses directly attributable to termination in accordance with the rates for Additional Services set forth in Schedule(s) `B" hereto measured from the date of termination, including fair and reasonable sums for overhead and profit and the costs of terminating the CONSULTANT's contracts with its subconsultants, subcontractors, or vendors. 2. For convenience If the SPONSOR terminates this Agreement for convenience upon completion of any phase of Basic Services,then progress payments due the CONSULTANT in accordance with this Agreement for all such services performed by or furnished through the CONSULTANT through the completion of such phase shall constitute total payment for such services.If the SPONSOR terminates this Agreement for convenience during any phase of Basic Services,the CONSULTANT will also be paid for such services performed or furnished in accordance with this Agreement by the CONSULTANT during that phase through the date of termination on the basis specified in Schedule(s)`B".Additionally, the CONSULTANT will be paid for the charges of its subconsultants, subcontractors, or vendors who performed or furnished Basic Services through the effective date of termination. The SPONSOR shall also pay the CONSULTANT for all unpaid Additional Services and unpaid Reimbursable Expenses, as well as for the CONSULTANT's reasonable expenses directly attributable to termination in accordance with the rates for Additional Services set forth in Schedule(s)`B"measured from the date of termination, including fair and reasonable sums for overhead and profit and the costs of terminating the CONSULTANT's contracts with its subconsultants, subcontractors, or vendors. ARTICLE 13—SUSPENSION OF SERVICES If the CONSULTANT's services hereunder are delayed or suspended, in whole or in part,by the SPONSOR for' more than thirty(30)calendar days,consecutively or in the aggregate,through no fault of the CONSULTANT, then the CONSULTANT shall be entitled to equitable adjustments of rates and amounts of compensation to reflect, among other things, reasonable costs incurred by the CONSULTANT in connection with the delay or suspension and reactivation and the fact that the time for performance of the CONSULTANT's services hereunder has been revised.If the delay or suspension persists for more than ninety(90)days,consecutively or in the aggregate,then the CONSULTANT may consider the Project to have been abandoned by the SPONSOR and may terminate this Agreement for cause. Upon the SPONSOR's resumption of its Project,and if the CONSULTANT has not terminated this Agreement for cause,the CONSULTANT shall resume its services under this Agreement until the services are completed and accepted, subject to any adjustment in the rates set forth in Schedule(s)`B"because of the passage of time. 6 G\Group\Aviation\GRANTS\FAAAIP\211\xxl8 Rehabilitate Electrical Budding(Design)\Grant Appheation\Design Agreement\DRAFT 0138 Electric Vault Design-LS doe 09/04 ARTICLE 14—INTERCHANGE OF DATA During the performance of this Agreement,all technical data in regard to the Project whether(a)existing in the office of the SPONSOR or(b)existing in the office of the CONSULTANT, shall be made available to the other party to this Agreement without expense to such other party. ARTICLE 15—DISPOSITION OF PROJECT DOCUMENTS At the time of completion of its services and upon payment in full therefor, the CONSULTANT shall make available to the SPONSOR copies of documents prepared as the result of this Agreement.These documents shall then become the property of the SPONSOR and the maintenance of the data therein shall be the sole responsibility of the SPONSOR.Any reuse of the documents by the SPONSOR or others on extensions of the Project, or on any other project, without written verification or adaptation by the CONSULTANT and its subconsultants, subcontractors, or vendors, as appropriate, for the specific purpose intended will be at the SPONSOR's sole risk and expense and without liability or legal exposure to the CONSULTANT or its subconsultants, subcontractors, or vendors. The SPONSOR shall indemnify the CONSULTANT, its subconsultants,subcontractors,and vendors against,and hold them harmless from,all claims,damages,losses, and expenses(including reasonable expert and attorneys' fees)arising out of or resulting from such reuse. In the event that this Agreement is terminated for any reason,then within ten(10)days after such termination, the CONSULTANT shall make available to the SPONSOR all data and material prepared under this Agreement, including cover sheets,in accordance with and subject to the terms of the above paragraphs. ARTICLE 16—CODE OF ETHICS The CONSULTANT specifically agrees that this Agreement may be canceled or terminated if any service under this Agreement is in conflict with the provisions of Section 74 of the New York State Public Officers'Law,as amended, and Schedule"G",which is attached hereto and made a part hereof. ARTICLE 17—INDEPENDENT CONTRACTOR The CONSULTANT, in accordance with its status as an independent contractor,shall conduct itself consistent with such status; shall neither hold itself out as nor claim to be an officer or employee of the SPONSOR by reason hereof; and shall not,by reason hereof,make any claim,demand,or application to or for any right or privilege applicable to an officer or employee of the SPONSOR, including, but not limited to, workers' compensation coverage,unemployment insurance benefits,Social Security coverage,or retirement membership or credit. ARTICLE 18—PATENT RIGHTS AND COPYRIGHTS Any patentable result arising out of this Agreement,as well as all information,designs,specifications,know- how,data,and findings,shall be made available without cost to the State of New York or its licensees and the FAA for public use.No material prepared in connection with this Project shall be subject to copyright. The State and the FAA shall have the right to publish,distribute,disclose,or otherwise use any material prepared under this Project, subject to the provisions of Article 15 hereof. ARTICLE 19—NEW YORK STATE PARTICIPATION The services to be performed in this Agreement are included in aNYSDOT Project,which is being undertaken and accomplished by the SPONSOR and the State of New York and pursuant to which the State of New York has agreed to pay a certain percentage of the allowable Project costs.The State of New York is not a party to 7 0\Group\Aviation\GRANTS\FAAAIP\21 I\xxl8 Rehabilitate Electrical Budding(Design)\Grant Apphcation\Design Agreement\DRAFT OB8 Electric Vault Design-LS doe 09/04 this Agreement and no reference in this Agreement to the Commissioner of Transportation or any representative thereof, or to any rights granted to the Commissioner of Transportation or any representative thereof or the State of New York by the Agreement,makes the State of New York a parry to this Agreement. The CONSULTANT and the SPONSOR agree that properly authorized officials of the State of New York may from time to time inspect all Project documents for the purpose of insuring compliance with New York State laws and protecting the interests of the State of New York. ARTICLE 20—FEDERAL PARTICIPATION The FAA is not a party to this Agreement,although the Project work program covered by this Agreement may be financially aided in part by a Grant Agreement between the SPONSOR and the FAA. The SPONSOR and the CONSULTANT hereby agree to comply fully with the conditions set forth in detail in the Grant Agreement as though they were set forth in detail in this Agreement,including the requirements set forth in Schedules"F", "G",and"H"hereto.The CONSULTANT further agrees that,by reason of complying with the conditions of the Grant Agreement,no obligation is entailed on the part of the FAA to the CONSULTANT. The CONSULTANT and the SPONSOR agree that properly authorized officials of the FAA may from time to time inspect all Project documents for the purpose of insuring compliance with Federal laws and protecting the interests of the FAA. ARTICLE 21—MISCELLANEOUS A. The CONSULTANT shall require all persons employed to perform services hereunder, including its subconsultants or subcontractors,vendors,agents,officers,and employees,to comply with applicable laws in the jurisdiction in which the Project is located. B. If any provision of this Agreement is held to be invalid,the remainder of this Agreement shall not be affected thereby if such remainder would then continue to conform to the terms and requirements,of applicable law. C. By execution of this Agreement,the CONSULTANT represents that it has not paid,and also agrees not to pay, any bonus or commission for the purpose of obtaining any approval of this Agreement. D. Any notice required under this Agreement shall be in writing,addressed to the appropriate party at the address set forth above, and shall be given personally; by registered or certified first-class mail, postage prepaid and return receipt requested;by facsimile transmission,with confirmation of receipt; or by a nationally-recognized overnight courier service,with proof of receipt. Notice shall be effective upon the date of receipt. For purposes of this Agreement, failure or refusal to accept receipt shall constitute receipt nonetheless. Either party may change its address for notice by giving notice to the other in accordance with the terms of this paragraph. E. This Agreement,and the interpretation and enforcement of the provisions hereof,is governed by the laws of the State of New York. F. SPONSOR acknowledges that: • CONSULTANT is not recommending any action to SPONSOR or other obligated person hereunder that would cause CONSULTANT to be considered a municipal advisor for purposes of the Securities and Exchange Commission Registration of Municipal Advisors Rule, 78 Fed.Reg. 67468 (2013); • CONSULTANT does not owe a fiduciary duty pursuant to Section 15B of the Securities Exchange Act of 1934(15 U.S.C.78o-4)to SPONSOR or other obligated person with respect to the information and material contained in this Agreement or any Project deliverable; and 8 G\Group\Avtation\GRANTS\FAAAIP\211\xx18 Rehabilitate Electrical Budding(Design)\Grant Application\Design Agreement\DRAFT 0138 Electric Vault Design-LS doc 09/04 a � • SPONSOR or other obligated person should discuss any information and material contained in this Agreement or Project deliverable with any and all internal or external advisors and experts that SPONSOR or other obligated person deems appropriate before acting on this information or material. ARTICLE 22—SUBCONSULTANTS/SUBCONTRACTORS AND VENDORS All subconsultants and subcontractors performing services for or work on this Project shall be bound by the same required provisions of this Agreement as is the CONSULTANT. As set forth above, all agreements between the CONSULTANT and a subconsultant, subcontractor, or vendor shall include all standard required contract provisions, and such agreements shall be subject to review by the NYSDOT and the FAA. ARTICLE 23—FORCE MAJEURE Any delay in or failure of performance of any party to this Agreement shall not constitute a default under this Agreement nor give rise to any claim for damage, if and to the extent such delay or failure is caused by occurrences or events beyond the control of the party affected, including, but not limited to, acts of God; expropriation or confiscation of facilities or compliance with any order or request of government authority, affecting to a degree not presently existing,the supply,availability,or use of personnel or equipment;loss of utility services;blizzard;flood;fire;labor unrest;strikes;war;riot;or any cause the party is unable to prevent . with reasonable diligence.A party who is prevented from performing for any reason shall immediately notify the other in writing of the reason for the nonperformance and the anticipated extent of any delay. Additionally, if the delay resulting from any of the foregoing increases the cost of or time required by CONSULTANT to perform its services hereunder in an orderly and efficient manner,then CONSULTANT shall be entitled to an equitable adjustment in schedule and/or compensation. ARTICLE 24—DISPUTE RESOLUTION A. The SPONSOR and the CONSULTANT agree to negotiate in good faith for a period of thirty(30)days from the date of notice of disputes between them prior to exercising their right under Section 24B below. The thirty-day period may be extended upon mutual agreement of the parties. B. If any dispute cannot be resolved pursuant to paragraph(A) above, and only if mutually agreed by SPONSOR and CONSULTANT,said dispute and all unsettled claims,counterclaims,and other matters in question between them arising out of or relating to this Agreement or the breach of any provision hereof("disputes")shall be submitted to mediation by a mediator,to be selected bythe parties jointly, prior to a party initiating a legal action against the other,unless initiating mediation would irrevocably prejudice one of the parties.It is the intention of the parties that any agreement reached at mediation become binding.The cost of mediation shall be shared equally between the parties. 9 0\Group\Aviation\GRANTS\FAAAIP\211\ 18 Rehabilitate Electrical Building(Design)\Grant Application\Design Agreement\DRAFT 0138 Electric Vault Design-LS doe 09/04 IN WITNESS WHEREOF,this Agreement has been executed by the SPONSOR,acting by and through the Town of Southold who has caused the seal of his or her office to be affixed hereto,and by the CONSULTANT,acting by and through a duly-authorized officer,effective the day and year first above-written,subject to the approval of the Commissioner of the NYSDOT,the State Comptroller, and the FAA. SPONSOR(S) CONSULTANT Fishers Island Ferry District C&S Engineers,Inc. By: By: Kirsten A. Cerro,P.E. (Print Name) Title: Title: Department Manager-Aviation Group Date: Date: Town of Southold By: Scott A.Russell Title: Town Supervisor Date: 10 G\Group\Aviatron\GRANTS\FAAAIP\21 lex 18 Rehabilitate Electncal Budding(Design)\Grant Apphcanon\Design AgreementWRAFT OB8 Electnc Vault Design-LS doc 09/04 SCHEDULE A SCOPE OF WORK Project Title: Airfield Electric Vault Rehabilitation Airport Name: Elizabeth Field Airport—Town of Southold Services Provided: Design and Bidding Project Description: The CONSULTANT shall provide required services to design the Rehabilitation of the Existing Airfield Electric Vault project(the"Project").The Project will be performedard constructed by the SPONSOR with grant assistance from the Federal Aviation Administration(FAA))-Airport Improvement Program(All?)and the New York State Department of Transportation(NYSDOT). Ah environmental permitting required by the various items of work will be included in the design services. The proposed project involves replacing airfield lighting,quipment(cur��iregqlators),� installing shelving to elevate the airfield lighting equipment and raise it-o°ut of frequent flood elevations, address lighting and mechanical/HVAC system install to prevent accelerated corrosion,,due to the'salt'air environment, and address repairs to previous flood damage(interior lighting repairs painting, etc.).Exterior renovations are anticipated to include replacement of the_main entry door dnd`repairing damaged buildinfascia. E; t � Exhibit A-2:Electric Raceways Exhibit A-1: BuildingEntrance c„ .may, Exhibit A-3: Current Regulator Services to be provided by the CONSULTANT shall include architectural,mechanical, electrical,structural, and environmental engineering'services, as applicable,required to accomplish the following items("Basic Services"): Assumptions used in preparation of this proposal are included on the last page. A-1 09/04 ADMINISTRATION PHASE The CONSULTANT shall aid the SPONSOR by acting as its liaison and Project coordinator with FAA and NYSDOT during the Project's design. In addition, the CONSULTANT shall assist the SPONSOR in the preparation of paperwork required to secure funds for the Project. The specific services to be provided or furnished for this Phase of the Project are the following: 1. Preparation of grant application packages; coordination of their execution by the Sponsor; and submission to the funding agencies. Preparation of the grant application includes the preparation or update of the Categorical Exclusion(LATEX)Environmental Assessment. 2. Prepare quarterly progress reports for submission to the FAA. 3. Preparation of reimbursement request packages; coordination of their execution by the Sponsor; and submission to the funding agencies f 4. During the Design Phase, to aid the Sponsor by acting as,iis liaison and Project coordinator with the funding agencies. f� / \', X 5. The construction budget for the Project is approximately$175,000.'The Consultant shall evaluate the feasibility of this budget,based upon the Consultant's experience as\a design professional, and keep the Sponsor apprised during each phase of the Project of the results of such evaluation. The Consultant shall advise the Sponsor as to options available�for reducing construction costs to stay within the budget,if it appears likely that contractor°.bidpnces will exceed this budget. /� \\ e,l- i -�J 6. Perform project managements uties-.such as poject-planning,invoice preparation, schedule coordination and coordination of. esign team. '` 7. Provide to the SPONSOR monthly pr9ject stat reports. 8. Schedule coordination-consultant shall provide continued coordination so that project schedules are met for each phase of work included'in=this contractParticular phases of design may be delayed by the FAA or,NYSDOTer view process " 9. The design schedule-is,anticipated to be as follows: Time from Anticipated < \Receipt'ofiNTP Completion Date �Coritract Execution `` September 1 2018 Notice to Proceed(NTP)` �°., �, September 1,2018 Schematic Design `. `t, \ 110 days December 15,2018 Preliminary Desi ``, gn '°�J 190 days March 9,2019 Final Design220 days April 20,2019 PRELIMINARY DESIGN The services to be performed-during this Phase consist generally of services required to furnish the SPONSOR with a set of Preliminary Plans and Specifications.The CONSULTANT will evaluate alternatives and conduct field investigations to provide cost-effective and practical solutions for the work items identified. The specific services to be provided or furnished for this Phase of the Project are the following: 1. Schedule and conduct a pre-design meeting with the SPONSOR, FAA and NYSDOT to review the scope of services and become familiar with the Project requirements and operational concerns during the Project's construction. 2. Acquire and review record documents (such as plans, specifications, reports, and studies) to become familiar with data that is available for the Project. A-2 09/04 3. Perform a preliminary Project site inspection to further familiarize the design team with Project areas. 4. Develop a draft construction safety phasing plan(CSPP)that endeavors to limit interference by the Project's construction with airport and tenant operations. The scope of services assumes that FAA will perform Safety Risk Management(SRM) review based on the draft CSPP, and that a Safety Risk Management Panel (SRMP) and safety risk mitigation will not be necessary. If SRMP is determined by FAA to be necessary,the cost of these services is not included in the CONSULTANT'S original Scope of Services and shall therefore be an Additional Service, as described in Article 11 of the Agreement. 5. Develop preliminary designs of structural Project elements,.guch as lighting equipment rack and shelving systems, support system for HVAC equipment. // 6. Develop preliminary designs of architectural building elements . 7. Develop preliminary designs of HVAC climate controlrsystem�` 8. Investigate existing electrical system capacities and perform preliminary design of electrical power distribution and control systems. �\ 9. Update draft CSPP based on schematic d sign review meeting. F ,N 10. Prepare preliminary Contract Drawings (app oki ately 50%complete)providing sufficient detail for review of design concepts by the SPONSOR,FAA and NYSDOT. 11. Develop general and technical specificationss expected'to be required for the proposed work. 12. Prepare opinion of probable construction costareflect theou comes of preliminary Project design. 13. Perform an internal quality control'review, mcluding,,a constructability review, on all design documents. 14. Submit sufficient copies of preliminary design°documents to the SPONSOR,FAA and NYSDOT for their review and comment. 15. Schedule and co duct a prelimmary design r viewpeeting to discuss and resolve SPONSOR,FAA and NYSDOT comments.` FINAL DESIGN PHASE The services included under this Phaste shall generally consist of services required to furnish the SPONSOR with a complete set of Contract Documents for the Project, including Final Plans, Specifications, and opinion of probable donstruction costs I Services to be performed or furnished during this Phase may include revising the preliminar�y,s ubmittai information to comply with SPONSOR, FAA and NYSDOT comments and then completion of the.fnal design. Plans and Specifications, suitable for unit price bidding, will be completed; final design will be_coordinated with the SPONSOR, FAA and NYSDOT and a complete set of bid documents will be furnished to the SPONSOR, FAA and NYSDOT. A final opinion of probable construction cost will also be prepared and submitted. A final Construction Safety and Phasing Plan will be included as part of the Contract Documents. The specific services to be provided or furnished for this Phase of the Project are the following: 1. Finalize structure building design elements and related installations. 2. Finalize architectural building elements. 3. Finalize design and detailing of HVAC climate control system. A-3 09/04 4. Finalize airfield electrical power distribution and system designs, and detail installations. 5. Prepare final Contract Drawings on 22" x 34" or 11" x 17" Paper. It is anticipated that the final drawings will consist of the following sheets: Sheets Name 1 Title Sheet and Sheet Index 1 General Notes and Legend 1 General Plan 1 Construction Safety Phasing Plan and Details 1 Overall Building Plan 2 Exterior Elevations and Building Secfibns 2 Building Mechanical Plans and Details' 1 Electrical Plan 2 Electrical Details and One, in6/ \. 1 Existing Panel Schedules-\\�/ ff .d 6. Finalize General Specifications .ti X�\ 7. Finalize written Technical Specifications for-_all construction materials\and installations. FAA standard technical specifications shall be used whenever possible,with supple me tal specifications developed by the consultant. 8. Finalize CSPP and include in Specficati6ns and on the.Contract Drawings. y "' 9. Prepare final opinion of probable const ction costs bas d',up n the actual bid items and quantity takeoffs. ----�� \ 10. Submit both the nstructio.safety phasing sing plan and 7460 form electronically to the FAA. 11. Perform final in al quality�co trol review onrall designciiments. 12. Submit draft fmail documeentsL the SPONSOR,FAA and NYSDOT for final review and comment. 13. Scheduleedule nd conduct draft final PA meeting\ith the SPONSOR,FAA and NYSDOT to discuss and resolve final comments. 14tReproduce and su mit\sufficient copies of bi documents to SPONSOR for bidding purposes. Bid do`cunients shall consist ofathe Contract Drawings and Specifications. Soils investigation data shall also be,provided to bidd'ers'for inform tional purposes. �\\ BID PHASE � The Bid Phase is that,,tiuhe frame between completion of the design process and beginning of actual construction when the SPONSOR publicly advertises and receives bids, awards contracts to the lowest responsible bidder, and executes a construction contract to perform the work with the successful contractor(s).The CONSULTANT shall assist the SPONSOR during this Phase as required. The specific services to be provided or furnished for this Phase of the Project are the following: 1. Assist the SPONSOR in the advertisement of the Project and issuance of bid documents. 2. Receive and respond as required to questions from potential bidders regarding the Contract Documents. 3. If requested by the Sponsor, schedule and conduct pre-bid conference(s) by the SPONSOR and advise the SPONSOR on matters relating to design. Prepare meeting minutes of the pre-bid conference(s). A-4 09/04 4. Prepare addenda to the bid documents after advertisement and prior to bidding as required upon the SPONSOR's approval. 5. Attend bid opening. Upon receipt of bids,perform bid reviews. The bid review shall include items such as a check of the contractor's bid extensions, bid security, execution of bid, non-collusive bidding certificate, EEO certification, statement of surety's intent, addenda receipt, "Buy American"certificate, subcontractors and suppliers list, eligibility certification, corporate bidder's certification, non-discrimination statement and nonsegregated facilities certificate. Request evidence of competency and evidence of financial responsibility from the contractor. Review contractor's list of personnel, list of equipment, and financial statement. Formal contact of the contractor's references shall be made upon SPONSOR's request or if the contractor has no past working relationship with the CONSULTANT,the SPONSOR;FA A and NYSDOT. 6. Prepare final bid tabulation, recommendation/rejectior FAAof award to the SPONSOR, and a sample award letter. Request concurrence of award from t(he` . 7. Upon award of contract,prepare conformed copies of contracts, coordinate contractors execution of contract; review contractor's bonds, and insurance certificates; review contractor's submission with SPONSOR;coordinate SPONSOR's exeeution�ofthe contract; ai4assist in distributing copies of executed contracts to the contractor and the F-,A. °, 8. Coordinate Notice to Proceed (NTP) for construction. Contact the FAA�for permission to issue NTP.Prepare a sample NTP letterfor the SPONSOR to.send to the contractorN� ASSUMPTIONS: \ The conditions or considerations in developing•the scope`and fee for`°the'project described above include: 1. No 3D building'survey is�mcluded in this`propo'sa ' o 'ti ) 2. C&S has the Updated As-built drawing in inventory. 3. Existing electrical\se vice can support the',new work within this proposal without the addition of new ele trical'seruice.� 4. Access-to the-site for inspection/survey¢ca only'be'performed during daytime hours. 5. (\Co`st estimates will�be based` on 'id prices from recent projects at the airport. 6. Estimate up to three(3)meetings wil'l\be conducted with Airport representatives to review project alternatives and construction�phasirigalternatives. `. END OF SCHEDULE A L � A-5 09/04 ces ARCHITECTURAL/ENGINEERING COMPANIES COST SUMMARY SCHEDULE "B" DESIGN and BIDDING PHASE PROJECT NAME: AIRFIELD ELECTRIC VAULT IMPROVEMENTS DATE 30-Jun-18 PROJ DESCRIPTION AIRFIELD ELECTRIC VAULT IMPROVEMENTS A/E: C&S ENGINEERS,INC PROJECT NO 211 CLIENT• TOWN OF SOUTHOLD/FISHERS ISLAND FERRY DISTRICT C&S CONTACT• TJH CLIENT MANAGER Fishers Island,NY 06390 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 $8650 $8220 X 0 = $000 B DEPARTMENT MANAGER $7140 $6480 X 16 = $1,03700 C. MANAGING/CHIEF ENGINEER $6390 $5610 X 10 = $56100 D PRINCIPAL ENGINEER $6060 $5650 X 14 = $79100 E SENIOR PROJECT ENGINEER $5460 $4730 X 100 = $4,73000 F PROJECT ENGINEER/ENV SCIENTIST $4440 $3980 X 0 = $0.00 G ENGINEER $4040 $3330 X 0 = $000 H STAFF ENGINEER $31 90 $2790 X 0 = $0.00 I. SENIOR DESIGNER $4270 $39.40 X 20 = $788.00 J DESIGNER $32.40 $27.60 X 0 = $0.00 K CADD OPERATOR/DESIGN TECHNICIAN $3140 $28.40 X 0 = $000 L ADMINISTRATIVE ASSISTANT $28.20 $24.50 X 0 = $0.00 M INTERN $19.50 $1630 X 0 = $0.00 N GRANTS ADMINISTRATOR $34.40 $3280 X 20 = $656.00 O ASSISTANT GRANTS ADMINISTRATOR $2780 $2650 X 20 = $530.00 P MANAGING PLANNER $58.70 $5590 X 0 = $000 Q SENIOR PROJECT PLANNER $5060 $4820 X 0 = $000 R. PLANNER $3360 $31.10 X 0 = $0.00 S STAFF PLANNER $3060 $2840 X 0 = $000 T SENIOR/MANAGING ARCHITECT $5550 $5450 X 0 = $000 U SENIOR GIS ANALYST $3520 $3360 X 0 = $000 V GEOLOGIST $3460 $3300 X 0 = $0.00 W ENVIRONMENTAL SCIENTIST $3240 $3030 X 0 = $000 X SENIOR CONSTRUCTION SUPERVISOR $7790 $6920 X 0 = $0.00 Y CONSTRUCTION SUPERVISOR $4440 $4220 X 0 = $0.00 Z RESIDENT ENGINEER $50.90 $4560 X 0 = $0.00 AA CHIEF INSPECTOR $4500 $3870 X 0 = $000 BB SENIOR INSPECTOR $41 60 $3450 X 0 = $000 CC INSPECTOR $3300 $3140 X 0 = $0.00 DD JUNIOR INSPECTOR $21 60 $20.60 X 0 = $0.00 EE SENIOR TECHNICAL ADMINISTRATOR $3570 $3210 X 0 = $000 FF SENIOR PROJECT LANDSCAPE ARCHITECT $4440 $4220 X 0 = $000 GG PROJECT LANDSCAPE ARCHITECT $4200 $4010 X 0 = $000 TOTAL ESTIMATED DIRECT SALARY COST. $9,09300 IL OVERHEAD EXPENSES&PAYROLL BURDEN PER SCHEDULE"C"- (AGREED OVERHEAD EXPRESSED AS A PERCENTAGE OF DIRECT SALARY COST). 16600% $15,09400 111. SUBTOTAL OF ITEMS I&11: $24,18700 B-1 IV. ESTIMATE OF DIRECT EXPENSES: A TRAVEL,BY AUTO 1, TRIPS @ 640, MILES/TRIP @ $0535 = $34240 B. PER R DIEM 2 DAYS @ 1 PERSONS @ $19400 = $38800 C MISCELLANEOUS = $4 55 TOTAL ESTIMATE OF DIRECT EXPENSES $73495 V. FIXED FEE(PROFIT,LUMP SUM): A LABOR PLUS OVERHEAD 15% (OF III.) $3,62805 B DIRECT EXPENSES 0% (OF IV) $000 TOTAL FIXED FEE $3,62805 VI. SUBCONTRACTS: A NONE $0 00 VII. TOTALS: A. MAXIMUM TOTAL COST FOR DESIGN SERVICES,AGREEMENT TOTAL&FAA ELIGIBLE: $28,550.00 B-2 SCHEDULE "C" C&S ENGINEERS, INC AGREED OVERHEAD Indirect Labor 13,833,871 80% P/R Taxes & Benefits 5,563,283 32% Legal &Accounting 235,447 1% Rent& Maintenance 2,263,483 13% Utilities 129,165 1% Office Supplies 685,114 4% Telephone/Internet 666,017 4% Professional Activity 217,843 1% Business Development 393,061 2% Auto &Truck Expenses 892,789 5% Insurance 644,954 4% Office Equipment Rent/ Maintenance 2,282,451 13% Library& Reference Data 249,547 1% Depreciation 774,903 4% TOTAL INDIRECT EXPENSES 28,831,928 166% TOTAL DIRECT LABOR 17,350,990 C-1 G\Group\Aviation\GRANTS\FAAAIP\211bod8 Rehabilitate Electrical Budding(Design)\Grant Apphcation\Design Agreement\DRAFT 0138 Electric Vault Design-LS doc 08/04 SCHEDULE E (RESOLUTION TO BE INSERTED) G\Group\Aviation\GRANTS\FAAAIP\21 lbatl8 Rehabilitate Electrical Budding(Design)\Grant Appheanon\Design Agreement\DRAFT 0138 Electric Vault Design-LS doc 09/04 SCHEDULE G CERTIFICATION OF CONSULTANT I hereby certify that I am the Manager of the Airport Services Group and a duly authorized representative of the firm of C&S Engineers,Inc.,whose address is 499 Col.Eileen Collins Blvd.,Syracuse,NY,and that neither I nor the above firm I here represent has: A. employed or retained for a commission,percentage,brokerage,contingent fee,or other consideration, any firm or person(other than a bona fide employee working solely for me or the above CONSULTANT) to solicit or secure this Contract. B. agreed,as an express or implied condition for obtaining this Contract,to employ or retain the services of any firm or person in connection with carrying out the Contract, or C. paid or agreed to pay to any firm,organization, or person(other than a bona fide employee working solely for me or the above CONSULTANT)any fee,contribution,donation,or consideration of any kind for, or in connection with,procuring or carrying out the Contract except as here expressly stated(if any): I acknowledge that this certificate is to be furnished to the Federal Aviation Administration of the United States Department of Transportation, in connection with this Contract, involving participation of Airport Improvement Program(AIP)funds,and is subject to applicable state and Federal laws,both criminal and civil. Date Kirsten A. Cerrro,P.E. Department Manager-Aviation Group END OF SCHEDULE 0 G-1 G\Group\Aviation\GRANTS\FAAAIP\21 toad 8 Rehabilitate Electrical Budding(Design)\Grant Application\Design Agreement\DRAFT OB8 Electric Vault Design-LS doc 11/I 1 SCHEDULE H AIRPORT AID PROGRAM A/E SERVICES REQUIRED FEDERAL CONTRACT PROVISIONS ACCESS TO RECORDS AND REPORTS The Contractor must maintain an acceptable cost accounting system. The Contractor agrees to provide the Sponsor,the Federal Aviation Administration,and the Comptroller General of the United States or any of their duly authorized representatives access to any books,documents,papers,and records of the contractor which are directly pertinent to the specific contract for the purpose of making audit,examination,excerpts and transcriptions.The Contractor agrees to maintain all books,records and reports required under this contract for a period of not less than three years after final payment is made and all pending matters are closed. BREACH OF CONTRACT TERMS Any violation or breach of terms of this contract on the part of the contractor or its subcontractors may result in the suspension or termination of this contract or such other action that may be necessary to enforce the rights of the parties of this agreement. The duties and obligations imposed by the Contract Documents and the rights and remedies available thereunder are in addition to,and not a limitation of,any duties,obligations,rights and remedies otherwise imposed or available by law. GENERAL CIVIL RIGHTS PROVISIONS The contractor agrees that it will comply with pertinent statutes,Executive Orders and such rules as are promulgated to ensure that no person shall,on the grounds of race,creed,color,national origin,sex,age,or handicap be excluded from participating in any activity conducted with or benefiting from Federal assistance. This provision binds the contractors from the bid solicitation period through the completion of the contract.This provision is in addition to that required of Title VI of the Civil Rights Act of 1964. This provision also obligates the tenant/concessionaire/lessee or its transferee for the period during which Federal assistance is extended to the airport through the Airport Improvement Program,except where Federal assistance is to provide,or is in the form of personal property;real property or interest therein;structures or improvements thereon. In these cases the provision obligates the party or any transferee for the longer of the following periods: (a) the period during which the property is used by the airport sponsor or any transferee for a purpose for which Federal assistance is extended,or for another purpose involving the provision of similar services or benefits;or (b) the period during which the airport sponsor or any transferee retains ownership or possession of the property. CIVIL RIGHTS—TITLE VI ASSURANCES. Title VI Solicitation Notice: The 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 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. Compliance with Nondiscrimination Requirements During the performance of this contract,the contractor,for itself,its assignees,and successors in interest(hereinafter referred to as the "contractor")agrees as follows: 1. Compliance with Regulations: The contractor(hereinafter includes consultants)will comply with the Title VI List of Pertinent Nondiscrimination Statutes and Authorities, as they may be amended from time to time, which are herein incorporated by reference and made a part of this contract. 2. Non-discrimination: The contractor,with regard to the work performed by it during the contract,will not discriminate on the grounds of race,color,or national origin in the selection and retention of subcontractors,including procurements of materials and leases of equipment. The contractor will not participate directly or indirectly in the discrimination prohibited H-1 G\Group\Aviation\GRANTS\FAAAIP\211\xxl8 Rehabilitate Electrical Budding(Design)\Grant Apphcauon�Destgn Agreement\DRAFF 0138 Electric Vault Design-LS doe 11/11 by the Acts and the Regulations,including employment practices when the contract covers any activity,project,or program set forth in Appendix B of 49 CFR part 21. 3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all solicitations, either by competitive bidding, or negotiation made by the contractor for work to be performed under a subcontract, including procurements of materials,or leases of equipment,each potential subcontractor or supplier will be notified by the contractor of the contractor's obligations under this contract and the Acts and the Regulations relative to Non-discrimination on the grounds of race,color,or national origin. 4. Information and Reports: The contractor will provide all information and reports required by the Acts,the Regulations,and directives issued pursuant thereto and will permit access to its books,records,accounts,other sources of information,and its facilities as may be determined by the sponsor or the Federal Aviation Administration to be pertinent to ascertain compliance with such Acts, Regulations, and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish the information,the contractor will so certify to the sponsor or the Federal Aviation Administration,as appropriate,and will set forth what efforts it has made to obtain the information. 5. Sanctions for Noncompliance: In the event of a contractor's noncompliance with the Non-discrimination provisions of this contract,the sponsor will impose such contract sanctions as it or the Federal Aviation Administration may determine to be appropriate,including,but not limited to: a. Withholding payments to the contractor under the contract until the contractor complies;and/or b. Cancelling,terminating,or suspending a contract,in whole or in part. 6. Incorporation of Provisions: The contractor will include the provisions of paragraphs one through six in every subcontract, including procurements of materials and leases of equipment,unless exempt by the Acts,the Regulations and directives issued pursuant thereto. The contractor will take action with respect to any subcontract or procurement as the sponsor or the Federal Aviation Administration may direct as a means of enforcing such provisions including sanctions for noncompliance.Provided,that if the contractor becomes involved in,or is threatened with litigation by a subcontractor,or supplier because of such direction,the contractor may request the sponsor to enter into any litigation to protect the interests of the sponsor. In addition,the contractor may request the United States to enter into the litigation to protect the interests of the United States. Title VI List of Pertinent Nondiscrimination Authorities (Source: Appendix E of Appendix 4 of FAA Order 1400.11,Nondiscrimination in Federally-Assisted Programs at the Federal Aviation Administration) During the performance of this contract,the contractor,for itself,its assignees,and successors in interest(hereinafter referred to as the "contractor")agrees to comply with the following non-discrimination statutes and authorities;including but not limited to: • Title VI of the Civil Rights Act of 1964(42 U.S.C.§2000d et seq.,78 stat.252),(prohibits discrimination on the basis of race,color,national origin); • 49 CFR part 21(Non-discrimination In Federally-Assisted Programs of The Department of Transportation—Effectuation of Title VI of The Civil Rights Act of 1964); • The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970,(42 U.S.C. §4601),(prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or Federal-aid programs and projects); • Section 504 of the Rehabilitation Act of 1973,(29 U.S.C.§794 et seq.),as amended,(prohibits discrimination on the basis of disability);and 49 CFR part 27; • The Age Discrimination Act of 1975,as amended,(42 U.S.C.§6101 et seq.),(prohibits discrimination on the basis of age); • Airport and Airway Improvement Act of 1982, (49 USC §471, Section 47123),as amended,(prohibits discrimination based on race,creed,color,national origin,or sex); • The Civil Rights Restoration Act of 1987,(PL 100-209),(Broadened the scope,coverage and applicability of Title VI of the Civil Rights Act of 1964,The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973,by expanding the definition of the terms"programs or activities"to include all of the programs or activities of the Federal-aid recipients,sub-recipients and contractors,whether such programs or activities are Federally funded or not); • Titles II and III of the Americans with Disabilities Act of 1990,which prohibit discrimination on the basis of disability in the operation of public entities,public and private transportation systems,places of public accommodation,and certain testing entities(42 U.S.C.§§12131-12189)as implemented by Department of Transportation regulations at 49 CFR parts 37 and 38; • The Federal Aviation Administration's Non-discrimination statute(49 U.S.C. §47123)(prohibits discrimination on the H-2 G\Group\Avmtion\GRANTS\FAAAIP\211bocl g Rehabilitate Electrical Buddmg(Design)\Grant Application\Design AgreementMRAFT 0138 Electric Vault Design-LS doe 11/11 basis of race,color,national origin,and sex); • Executive Order 12898,Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations, which ensures non-discrimination against minority populations by discouraging programs,policies, and activities with disproportionately high and adverse human health or environmental effects on minority and low-income populations; • Executive Order 13166,Improving Access to Services for Persons with Limited English Proficiency,and resulting agency guidance,national origin discrimination includes discrimination because of limited English proficiency(LEP). To ensure compliance with Title VI,you must take reasonable steps to ensure that LEP persons have meaningful access to your programs(70 Fed.Reg.at 74087 to 74100); • Title IX of the Education Amendments of 1972,as amended,which prohibits you from discriminating because of sex in education programs or activities(20 U.S.C. 1681 et seq). CLEAN AIR AND WATER POLLUTION CONTROL Contractors and subcontractors agree: 1. That any facility to be used in the performance of the contract or subcontract or to benefit from the contract is not listed on the Environmental Protection Agency(EPA)List of Violating Facilities; 2. To comply with all the requirements of Section 114 of the Clean Air Act,as amended,42 U.S.C.1857 et seq.and Section 308 of the Federal Water Pollution Control Act,as amended,33 U.S.C. 1251 et seq.relating to inspection,monitoring, entry,reports,and information,as well as all other requirements specified in Section 114 and Section 308 of the Acts, respectively,and all other regulations and guidelines issued thereunder; 3. That,as a condition for the award of this contract,the contractor or subcontractor will notify the awarding official of the receipt of any communication from the EPA indicating that a facility to be used for the performance of or benefit from the contract is under consideration to be listed on the EPA List of Violating Facilities; 4. To include or cause to be included in any construction contract or subcontract which exceeds$100,000 the aforementioned criteria and requirements. CONTRACT WORKHOURS AND SAFETY STANDARDS ACT REQUIREMENTS 1. Overtime Requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic,including watchmen and guards,in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. 2. Violation;Liability for Unpaid Wages;Liquidated Damages. In the event of any violation of the clause set forth in paragraph(1)above,the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages.In addition,such contractor and subcontractor shall be liable to the United States(in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic,including watchmen and guards,employed in violation of the clause set forth in paragraph 1 above,in the sum of$10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph 1 above. 3. Withholding for Unpaid Wages and Liquidated Damages. The Federal Aviation Administration or the Sponsor shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any monies payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor,or any other Federally-assisted contract subject to the Contract Work Hours and Safety Standards Act,which is held by the same prime contractor,such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph 2 above. 4. Subcontractors. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraphs 1 through 4 and also a clause requiring the subcontractor to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs 1 through 4 of this section. H-3 G\Group\Avmtwn\GRANTS\FAAAIP\211\x 18 Rehabilitate Electncal Budding(Design)\Grant Application\Design Agreement\DRAFT OB8 Electne Vault Design-LS doe 11/11 CERTIFICATE REGARDING DEBARMENT AND SUSPENSION(BIDDER OR OFFEROR) By submitting a bid/proposal under this solicitation,the bidder or offeror certifies that at the time the bidder or offeror submits its proposal that neither it nor its principals are presently debarred or suspended by any Federal department or agency from participation in this transaction. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION(SUCCESSFUL BIDDER REGARDING LOWER TIER PARTICIPANTS) The successful bidder,by administering each lower tier subcontract that exceeds$25,000 as a"covered transaction",must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. The successful bidder will accomplish this by: 1. Checking the System for Award Management at website: http://www.sam.gov 2. Collecting a certification statement similar to the Certificate Regarding Debarment and Suspension(Bidder or Offeror), above. 3. Inserting a clause or condition in the covered transaction with the lower tier contract If the FAA later determines that a lower tier participant failed to tell a higher tier that it was excluded or disqualified at the time it entered the covered transaction,the FAA may pursue any available remedy,including suspension and debarment. DISADVANTAGED BUSINESS ENTERPRISES Contract Assurance(§26.13)-The contractor or subcontractor shall not discriminate on the basis of race,color,national origin,or sex in the performance of this contract.The contractor shall carry out applicable requirements of 49 CFR Part 26 in the award and administration of DOT assisted contracts.Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy,as the recipient deems appropriate. Prompt Payment (§26.29) - The prime contractor agrees to pay each subcontractor under this prime contract for satisfactory performance of its contract no later than 15 days from the receipt of each payment the prime contractor receives from Sponsor.The prime contractor agrees further to return retainage payments to each subcontractor within 15 days after the subcontractor's work is satisfactorily completed.Any delay or postponement of payment from the above referenced time frame may occur only for good cause following written approval of the Sponsor.This clause applies to both DBE and non-DBE subcontractors. FEDERAL FAIR LABOR STANDARDS ACT(FEDERAL MINIMUM WAGE) All contracts and subcontracts that result from this solicitation incorporate the following provisions by reference,with the same force and effect as if given in full text. The contractor has full responsibility to monitor compliance to the referenced statute or regulation. The contractor must address any claims or disputes that pertain to a referenced requirement directly with the Federal Agency with enforcement responsibilities. Requirement Federal Agency with Enforcement' Responsibilities Federal Fair Labor Standards Act(29 USC 201) U.S.Department of Labor—Wage and Hour Division LOBBYING AND INFLUENCING FEDERAL EMPLOYEES The bidder or offeror certifies by signing and submitting this bid or proposal,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 bidder or offeror,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, H-4 G\Group\A ration\GRANTS\FAAAIP1211\xod8 Rehabilitate Electrical Budding(Design)\Grant Appbcatwn\Design Agreement\DRAFT OB8 Electric Vault Design-LS doc continuation,renewal,amendment,or modification of any Federal contract,grant,loan,or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract,grant,loan,or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL,"Disclosure Form to Report Lobbying,"in accordance with its instructions. 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. MANDATORY CONTRACT LANGUAGE All contracts and subcontracts that result from this solicitation incorporate the following provisions by reference,with the same force and effect as if given in full text. The contractor has full responsibility to monitor compliance to the referenced statute or regulation. The contractor must address any claims or disputes that pertain to a referenced requirement directly with the Federal Agency with enforcement responsibilities. Requirement Federal_Agency with Enforcement Responsibilities Occupational Safety and Health Act of U.S.Department of Labor—Occupational Safety 1970(20 CFR Part 19 10) and Health Administration RIGHTS TO INVENTIONS All rights to inventions and materials generated under this contract are subject to requirements and regulations issued by the FAA and the Sponsor of the Federal grant under which this contract is executed. TERMINATION OF CONTRACT a. The Sponsor may, by written notice, terminate this contract in whole or in part at any time, either for the Sponsor's convenience or because of failure to fulfill the contract obligations. Upon receipt of such notice services must be immediately discontinued(unless the notice directs otherwise)and all materials as may have been accumulated in performing this contract, whether completed or in progress,delivered to the Sponsor. b. If the termination is for the convenience of the Sponsor,an equitable adjustment in the contract price will be made,but no amount will be allowed for anticipated profit on unperformed services. C. If the termination is due to failure to fulfill the contractor's obligations,the Sponsor may take over the work and prosecute the same to completion by contract or otherwise. In such case,the contractor is liable to the Sponsor for any additional cost occasioned to the Sponsor thereby. d. If,after notice of termination for failure to fulfill contract obligations,it is determined that the contractor had not so failed, the termination will be deemed to have been effected for the convenience of the Sponsor. In such event,adjustment in the contract price will be made as provided in paragraph 2 of this clause. e. The rights and remedies of the sponsor provided in this clause are in addition to any other rights and remedies provided by law or under this contract. TRADE RESTRICTION CLAUSE The contractor or subcontractor,by submission of an offer and/or execution of a contract,certifies that it: a. is not owned or controlled by one or more citizens of a foreign country included in the list of countries that discriminate against U.S.firms published by the Office of the United States Trade Representative(USTR); b. has not knowingly entered into any contract or subcontract for this project with a person that is a citizen or national of a foreign country on said list,or is owned or controlled directly or indirectly by one or more citizens or nationals of a foreign country on said list; c. has not procured any product nor subcontracted for the supply of any product for use on the project that is produced in a foreign country on said list. H-5 G 1Group\Aviation\GRANTS\FAAAIP\211\a 18 Rehabilitate Electrical Budding(Design)\Grant Application\Design Agreement\DRAFT OB8 Electric Vault Design-LS doc i l/11 Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with 49 CFR 30.17,no contract shall be awarded to a contractor or subcontractor who is unable to certify to the above. If the contractor knowingly procures or subcontracts for the supply of any product or service of a foreign country on said list for use on the project,the Federal Aviation Administration may direct through the Sponsor cancellation of the contract at no cost to the Government. Further, the contractor agrees that, if awarded a contract resulting from this solicitation, it will incorporate this provision for certification without modification in each contract and in all lower tier subcontracts. The contractor may rely on the certification of a prospective subcontractor unless it has knowledge that the certification is erroneous. The contractor shall provide immediate written notice to the sponsor if the contractor learns that its certification or that of a subcontractor was erroneous when submitted or has become erroneous by reason of changed circumstances. The subcontractor agrees to provide written notice to the contractor if at any time it learns that its certification was erroneous by reason of changed circumstances. This certification is a material representation of fact upon which reliance was placed when making the award. If it is later determined that the contractor or subcontractor knowingly rendered an erroneous certification,the Federal Aviation Administration may direct through the Sponsor cancellation of the contract or subcontract for default at no cost to the Government. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render,in good faith, the certification required by this provision. The knowledge and information of a contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. This certification concerns a matter within the jurisdiction of an agency of the United States of America and the making of a false, fictitious,or fraudulent certification may render the maker subject to prosecution under Title 18,United States Code,Section 1001. DAVIS-BACON ACT PROVISIONS 1. All mechanics and laborers employed or working upon the site of the work will be paid unconditionally and not less often than once a week and without subsequent deduction or rebate on any account(except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act(29 CFR Part 3),the full amounts due at time of payment computed at wage rates not less than those contained in the wage determination decision(s)of the Secretary of Labor which is (are)attached hereto and made a part hereof,regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics;and the wage determination decision(s)shall be posted by the contractor at the site of the work in a prominent place where it (they) can be easily seen by the workers. For the purpose of this paragraph, contributions made or costs reasonably anticipated under Section 1(b) (2) of the Davis-Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics,subject to the provisions of Subparagraph 4 below. Also for the purpose of this paragraph,regular contributions made or costs incurred for more than a weekly period under plans,funds,or programs,but covering the particular weekly period, are deemed to be constructively made or incurred during such weekly period[29 CFR 5.5(a)(1)(i)]. 2. Any class of laborers or mechanics,including apprentices and trainees,which is not listed in the wage determination(s)and which is to be employed under the contract,shall be classified or reclassified conformably to the wage determination(s),and a report of the action taken shall be sent by the SPONSOR to the FAA for approval and transmittal to the Secretary of Labor. In the event that the interested parties cannot agree on the proper classification or reclassification of a particular class of laborers and mechanics,including apprentices and trainees,to be used,the question accompanied by the recommendation of the FAA shall be referred to the Secretary of Labor for final determination[29 CFR 5.5(a)(1)(ii)]. 3. -Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly wage rate and the contractor is obligated to pay a cash equivalent of such a fringe benefit,an hourly cash equivalent thereof shall be established. In the event the interested parties cannot agree upon a cash equivalent of the fringe benefit,the question accompanied by the recommendation of the FAA shall be referred to the Secretary of Labor for determination[29 CFR 5.5(a)(1)(iii)]. 4. If the Contractor does not make payments to a trustee or other third person,he may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing benefits under a plan or program of a type expressly listed in the wage determination decision of the Secretary of Labor which is a part of this contract. Provided,however, the Secretary of Labor has found,upon the written request of the Contractor,that the applicable standards of the Davis-Bacon Act have been met. The Secretary of Labor may require the Contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. SPECIAL GRANT CONDITIONS Office of Management and Budget issued Memorandum M-08-03 implementing Section 106(g)of the Trafficking Victims Protection Act of 2000,as amended(TVPA)(22 U.S.0 7104(g)) TRAFFICKING IN PERSONS: H-6 G\GroupWviahon\GRANTSIFAAAIP\211bod8 Rehabilitate Electncal Buildmg(Design)\Grant Apphcation\Destgn Agreement\DRAFT 0138 Electnc Vault Design-LS doc 11/I 1 a.Provisions applicable to a recipient that is a private entity. 1.You as the recipient,your employees,subrecipients under this award,and subrecipients' employees may not— i.Engage in severe forms of trafficking in persons during the period of time that the award is in effect; ii.Procure a commercial sex act during the period of time that the award is in effect;or iii.Use forced labor in the performance of the award or subawards under the award. BAN ON TEXTING WHEN 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 when driving in all subgrants,contracts and subcontracts. END OF SCHEDULE H-7 G\Group\Avianon\GRANTS\FAAAIP\21 1\�18 Rehabihtate Electncal Buddmg(Design)\Grant Apphcanon\Design AgreententORAFT OB8 Electnc Vault Design-LS doc 11/11 SCHEDULE I NEW YORK STATE DEPARTMENT OF TRANSPORTATION REQUIREMENTS A. Standard Clauses For All New York State Contracts(Appendix A). The parties to the attached contract,license,lease,amendment or other agreement of any kind(hereinafter,"the contract"or "this contract") agree to be bound by the following clauses which are hereby made a part of the contract(the word "Contractor"herein refers to any party other than the State,whether a contractor,licensor,licensee,lessor,lessee,or any other party): 1. Executory Clause. In accordance with Section 41 of the State Finance Law,the State shall have no liability under this contract to the Contractor or to anyone else beyond funds appropriated and available for this contract. 2. Non-Assignment Clause. In accordance with Section 138 of the State Finance Law,this contract may not be assigned by the Contractor or its right, title or interest therein assigned, transferred, conveyed, sublet, or otherwise disposed of without the previous consent, in writing, of the State and any attempts to assign the contract without the State's written consent are null and void. The Contractor may,however,assign its right to receive payment without the State's prior written consent unless this contract concerns Certificates of Participation pursuant to Article 5-A of the State Finance Law. 3. Comptroller's Approval. In accordance with Section 112 of the State Finance Law(or,ifthis contract is with the State University or City University of New York,Section 355 or Section 6218 of the Education Law),if this contract exceeds$5,000($20,000 for certain S.U.N.Y.and C.U.N.Y.contracts),or if this is an amendment for any amount to a contract which,as so amended,exceeds said statutory amount,or if,by this contract,the State agrees to give something other than money,it shall not be valid,effective,or binding upon the State until it has been approved by the State Comptroller and filed in his office. 4. Worker's Compensation Benefits. In accordance with Section 142 of the State Finance Law,this contract shall be void and of no force and effect unless the Contractor shall provide and maintain coverage during the life of this contract for the benefit of such employees as are required to be covered by the provisions of the Workers' Compensation Law. 5. Non-Discrimination Requirements. In accordance with Article 15 of the Executive Law(also known as the Human Rights Law)and all other State and Federal statutory and constitutional non-discrimination provisions, the Contractor will not discriminate against any employee or applicant for employment because of race,creed, color,sex,national origin,age,disability,or marital status. Furthermore,in accordance with Section 220-e of the Labor Law,if this is a contract for the construction,alteration,or repair of any public building or public work or for the manufacture,sale,or distribution of materials,equipment,or supplies,and to the extent that this contract shall be performed within the State of New York,Contractor agrees that neither it nor its subcontractors shall,by reason of race,creed,color,disability,sex,or national origin: (a)discriminate in hiring against any New York State citizen who is qualified and available to perform the work;or(b)discriminate against or intimidate any employee hired for the performance of work under this contract. If this is a building service contract as defined in Section 230 of the Labor Law,then,in accordance with Section 239 thereof,Contractor agrees that neither it nor its subcontractors shall,by reason of race,creed,color,national origin,age,sex,or disability: (a)discriminate in hiring against any New York State citizen who is qualified and available to perform the work: or(b)discriminate against or intimidate any employee hired for the performance ofwork under this contract. Contractor is subject to fines of$50.00 per person per day for any violation of Section 220-e or Section 239 as well as possible termination of this contract and forfeiture of all moneys due hereunder for a second or subsequent violation. 6. Wage and Hours Provisions. If this is a public work contract covered by Article 8 of the Labor Law or a building service contract covered by Article 9 thereof, neither Contractor's employees nor the employees of its subcontractors may be required or permitted to work more than the number of hours or days stated in said statues, except as otherwise provided in the Labor Law and as set forth in prevailing wage and supplement schedules issued by the State Labor Department. Furthermore, Contractor and its subcontractors must pay at least the prevailing wage rate and pay or provide the prevailing supplements,including the premium rates for overtime pay,as determined by the State Labor Department in accordance with the Labor Law. 7. Non-Collusive Bidding Requirement. In accordance with Section 139-d of the State Finance Law,ifthis contract was awarded based upon the submission of bids,Contractor warrants,under penalty of perjury,that its bid was arrived at independently and without collusion aimed at restricting competition. Contractor further warrants that, at the time contractor submitted its bid,an authorized and responsible person executed and delivered to the State a non-collusive bidding certification on Contractor's behalf. I-1 G\GROUP\AVIATION\GRANTS\FAAAIP\211\XX18 REHABILITATE ELECTRICAL BUILDING(DESIGN)\GRANT APPLICATION\DESIGN AGREEMENT\DRAFT 0138 ELECTRIC VAULT DESIGN-LS DOC 09/04 8. International Boycott Prohibition. In accordance with Section 220-f of the Labor Law and Section 139-h of the State Finance Law,if this contract exceeds$5,000,the Contractor agrees,as a material condition of the contract, that neither the Contractor nor any substantially owned or affiliated person,firm,partnership,or corporation has participated,is participating,or shall participate in an international boycott in violation of the federal Export Administration Act of 1979(50 USC App.Sections 240,1 et seq.)or regulations thereunder. If such Contractor, or any of the aforesaid affiliates of Contractor,is convicted or is otherwise found to have violated said laws or regulations upon the final determination of the United States Commerce Department or any other appropriate agency of the United States subsequent to the contract's execution,such contract,amendment,or modification thereto shall be rendered forfeit and void. The contractor shall so notify the State Comptroller within five(5) business days of such conviction,determination,or disposition of appeal(2 NYCRR 105.4). 9. Set-Off Rights. The State shall have all of its common law and statutory rights of set-off. These rights shall include,but not be limited to,the State's option to withhold for the purposes of set-off any moneys due to the Contractor under this contract up to any amounts due and owing to the State with regard to this contract,any other contract with any State department or agency,including any contract for a term commencing prior to the term of this contract, plus any amounts due and owing to the State for any other reason including, without limitation,tax delinquencies,fee delinquencies,or monetary penalties relative thereto. The State shall exercise its set-off rights in accordance with normal State practices including,in cases of set-off pursuant to an audit,the finalization of such audit by the State agency,its representatives,or the State Comptroller. 10. Records. The Contractor shall establish and maintain complete and accurate books,records,documents,accounts and other evidence directly pertinent to performance under this contract(hereinafter,collectively"the Records"). The Records must be kept for the balance of the calendar year in which they were made and for six(6)additional years thereafter. The State Comptroller, the Attorney General, and any other person or entity authorized to conduct an examination, as well as the agency or agencies involved in this contract,shall have access to the Records during normal business hours at an office of the Contractor within the State of New York or,if no such office is available,at a mutually agreeable and reasonable venue within the State,for the term specified above for the purposes of inspection,auditing and copying. The State shall take reasonable steps to protect from public disclosure any of the Records which are exempt from disclosure under Section 87 ofthe Public Officers Law(the "Statute")provided that:(i)the Contractor shall timely inform an appropriate State official,in writing,that said records should not be disclosed;and(ii)said records shall be sufficiently identified;and(iii)designation of said records as exempt under the Statute is reasonable. Nothing contained herein shall diminish, or in any way adversely affect,the State's right to discovery in any pending or future litigation. 11. Identifying Information and Privacy Notification: (a) Federal Employer Identification Number and/or Federal Social Security Number. All invoices or New York State standard vouchers submitted for payment for the sale of goods or services or the lease of real or personal property to a New York State agency must include the payee's identification number, (i.e.,the seller's or lessor's identification number). The number is either the payee's Federal employee identification number or Federal social security number,or both such numbers when the payee has both such numbers. Failure to include this number or numbers may delay payment. Where the payee does not have such number or numbers,the payee,on his invoice or New York State standard voucher, must give the reason or reasons why the payee does not have such number or numbers. (b) Privacy Notification. (1)The authority to request the above personal information from a seller of goods or services or a lessor of real or personal property,and the authority to maintain such information,is found in Section 5 of the State Tax Law. Disclosure of this information by the seller or lessor to the State is mandatory. The principal purpose for which the information is collected is to enable the State to identify individuals, businesses, and others who have been delinquent in filing tax returns or may have understated their tax liabilities and to generally identify persons affected by the taxes administered by the Commissioner of Taxation and Finance. The information will be used for tax administration purposes and for any other purpose authorized by law. (2)The personal information is requested by the purchasing unit of the agency contracting to purchase the goods or services or lease the real or personal property covered by this contract or lease. The information is maintained in New York State's Central Accounting System by the Director of State Accounts,Office of the State Comptroller,AESOB,Albany,New York 12236. 12. Equal Employment Opportunities For Minorities And Women. In accordance with Section 312 of the Executive Law,if this contract is:(i) a written agreement or purchase order instrument,providing for a total expenditure in excess of$25,000.00,whereby a contracting agency is committed to expend or does expend funds In return for labor, services, supplies, equipment, materials or any combination of the foregoing,to be performed for, or I-2 G\GROUP\AVIATION\GRANTS\FAAAIP\211=18 REHABILITATE ELECTRICAL BUILDING(DESIGN)\GRANT APPLICATION\DESIGN AGREEMENT\DRAFr 0138 ELECTRIC VAULT DESIGN-LS DOC 09/04 rendered or furnished to,the contracting agency;or(ii)a written agreement in excess of$100,000.00 whereby a contracting agency is committed to expend or does expend funds for the acquisition,construction,demolition, replacement,major repair or renovation of real property and improvements thereon;or(iii)a written agreement in excess of$100,000.00 whereby the owner of a State assisted housing project is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair, or renovation of real property and improvements thereon for such project,then: (a)The contractor will not discriminate against employees or applicants for employment because of race,creed,color,national origin,sex,age,disability,or marital status,and will undertake or continue existing programs of affirmative action to ensure that minority group members and women are afforded equal employment opportunities without discrimination. Affirmative action shall mean recruitment, employment,job assignment,promotion,upgradings,demotion,transfer,layoff,or termination and rates of pay or other forms of compensation; (b)at the request of the contracting agency,the Contractor shall request each employment agency, labor union,or authorized representative of workers with which it has a collective bargaining or other agreement or understanding,to furnish a written statement that such employment agency,labor union or representative will not discriminate on the basis of race, creed, color, national origin, sex, age, disability,or marital status,and that such union or representative will affirmatively cooperate in the implementation of the contractor's obligations herein;and (c) the contractor shall state, in all solicitations or advertisements for employees, that, in the performance of the State contract, all qualified applicants will be afforded equal employment opportunities without discrimination because of race,creed,color,national origin,sex,age,disability, or marital status. Contractor will include the provisions of"a", "b", and "c", above, in every subcontract over $25,000.00 for the construction,demolition,replacement,major repair,renovation,planning or design of real property and improvements thereon(the"Work")except where the Work is for the beneficial use of the contractor. Section 312 does not apply to: (i)work,goods or services unrelated to this contract;or(ii)employment outside New York State;or(iii)banking services,insurance policies or the sale of securities. The State shall consider compliance by a contractor or subcontractor with the requirements of any federal law concerning equal employment opportunity which effectuates the purpose of this section. The contracting agency shall determine whether the imposition of the requirements of the provisions hereof duplicate or conflict with any such federal law and if such duplication or conflict exists,the contracting agency shall waive the applicability of Section 312 to the extent of such duplication or conflict. Contractor will comply with all duly promulgated and lawful rules and regulations of the Governor's Office of Minority and Women's Business Development pertaining hereto. 13. Conflicting Terms. In the event of a conflict between the terms of the contract(including any and all attachments thereto and amendments thereof)and the terms of this Appendix A,the terms of this Appendix A shall control. 14. Governing Law. This contract shall be governed by the laws of the State of New York except where the federal supremacy clause requires otherwise. 15. Late Payment. Timeliness of payment and any interest to be paid to Contractor for late payment shall be governed by Article XI-A of the State Finance Law to the extent required by law. 16. No Arbitration. Disputes involving this contract,including the breach or alleged breach thereof,may not be submitted to binding arbitration(except where statutorily authorized)but must,instead,be heard in a court of competent jurisdiction of the State of New York. 17. Service of Process. In addition to the methods of service allowed by the State Civil Practice Law&Rules ("CPLR"),contractor hereby consents to service of process upon it be registered or certified mail,return receipt request. Service hereunder shall be complete upon contractor's actual receipt of process or upon the State's receipt of the return thereof by the United States Postal Service as refused or undeliverable. Contractor must promptly notify the State,in writing,of each and every change of address to which service of process can be made. Service by the State to the last known address shall be sufficient. Contractor will have thirty(30)calendar days after service hereunder is complete in which to respond. 18. Prohibition on Purchase of Tropical Hardwoods.The Contractor certifies and warrants that all wood products to be used under this contract award will be in accordance with,but not limited to,the specifications and provisions of Section 165 of the State Finance Law, (Use of Tropical Hardwoods)which prohibits purchase and use of I-3 G•\GROUP\AVIATION\GRANTS\FAAAIP\211UIX18 REHABILITATE ELECTRICAL BUILDING(DESIGN)\GRANT APPLICATIOMDESIGN AGREEMENMRAFT 0138 ELECTRIC VAULT DESIGN-LS DOC 09/04 tropical hardwoods, unless specifically exempted, by the State or any governmental agency or political subdivision or public benefit corporation.Qualification for an exemption under this law will be the responsibility of the contractor to establish to meet with the approval of the State. In addition,when any portion of this contract involving the use of woods,whether supply or installation,is to be performed by any subcontractor,the prime Contractor will indicate and certify in the submitted bid proposal that the subcontractor has been informed and is in compliance with specifications and provisions regarding use of tropical hardwoods as detailed in§165 State Finance Law.Any such use must meet with the approval of the State;otherwise,the bid may not be considered responsive.Under bidder certifications,proof of qualification for exemption will be the responsibility of the Contractor to meet with the approval of the State. 19. Macbride Fair Employment Principles.In accordance with the MacBride Fair Employment Principles(Chapter 807 of the Laws of 1992), the Contractor hereby stipulates that the Contractor either (a) has no business operations in Northern Ireland,or(b)shall take lawful steps in good faith to conduct any business operations in Northern Ireland in accordance with the MacBride Fair Employment Principles(as described in Section 165 of the New York State Finance Law),and shall permit independent monitoring of compliance with such principles. 20. Omnibus Procurement Act of 1992. It is the policy of New York State to maximize opportunities for the participation ofNew York State business enterprises,including minority and women-owned business enterprises as bidders,subcontractors and suppliers on its procurement contracts. Information on the availability of New York State subcontractors and suppliers is available from: NYS Department of Economic Development Division for Small Business 30 South Pearl St--7t'Floor Albany,New York 12245 Telephone:518-292-5220 Fax:518-292-5884 http://www.empire.state.ny.us A directory of certified minority and women-owned business enterprises is available from: NYS Department of Economic Development Division of Minority and Women's Business Development 30 South Pearl St--2nd Floor Albany,New York 12245 Telephone:518-292-5250 Fax:518-292-5803 http://www.empire.state.ny.us The Omnibus Procurement Act of 1992 requires that by signing this bid proposal or contract,as applicable, Contractors certify that whenever the total bid amount is greater than$1 million:a)The Contractor has made reasonable efforts to encourage the participation of New York State Business Enterprises as suppliers and subcontractors, including certified minority and women-owned business enterprises, on this project, and has retained the documentation of these efforts to be provided upon request to the State; (b)The Contractor has complied with the Federal Equal Opportunity Act of 1972(P.L.92-261),as amended;(c)The Contractor agrees to make reasonable efforts to provide notification to New York State residents of employment opportunities on this project through listing any such positions with the Job Service Division ofthe New York State Department of Labor,or providing such notification in such manner as is consistent with existing collective bargaining contracts or agreements.The Contractor agrees to document these efforts and to provide said documentation to the State upon request;and(d)The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with the State in these efforts. 21. Reciprocity And Sanctions Provisions. Bidders are hereby notified that if their principal place of business is located in a country,nation,province,state or political subdivision that penalizes New York State vendors,and if the goods or services they offer will be substantially produced or performed outside New York State, the Omnibus Procurement Act 1994 and 2000 amendments(Chapter 684 and Chapter 383,respectively)require that they be denied contracts which they would otherwise obtain. NOTE: As of May 15, 2002, the list of discriminatory jurisdictions subject to this provision includes the states of South Carolina,Alaska,West Virginia, Wyoming, Louisiana and Hawaii. Contact NYS Department of Economic Development for a current list of jurisdictions subject to this provision. 22. Compliance with New York State Information Security Breach and Notification Act.Contractor shall comply with the provisions of the New York State Information Security Breach and Notification Act(General Business Law Section 899-aa;State Technology Law Section 208). 23. Compliance with Consultant Disclosure Law.If this is a contract for consulting services,defined for purposes of this requirement to include analysis, evaluation,research,training, data processing, computer programming, engineering,environmental,health,and mental health services,accounting,auditing,paralegal,legal or similar services,then,in accordance with Section 163(4-g)of the State Finance Law(as amended by Chapter 10 of the Laws of 2006),the Contractor shall timely,accurately and properly comply with the requirement to submit an annual employment report for the contract to the agency that awarded the contract, the Department of Civil Service and the State Comptroller. I-4 G\GROUP\AVIATION\GRANTS\FAAAIP\21 I\XXI 8 REHABILITATE ELECTRICAL BUILDING(DESIGN)\GRANT APPLICATION\DESIGN AGREEMENTIDRAFr 0138 ELECTRIC VAULT DESIGN-LS DOC 09/04 24. Procurement Lobbying.To the extent this agreement is a"procurement contract"as defined by State Finance Law Sections 139-j and 139-k,by signing this agreement the contractor certifies and affirms that all disclosures made in accordance with State Finance Law Sections 139 j and 139-k are complete,true and accurate.In the event such certification is found to be intentionally false or intentionally incomplete,the State may terminate the agreement by providing written notification to the Contractor in accordance with the terms of the agreement. 25. Certification of Registration To Collect Sales And Compensating Use Tax By Certain State Contractors, Affiliates And Subcontractors. To the extent this agreement is a contract as defined by Tax Law Section 5-a,if the contractor fails to make the certification required by Tax Law Section 5-a or if during the term ofthe contract, the Department of Taxation and Finance or the covered agency,as defined by Tax Law 5-a,discovers that the certification, made under penalty of perjury, is false,then such failure to file or false certification shall be a material breach of this contract and this contract may be terminated, by providing written notification to the Contractor in accordance with the terms of the agreement,if the covered agency determines that such action is in the best interest of the State. END OF SCHEDULE I-5 G\GROUP\AVIATION\GRANTS\FAAAIP\211=18 REHABILITATE ELECTRICAL BUILDING(DESIGN)\GRANT APPLICATION\DESIGN AGREEMENT\DRAFT OB8 ELECTRIC VAULT DESIGN-LS DOC 09/04 „�.. � �. r+.V...�.s...s n•..�r/',�. ..�N��,I�W�..r�May-'�411�..NMri� .a.. .-.. y- . •��� � 1 [ .!t. tW �.�y.s 'v dY.Ml y .. 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O LONG ISLAND EisN r oisiutr OFFM �\Esrwwrn AVE $ ATLANTM:OCEAN LOCATION MAP l / _ —11 ITATION F—R,s0 I 11N z a I3. M I G+uoaEps INOTES L=---------------i - E— GES MER— O,M a g s 8 / IE___ _ RGD. RW 36 ENC W,16t] Wr30tu \\�" _U. —EF—ECOOF0WEereE s w ] z I nEs ITmE iR EEE swrL�l 0 0 + xaacwAweaua u w z � z " 3 ANOGPr�rEAe„ rGE nE�.e GW �.rE 2o w 11— w LL CMEMeEe eEOTG �RET�sPR�ER - - >m a >oo IOOfT PM a - �IW� - EEGENO a = a Z RS-yA.lRSAI�a,RGFAI a ��- � AGEA, o - =------ Ate. Y d'Wa a �,aRE 5 a O LAND ACOUIff10N TABLE ® o a P�Rcsl Fowl Ux]Eo srA Es ka a T,w LrM SHEETHFF(]EN�{FHCE HO a or e Y • Sponsor 3 -36 -0029 -022 - 2018 �1 U.S.Department of Transportation Federal Aviation Administration GRANTAGREEMENT PART I—OFFER Date of Offer August 3, 2018 Airport/Planning Area Elizabeth Field AIP Grant Number 3-36-0029-022-2018 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 July 3, 2018,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: Rehabilitate Electrical Vault(Replacing regulators, Elevating Airfield Lighting Equipment, Install Lighting and Mechanical HVAC system to prevent corrosion due to salt, repair previous flood damage, repair exterior fascia, replace main entry door.)-Design which is more fully described in the Project Application. 1 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. 1 r 3 -36 -0029 -022- 2018 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$26,505. The following amounts represent a breakdown of the maximum obligation for the purpose of establishing allowable amounts for any future grant amendment,which may increase the foregoing maximum obligation of the United States under the provisions of 49 U.S.C. §47108(b): $0 for planning $26,505 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. S. 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 Proiect 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. Per 2 CFR§200.308,the Sponsor agrees to report to the FAA any disengagement from performing the project that exceeds three months.The report must include a reason for the project stoppage.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 September 3, 2018,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 2 3 - 36 -0029 -022- 2018 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. 10. United States Not Liable for Damage or Iniury.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 elnvoicing System for Department of Transportation (DOT) Financial Assistance Awardees. 13. Informal Letter Amendment of AIP Projects. 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. 3 3 - 36 -0029 -022- 2018 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.In 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; 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. Audits for Public Sponsors.The Sponsor must provide for a Single Audit or program specific audit in accordance with 2 CFR part 200.The Sponsor must submit the audit reporting package to the Federal Audit Clearinghouse on the Federal Audit Clearinghouse's Internet Data Entry System at http://harvester.census.gov/facweb/. Provide one copy of the completed audit to the FAA if requested. 19. 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. 20. Ban on Texting 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. 4 3 -36 -0029 -022- 2018 J B. The Sponsor must insert the substance of this clause on banning texting while driving in all subgrants, contracts and subcontracts. 21. 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. 22. 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. 23. Employee Protection from Reprisal. A. Prohibition of Reprisals— 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: I. 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). 5 3 -36 -0029 -022- 2018 SPECIAL CONDITIONS 1. Lighting.The Sponsor must operate and maintain the lighting system during the useful life of the system in accordance with applicable FAA standards. 2. Airports GIS Survey. If the Airports GIS survey is not reflected on an updated ALP that meets FAA requirements within four(4)years from the date of the Phase 1 grant(regardless of whether it is generated using the AGIS/eALP system or through some other computer-aided design platform),then the sponsor may be required to repay that portion of the grant that relates to the survey work. 3. 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. 4. Protection of Runway Protection Zone-Easement.The Sponsor agrees to take any and all steps necessary to ensure that the owner of the land within the designated Runway Protection Zone will not build any structure in the Runway Protection Zone that is an airport hazard or which might create glare or misleading lights or lead to the construction of residences,fuel handling and storage facilities,smoke generating activities,or places of public assembly,such as churches,schools,office buildings,shopping centers,and stadiums. 5. Plans and Specifications Prior to Bidding.The Sponsor agrees that it will submit plans and specifications for FAA review prior to advertising for bids. 6. Plans and Specifications Approval Based Upon Certification.The FAA and the Sponsor agree that the FAA approval of the Sponsor's Plans and Specification is based primarily upon the Sponsor's certification to carry out the project in accordance with policies,standards,and specifications approved by the FAA.The Sponsor understands that: A. The Sponsor's certification does not relieve the Sponsor of the requirement to obtain prior FAA approval for modifications to any AIP standards or to''notify the FAA of any limitations to competition within the project; B. The FAA's acceptance of a Sponsor's certification does not limit the FAA from reviewing appropriate project documentation for the purpose of validating the certification statements;and, C. If the FAA determines that the Sponsor has not complied with their certification statements,the FAA will review the associated project costs to determine whether such costs are allowable under AIP. 7. 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. 8. Design Grant.This grant agreement is being issued in order to complete the design of the project.The Sponsor understands and agrees that within 2 years after the design is completed that the Sponsor will accept,subject to the availability of the amount of federal funding identified in the Airport Capital Improvement Plan (ACIP),a grant to complete the construction of the project in order to provide a useful and useable unit of work.The Sponsor also understands that if the FAA has provided federal funding to complete the design for the project,and the Sponsor has not completed the design within four(4)years from the execution of this grant agreement,the FAA may suspend or terminate grants related to the design. 6 3 - 36 -0029 -022- 2018 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 conditi9ins as provided herein. Such Grant Agreement shall become effective upon the Sponsor's acceptance of this Offer. UNITED STATES OF AMERICA FEDERAL AVIATION ADMINISTRATION JL (Signature) 'I�Dr Evelyn Martinez (Typed Name) Manager, New York Airports District Office (Title of FAA Official) 7 3 -36 -0029 -022 - 2018 PART 11-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 foregoing is true and correct.' Executed thisday of Town of Southold /J(Name of Sponsor) (Signature of Sponsor's Authorized Official) By: S( lTy (Printed Name of Sponsors Authorized Official) Title: _ _�_ �_ f_-J —_ (Title of Sponsor's Authorized Official CERTIFICATE OF SPONSOR'S ATTORNEY Q(11 I�t I)iJ 1 C W 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 an Sponsor'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 (location)this_ I ` day of u v ) By: V-L, 1/1� (Signature of Spo rs yJ '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 3 -36 -0029 -022- 2018 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 -022- 2018 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 sea. d. Hatch Act—5 U.S.C. 1501,et seg.z 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 sea. 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.' I. Title 49, U.S.C.,Section 303, (formerly known as Section 4(f)) m. Rehabilitation Act of 1973-29 U.S.C.794. n. Title 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 seg. q. American Indian Religious Freedom Act, P.L. 95-341,as amended. r. Architectural Barriers Act of 1968-42 U.S.C.4151,et seg.' 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 seg.' u. Copeland Anti-kickback Act- 18 U.S.C. 874.1 v. National Environmental Policy Act of 1969-42 U.S.C.4321,et seg.' 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.Z 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 -022- 2018 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].4,1,1 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.1z 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 3 -36 -0029 -022- 2018 s. 49 CFR Part 28—Enforcement of Nondiscrimination on the Basis of Handicap in Programs or Activities conducted by the Department of Transportation. t. 49 CFR Part 30-Denial of public works contracts to suppliers of goods and services of countries that deny procurement market access to U.S. contractors. u. 49 CFR Part 32—Governmentwide Requirements for Drug-Free Workplace (Financial Assistance) v. 49 CFR Part 37—Transportation Services for Individuals with Disabilities(ADA). w. 49 CFR Part 41-Seismic safety of Federal and federally assisted or regulated new building construction. SPECIFIC ASSURANCES Specific assurances required to be included in grant agreements by any of the above laws, regulations or circulars are incorporated by reference in this grant agreement. FOOTNOTES TO ASSURANCE C.1. 1 These laws do not apply to airport planning sponsors. 2 These laws do not apply to private sponsors. 3 49 CFR Part 18 and 2 CFR Part 200 contain requirements for State and Local Governments receiving Federal assistance.Any requirement levied upon State and Local Governments by this regulation and circular shall also be applicable to private sponsors receiving Federal assistance under Title 49, United States Code. 4 On December 26, 2013 at 78 FR 78590,the Office of Management and Budget(OMB) issued the Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards in 2 CFR Part 200. 2 CFR Part 200 replaces and combines the former Uniform Administrative Requirements for Grants(OMB Circular A-102 and Circular A-110 or 2 CFR Part 215 or Circular)as well as the Cost Principles(Circulars A-21 or 2 CFR part 220;Circular A-87 or 2 CFR part 225;and A-122,2 CFR part 230).Additionally it replaces Circular A-133 guidance on the Single Annual Audit. In accordance with 2 CFR section 200.110,the standards set forth in Part 200 which affect administration of Federal awards issued by Federal agencies become effective once implemented by Federal agencies or when any future amendment to this Part becomes final. Federal agencies, including the Department of Transportation, must implement the policies and procedures applicable to Federal awards by promulgating a regulation to be effective by December 26,2014 unless different provisions are required by statute or approved by OMB. s Cost principles established in 2 CFR part 200 subpart E must be used as guidelines for determining the eligibility of specific types of expenses. e 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 -022- 2018 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 -022- 2018 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 -022-2018 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 this grant is given or used, and the amount or nature of that portion of the cost of the project supplied by other sources,and such other financial records pertinent to the project. The accounts and records shall be kept in accordance with an accounting system that will facilitate an effective audit in accordance with the Single Audit Act of 1984. b. It shall make available to the Secretary and the Comptroller General of the United States,or any of their duly authorized representatives,for the purpose of audit and examination, any books, documents, papers,and records of the recipient that are pertinent to this grant.The Secretary may require that an appropriate audit be conducted by a recipient. In any case in which an independent audit is made of the accounts of a sponsor relating to the disposition of the proceeds of a grant or relating to the project in connection with which this grant was given or used,it shall file a certified copy of such audit with the Comptroller General of the United States not later than six(6)months following the close of the fiscal year for which the audit was made. 14. Minimum Wage Rates. It shall include, in all contracts in excess of$2,000 for work on any projects funded under this grant agreement which involve labor, provisions establishing minimum rates of wages,to be predetermined by the Secretary of Labor, in accordance with the Davis-Bacon Act, as amended (40 U.S.C. 276a-276a-5),which contractors shall pay to skilled and unskilled labor, and such minimum rates shall be stated in the invitation for bids and shall be included in proposals or bids for the work. 15. Veteran's Preference. It shall include in all contracts for work on any project funded under this grant agreement which involve labor,such provisions as are necessary to insure that, in the employment of labor(except in executive,administrative, and supervisory positions), preference shall be given to Vietnam era veterans, Persian Gulf veterans,Afghanistan-Iraq war veterans,disabled veterans, and small business concerns owned and controlled by disabled veterans as defined in Section 47112 of Title 1s March,2014 3 -36 -0029 -022- 2018 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 -022 - 2018 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 -022- 2018 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 3 - 36 -0029 -022 - 2018 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 -022- 2018 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 -022 - 2018 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 -022- 2018 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 requiringFcompliance 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 -022 - 2018 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 -022- 2018 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 -022 - 2018 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. 25 March,2014 3 - 36 -0029 -022 - 2018 o��PL AV�9Ti FAA 2 Airports 0 Is RP�� Current FAA Advisory Circulars Required for Use in AIP Funded and PFC Approved Projects Updated:2/20/2018 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 ' 70/7460-1L Change 1 Obstruction Marking and Lighting 150/5020-1 Noise Control and Compatibility Planning for Airports 150/5070-6B Airport Master Plans Changes 1-2 150/5070-7 The Airport System Planning Process Change 1 150/5100-13B Development of State Standards for Nonprimary Airports 150/5200-28F Notices to Airmen (NOTAMS)for Airport Operators 150/5200-30D Change 1 Airport Field Condition Assessments and Winter Operations Safety 150/5200-31C Changes 1-2 Airport Emergency Plan 150/5210-51) Painting, Marking, and Lighting of Vehicles Used on an Airport 150/5210-7D Aircraft Rescue and Fire Fighting Communications 150/5210-13C Airport Water Rescue Plans and Equipment 150/5210-148 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:2/20/2018 3 - 36 -0029 - 022 - 2018 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 150/5220-16E Automated Weather Observing Systems (AWOS)for Non-Federal Applications 150/5220-17B Aircraft Rescue and Fire Fighting(ARFF)Training Facilities 150/5220-18A Buildings for Storage and Maintenance of Airport Snow and Ice Control Equipment and Materials 150/5220-20A Airport Snow and Ice Control Equipment 150/5220-21C 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 150/5300-713 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 Change 1 150/5300-18B General Guidance and Specifications for Submission of Aeronautical Surveys to Change 1 NGS: Field Data Collection and Geographic Information System (GIS)Standards 150/5320-5D 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-2/20/2018 3 -36 -0029 -022 - 2018 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 150/5340-11- Standards for Airport Markings 150/5340-5D Segmented Circle Airport Marker System 150/5340-18F Standards for Airport Sign Systems 150/5340-26C Maintenance of Airport Visual Aid Facilities 150/5340-30J Design and Installation Details for Airport Visual Aids 150/5345-3G Specification for L-821, Panels for the Control of Airport Lighting 150/5345-56 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(PAP[)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:2/20/2018 3 -36 -0029 -022 - 2018 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 150/5345-49D Specification L-854, Radio Control Equipment 150/5345-50B Specification for Portable Runway and Taxiway Lights 150/5345-51B Specification for Discharge-Type Flashing Light Equipment 150/5345-52A Generic Visual Glideslope Indicators (GVGI) 150/5345-53D Airport Lighting Equipment Certification Program 150/5345-54B Specification for L-884, Power and Control Unit for Land and Hold Short Lighting Systems 150/5345-55A Specification for L-893, Lighted Visual Aid to Indicate Temporary Runway Closure 150/5345-56B Specification for L-890 Airport Lighting Control and Monitoring System (ALCMS) 150/5360-12F Airport Signing and Graphics 150/5360-13 Change 1 Planning and Design Guidelines for Airport Terminal Facilities 150/5360-14A Access to Airports By Individuals With Disabilities 150/5370-2G 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.2/20/2018 3 - 36 -0029 -022 - 2018 THE FOLLOWING ADDITIONAL APPLY TO AIP PROJECTS ONLY Updated:2/20/2018 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 1-7 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 30 FAA Advisory Circular Required for Use AIP Funded and PFC Approved Projects Updated.2/20/2018 ELIZABETH FIELD AIRPORT (0B8) FISHERS ISLAND IFY 0 • r+ Town of Southold RehabilitateFishers Island Ferry District Electrical Building Of SO #.IISCA o �► PREPARED COMPANIES® ��tiL AVj,�T 4WD V '.t FAA = New York Airports District Office c �o ��NIS ?. Airport Grant Pre-Application Checklist (COMPLETE ONE CHECKLIST PER GRA" Airport Name: Fishers Island Elizabeth Field Airport Date Prepared: 01/30/2018 SAM CAGE code#: 39TN9 SAM Expiration Date: 09/12/2018 Project Description: Rehabilitate Electrical Building(Design) ❑ We do not plan on having a project this fiscal year. The FAA is authorized to carry our entitlements into the next fiscal year. (If checked,sign below,and return to ADO.) Items Required with Preapplication D. • fi,-d 1. Project Schedule(NOTE FAA DUE DATES) 0 ❑ ❑ ❑ 2. Standard Form 424, Form 5100-100(parts 11--IV for airport development grants), Form 5100-101 (parts 11-IV for planning grants) (Includes project cost M ❑ ❑ ❑ breakdown and sketch) 3. Project Narrative and Justification(for Planning or Environmental Projects ❑ ❑ ❑ include Scope of Work) 4. Environmental Documentation(Is the complete environmental documentation matching the potential application project description included?) (Attached or Q ❑ ❑ 0 previously submitted to ADO) 5. Construction Safety Phasing Plan/Airspace ❑ ❑ Q ❑ 6. Exhibit A(SOP available) (attached or previously submitted to ADO) 0 ❑ ❑ ❑ 7. Title Certificate or Long Term Lease Agreement(at the request of ADO) ❑ ❑ ❑X ❑ Note: If you cannot complete any of the above documents with this submittal, explain in the space provided on page 2 and provide the expected submittal date, but no later than the date specified in the Federal Register. Scott A. Russell Sponsor's Design I d Official Representative (Official with authority to sign Grant Agreement) (Type or Print) Date: i Sponsor's D ignated Official Representative (Signature) The purpose of this checklist is to identify some of the requirements and considerations associated with requesting Airport Improvement Program(AIP)funds. Airport Sponsors should read and consider each of the items carefully. Some of the items can be answered by simply checking the"Yes" and "No" boxes while others require providing additional Information as part of the airport's request for AIP funds. Signatures are required,including in required attached forms. Updated October 2016 Electronic submittal using Portable Document Format(PDF)is preferred. Page 1 of 2 Common Key Requirements or Considerations Clear Approaches Per 49 USC § 47107(a)(9). The sponsor must take appropriate action to ensure that terminal airspace required to protect instrument and visual operations to the airport (including operations at established minimum flight altitudes)will be cleared and protected by mitigating existing, and preventing future, airport hazards. (see 5010-Airport Master Record) Bid Protest Procedures. The sponsor requirements for bid protests and appeals is contained in 49 CFR § 18.36(b)(12) Reimbursable Agreement. The cost for reimbursable agreements between the sponsor and a federal agency is allowable if the cost is necessary for the project and the other federal agencies statutes allow this action. For instance, 49 USC § 106(1)(16) allows the FAA to enter into reimbursable agreements in order to carry out the functions of the FAA. An example of this is a reimbursable agreement between a sponsor and the FAA Air Traffic Organization (ATO)for the purpose of having the ATO relocate an FAA-owned navigational aid that is required by an AIP funded project. Non-Fed Coordination. If any type of NAVAID (PAPI, PLASI, VAST, MALS, MALSR, ILS, etc.) is to be installed or relocated as part of the project, the FAA Non-Fed Coordinator must be notified and appropriate airspace studies completed. The airspace studies must be completed before the work can be included in a Federal aid project. These studies can take up to a year to complete. Required Forms (as applicable). Agreement for Transfer of Entitlements (FAA Form 5100-110); NAVAID Forms (PAPIs, AWOS, REILs); Modification of Airport Design Standards, Buy American Approval, Certificate of Economic Necessity, SRE Calculation, AIP Revenue-Generating Facility Eligibility Evaluation Form and attachments. Please contact your Program Manager if you cannot find the above forms on the Airports web site. ADDITIONAL INFORMATION: FONSI in route from 5-Year EA Signatures are required, including in required attached forms. Updated October 2016 Electronic submittal using Portable Document Format(PDF)is preferred. Page 2 of 2 AIRPORT PROJECT SCHEDULE LOCATION: Elizabeth Field Airport PROJECT NO: 3-36-0029- -2018 DATE No. ITEMFAA SponsorCOMMENTS (if appropriate) (Due) (Sent or will send) 1. Submission of Environmental Document 11/30/17- 01/12/2018 FONSI-5 yr CIP EA to be issued by 2/18 1/11/20118 Provide Airspace(For new structures only) N/A 3. Verify Project is on ALP(*Update to ALP) N/A 4. Submission of a Benefit-Cost Analysis N/A 5. Selection of Sponsor's Engineer(Within 5 year term 06/01/2017 or project included in associated RFQ) 6. Provide DBE plan and/or revisions to AEA-9 (See DBE and ACDBE Reporting Requirements for N/A Airport Grants) 7. Provide Preapplication Package to ADO 1/31/2018 01/31/2018 8. Provide Final Notice of Intent to Use Funds(via 4/15/2018 04/15/2018 Preapphcation Package) 9. Professional Services Agreement 05/18/2018 10. Submit Preliminary Engineers Design Report N/A (Verify rehabilitation method or pavement section) 11. Request deviations to FAA design standards form N/A with supporting documents 12. Submit project safety phasing plan for FAA N/A approval 13. 90%Complete Plans and Specs(Part 139) N/A (45 days pnor to advertising bids) 14. 90%Complete Plans and Specs(Other) N/A (30 days prior to advertising bids) 15. Submit all transfer agreements to FAA office N/A 16. Obtain wage rates N/A 17. Advertise for bids N/A 18 Bid Opening N/A 19. Bid Tab Submitted N/A 20. Application Submitted (Submit by date required by 6/15/2018 06/15/2018 FAA) 21. Acceptance of Grant Offer 09/17/2018 22 Award of Contract N/A 23. Const. Management Plan N/A 24. Preconstruction Meeting/Notice to Proceed N/A 25. Construction Start N/A 26. Construction Completion N/A 27. NAVAIDS Commissioned N/A 28. Exhibit A revised N/A 29. 5010 updated N/A 30. ALP revised/Construction As-Builts N/A 31. AGIS Updated N/A 32. Project Closeout Report 09/30/2019 Signatures are required, including in required attached forms. Updated October 2016 Electronic submittal using Portable Document Format(PDF)is preferred � w 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 letters) ® Preapplication ®New ❑Application ❑Continuation 'Other(Specify) ❑Changed/Corrected Application F�Revision `3.Date Received. 4.Applicant Identifier OB8 5a.Federal Entity Identifier: 5b Federal Award Identifier 3-36-0029- - 2018 State Use Only: 6 Date Received by State- 7.State Application Identifier 0913. S.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: Manager Organizational Affiliation. Fishers Island Ferry District 'Telephone Number. 631-788-7463 Fax Number: `Email- gmurphy@fiferry.com 1 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: 13-36-0029-----2018 *Title: Rehabilitate Electrical Building (Design) 13.Competition Identification Number: Title 14.Areas Affected by Project(Cities,Counties,States,etc.): 5. Project Map.pdf Add Attachment j DeleteAttachrn t i View Attachment *15.Descriptive Title of Applicant's Project: Rehabilitate Electrical Building (Design) Attach supporting documents as specified in agency instructions Add Attachments_ Delete Attachments ; View Attachments r Legend Airport Property Line Project Areas Runway 12-30 Rehabilitation Runway 7-25 Rehabilitation Obstruction Mitigation a ® Airport Entrance Road 1 a. Improvements ® Terminal Building Construction v' }r � Private Hangar Development = Private Hangar Development Entrance Improvements E Project Area=3 9 ac project Area=0 27 ac a E a Obstruction Removal Project Area=0 34 ac V_ B Airfield Lighting Vault 0 250 soo Feet o Runway 12-30 Rehabilitation 1 Inch=500 feet v Project Area=6 3 ac Obstruction Removal When printed at 11"x17" ProjectArea=0.16 ac Date 9/15/2016 5 Obstruction Removal W Project Area=069 ac Runway 7-25 Rehabilitation 0 c -�', a✓� ,+,�: Project Area=25ac U Q - ul ., _ • - Elizabeth Field $ Airport Town of Southold Atlantic Ocean Fishers Island, New York 0 t Alternative 2 0 Preferred Alternative z Figure 1-3 1. -r.:. a � �.r•.r.�.rwe`�wa'.'l14-.t ',,�y��,..,miw.yw....'�;�":.yl.+taa.".v+s r. �y...'. .,,.�, :a•+p«,r•x . � 1'i' - erA'1+t`t�-4��s i,..�, .�, .dJA�/(a�.•yy_}• ..i+:�': a. -i.,�p�. ,,y:�:Ipt' •ay.:. r.+ Ar,..;+.r .wla'?6 ^?? Jii�,,, ♦'+ -4p`." ..; «waw•u•'tar.•tl:tlo..,:..>.:_R't}aal"� .-...'T„+..:,.'..., ut t "�..' �" .d.•n'.�y .t - .«•. r.;..1�yJ.l. fi ?' ...'.• t1.a." :fe,4..A1w0 . ,:d;,y�,�'w.,,�,raw+Je�41R?•. a}a ''aTb�+•.'y�,,,,*.�g{fir,+!"-.�.m}::._ ".a.•.tt;�p+��+ qp as qk : R:.: ••S.Iw.uA:y_Tta•wsM:,x;, l.,,, .. • '�li -.tiMY,.r5 v♦ ?�• ...�. .;'pit ♦.e.:p -.., •. sem#'T r:. .fKT•- .'it ... M--:a! ..-..•, 1 . '.�.i'1'zp * '+�?+ Y a - �> /6i�y� •fit' �'�• +��r�' Y:/ T� '., ��R�rv' ^ °l• h rs a K fifemoo— ..- 10 : 00 12 , 31 . 2003 10 : 00 k 1 t . F 12 . 31 . 2003 10 : 00 S y � Qr 12 . 31 . 2003 10 : 00 12 . 20 -i ti - w r a R/W 12-30 P � W 12: 3r T 2003'"10 : 00 0 g W ' 0 0 ,� ,f �.rr.nya.ruwrrore� j - ` y WARN1Nt� R — A N) lip 0 . 2003 10 : 00 12 . 31 . 2003 10 : 00 12 . 31 . 2003 10 : 00 tea.��� 4. r � } Jrr`� 1 1r i _ 4 tRr` 4 t r 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. Add Attachment Delete Attachment view Attachment 17.Proposed Project: "a.Start Date 09/01/2018 *b.End Date: 03/31/2019 18.Estimated Funding(5): *a.Federal 40,500.001 'b.Applicant 0.00 *c.State 2,250.001 *d.Local 2,250.00 e.Other 0.001 If. Program Income 0.001 *g,TOTAL 45,000.00 *19.Is Application Subject to Review By State Under Executive Order 12372 Process? ® a.This application was made available to the State under the Executive Order 12372 Process for review on 01/3 0/2018 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) F Yes ®No If"Yes",provide explanation and attach Add Attachment Delete Attachment View Attachment 21.*By signing this application,I certify(1)to the statements contained In the list of certifications"*and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances"*and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) ®"*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 scot t Middle Name: n. Last Name: Russell Suffix: I '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, j• r � � ' US Department of Transportation OMB CONTROL NUMBER.2120-0569 •/ Federal Aviation Administration EXPIRATION DATE:8/31/2019 Application for Federal Assistance (Development and Equipment Projects) PART II — PROJECT APPROVAL INFORMATION Part II -SECTION A The term "Sponsor" refers to the applicant name provided in box 8 of the associated SF-424 form. Item 1. Does Sponsor maintain an active registration in the System for Award Management ❑X Yes ❑No (www.SAM.gov)? Item 2. Can Sponsor commence the work identified in the application in the fiscal year the ❑X Yes ❑No ❑N/A grant is made or within six months after the grant is made, whichever is later? Item 3. Are there any foreseeable events that would delay completion of the project? If yes, ❑Yes N No ❑N/A provide attachment to this form that lists the events. Item 4. Will the project(s)covered by this request have impacts or effects on the environment that require mitigating measures? If yes, attach a summary listing of ❑Yes ❑X No ❑N/A mitigating measures to this application and identify the name and date of the environmental document(s). Item 5. Is the project covered by this request included in an approved Passenger Facility Charge (PFC)application or other Federal assistance program? If yes, please ❑Yes ❑X No ❑N/A identify other funding sources by checking all applicable boxes. ❑ The project is included in an approved PFC application. If included in an approved PFC application, does the application only address AIP matching share? ❑Yes ❑No ❑ The project is included in another Federal Assistance program. Its CFDA number is below. Item 6. Will the requested Federal assistance include Sponsor indirect costs as described in ❑Yes ❑X No ❑N/A 2 CFR Appendix VII to Part 200, States and Local Government and Indian Tribe Indirect Cost Proposals? If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate the Sponsor proposes to apply: ❑ De Minimis rate of 10% as permitted by 2 CFR§ 200.414. ❑ Negotiated Rate equal to % as approved by (the Cognizant Agency) on (Date) (2 CFR part 200, appendix VII). Note:Refer to the instructions for limitations of application associated with claiming Sponsor indirect costs. FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 1 of 7 r r OMB CONTROL NUMBER.2120-0569 OMB EXPIRATION DATE'8/31/2019 PART II -SECTION B Certification Regarding Lobbying The declarations made on this page are under the signature of the authorized representative as identified in box 21 of form SF-424, to which this form is attached. The term "Sponsor' refers to the applicant name provided in box 8 of the associated SF-424 form. The Authorized Representative certifies, to the best of his or her knowledge and belief,that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,the Authorized Representative shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3)The Authorized Representative shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code.Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 2 of 7 • i OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE'8/31/2019 PART II—SECTION C The Sponsor hereby represents and certifies as follows: 1. Compatible Land Use—The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity of the airport: Present and future land use is compatible with the airport. No significant impact on land use in vicinity of the airport. 2. Defaults—The Sponsor is not in default on any obligation to the United States or any agency of the United States Government relative to the development, operation, or maintenance of any airport, except as stated herewith: None 3. Possible Disabilities—There are no facts or circumstances (including the existence of effective or proposed leases, use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings)which in reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of the Grant Assurances, either by limiting its legal or financial ability or otherwise, except as follows: None 4. Consistency with Local Plans—The project is reasonably consistent with plans existing at the time of submission of this application) of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding the airport. The project is consistent with existing plans. 5. Consideration of Local Interest—It has given fair consideration to the interest of communities in or near where the project may be located. Yes 6. Consultation with Users—In making a decision to undertake an airport development project under Title 49, United States Code, it has consulted with airport users that will potentially be affected by the project(§47105(a)(2)). Primary users of the airport are aware of the project. 7. Public Hearings—In projects involving the location of an airport, an airport runway or a major runway extension, it has afforded the opportunity for public hearings for the purpose of considering the economic, social, and environmental effects of the airport or runway location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall, when requested by the Secretary, submit a copy of the transcript of such hearings to the Secretary. Further, for such projects, it has on its management board either voting representation from the communities where the project is located or has advised the communities that they have the right to petition the Secretary concerning a proposed project. N/A 8. Air and Water Quality Standards—In projects involving airport location, a major runway extension, or runway location it will provide for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located, designed, constructed, and operated so as to comply with applicable and air and water quality standards. In any case where such standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to certify shall be provided within sixty days after the project application has been received by the Secretary. N/A FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 3 of 7 f d OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE 8/31/2019 PART II—SECTION C (Continued) 9. Exclusive Rights—There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or controlled by the Sponsor except as follows: None 10. Land—(a)The sponsor holds the following property interest in the following areas of land, which are to be developed or used as part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse interests, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1] None The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such attorney or title company has determined that the Sponsor holds the above property interests. (b)The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work under the Project, the following property interest in the following areas of land on which such construction work is to be performed, all of which areas are identified on the aforementioned property map designated as Exhibit"K. [1] (c)The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the Project, the following property interest in the following areas of land which are to be developed or used as part of or in connection with the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated as Exhibit"A". [1] State the character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of every kind and nature, including liens, easements, leases, etc.The separate areas of land need only be identified here by the area numbers shown on the property map. FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 4 of 7 OMB CONTROL NUMBER'2120-0569 OMB EXPIRATION DATE.8/31/2019 PART III - BUDGET INFORMATION - CONSTRUCTION SECTION A—GENERAL 1. Federal Domestic Assistance Catalog Number: 20.106 2. Functional or Other Breakout: AIP- Rehabilitate Electrical Building (Design) SECTION B—CALCULATION OF FEDERAL GRANT Latest Approved Adjustment Total Cost Classification Amount +or(-)Amount Amount (Use only for (Use only for Required revisions) revisions 1. Administration expense 900 2. Preliminary expense 3. Land,structures, right-of-way 4. Architectural engineering basic fees 44,100 5. Other Architectural engineering fees 6. Project inspection fees 7. Land development 8. Relocation Expenses 9. Relocation payments to Individuals and Businesses 10. Demolition and removal 11. Construction and project improvement 12. Equipment 13. Miscellaneous 14. Subtotal(Lines 1 through 13) 45,000 15. Estimated Income(if applicable) 16. Net Project Amount(Line 14 minus 15) 17. Less: Ineligible Exclusions(Section C, line 23 g.) 18. Subtotal(Lines 16 through 17) 45,000 19. Federal Share requested of Line 18 40,500 20. Grantee share 2,250 21. Other shares 2,250 22. TOTAL PROJECT(Lines 19,20&21) 45 000 FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 5 of 7 .f t 7 OMB CONTROL NUMBER 2120-0569 OMB EXPIRATION DATE:8/31/2019 SECTION C—EXCLUSIONS Amount Ineligible for 23.Classification(Description of non-participating work) Participation a. b. C. d. e. f. g. Total SECTION D—PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE 24.Grantee Share—Fund Categories Amount a. Securities b. Mortgages c.Appropriations(by Applicant) 2,250 d. Bonds e.Tax Levies f. Non-Cash g. Other(Explain): h.TOTAL-Grantee share 2,250 25.Other Shares Amount a. State 2,250 b Other c.TOTAL-Other Shares 2,250 26.TOTAL NON-FEDERAL FINANCING 4,500 SECTION E—REMARKS (Attach sheets if additional space is required) FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 6 of 7 OMB CONTROL NUMBER:2120-0569 OMB EXPIRATION DATE 8/31/2019 PART IV—PROGRAM NARRATIVE (Suggested Format) PROJECT: Rehabilitate Electrical Building (Design) AIRPORT: Elizabeth Field Airport 1. Objective: The proposed project involves replacing airfield lighting equipment(regulators), installing shelving to elevate the airfield lighting equipment and raise it out of frequent flood elevations, address lighting and mechanical/HVAC system install to prevent accelerated corrosion due to the in the salt air environment, and address repairs to previous flood damage(interior lighting repairs, painting,etc.). Exterior renovations would include replacement of the main entry door and repairing damaged building fascia.There would be no change in the building use, no change in the building footprint, nor will there be any ground disturbance as part of this work. 2. Benefits Anticipated: The existing airfield electrical vault is over 20 years old, and has been subjected to frequent storms and flooding.Along with the salt- air environment,the elements are rapidly deteriorating the airfield lighting equipment.The Airport was devastated during Superstorm Sandy,with floodwaters breaching the vault and exposing the lighting equipment to saltwater.The regulators had temporarily failed, requiring the airport to close due to inoperable lights, until they were repaired.As the airport isn't monitored 24-7, providing a safe, reliable lighting system and lighting equipment will improve the building by addressing much-needed repairs and mitigating impacts to airfield lighting equipment during flooding events. Improving the flooding resistance will increase the service life as well as enhance the overall level of safety at the airport. 3. Approach: (See approved Scope of Work in Final Application) 4. Geographic Location: Elizabeth Field Airport is located on the western side of Fisher's Island. Fishers Island is located at the eastern end of Long Island Sound,2 miles off the southeastern coast of Connecticut. 5. If Applicable, Provide Additional Information: 6.Sponsor's Representative: (include address&telephone number) Scott Russell, Telephone: 631-765-1889, Email: scott.russell@town.southold.ny.us Address: Town of Southold, PO Box 1179, Southold, New York 11971 FAA Form 5100-100(3/16)SUPERSEDES PREVIOUS EDITION Page 7 of 7 r. Project Cost Breakdown Airport: Elizabeth Field Aiport Project Description: Rehabilitate Electrical Building(Design) Construction or Engineering/ Brief Item Description Land Cost Land Incidental Admin.Cost Total Cost Federal Share Non-Federal _ 90% 10% Rehab. Electrical Bldg. (Design) $34,100 $900 $35,000 $31,500 $3,500 Improve Airport—Misc. 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