U.S. DEPARTMENT OF TRANSPORTATION\
FEDERAL AVIATION ADMINISTRATION

AIRPORT IMPROVEMENT PROGRAM

[PREDESIGN CHECKLIST]{.underline}

1\. Scope of project should include description of both Federally and
non-Federally-funded work, provisions for environmental mitigation for
Federally funded projects, updating Airport Layout Plans when
construction is completed, and all related items listed below.

2\. Amount of design fee eligible for Federal participation must be
approved by ADO. ADO will make a \"reasonableness of cost\"
determination. Design work performed prior to FAA approval is at
consultant\'s/sponsor\'s own risk. Refer to Advisory Circular (AC)
150/5100-14D for consultant negotiation process. Sponsor should provide
to the ADO:

> a\. Scope of work
>
> b\. Independent estimate
>
> c\. Consultant estimate
>
> d Cost analysis comparing estimate

e.  Record of negotiations

f.  Letter requesting approval (include negotiated fee for design and
    construction management)

g.  Sponsor Certification for Selection of Consultants

3\. Provide schedule to ADO project manager at the predesign which shows
at a minimum: 1) submit record of negotiations, 2) submit Environmental
Checklist, 3) final design review submittal date, 4) advertise date, 5)
bid open date, 6) application submittal date,7) grant acceptance date,
8) notice to proceed date, 9) construction completion date. (See Page 3
-PROJECT SCHEDULE). This document may also be found at:
<http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/forms/media/engineering/predesign_package.doc>

4\. Reimbursable agreements. Determine if any FAA owned navigation aids
need to be moved or altered as part of construction. If so, sponsor is
required to initiate a reimbursable agreement with Airway Facilities
(AF). A reimbursable agreement can take six (6) to nine (9) months
before it is signed. Airway Facilities specifications must be used.
Partial advance payment is required.

5\. Use applicable FAA construction specifications (AC 150/5370-10B,
Standards for Specifying Construction at Airports and current Northwest
Mountain Region Notice). Available on the internet at:
<http://www.faa.gov/airports_airtraffic/airports/resources/advisory_circulars/media/150-5370-10B/150_5370_10b.pdf>.
List any modifications to standards (see attachment 2, last page), and
submit for approval in accordance with Order 5300.1E.

6\. Note any deviation from AC 150/5300-13, Airport Design, or other
applicable design advisory circulars in design report. Before proceeding
with design, check with ADO to see if a \"modification to standards\"
must be prepared for approval by Air Traffic, Flight Standards, and
Airway Facilities. Submit for approval in accordance with Order 5300.1E.
Submit \"Modifications to Design Standards\" as soon as identified.
Coordinate submission with ADO. Allow long lead time for review by all
divisions. Discuss need for any proposals requiring submittal of FAA
Form 7460-1 (available on the internet at:
[http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/
forms/media/airspace/7460_1.doc](http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/ forms/media/airspace/7460_1.doc)).
Allow 60 -- 90 days for approval.

7\. Turn in Engineer\'s Design Report with plans and specifications for
review including a copy of this completed checklist (see attachment 2
for outline). (Submit a draft report at the 90% design review phase and
the final report at the 100% design phase).

a\. Design report shall include alternatives such as Portland Cement
concrete, to provide justification (e.g. life cycle cost), this includes
overlay projects.

b\. Turn in a completed \"Plans and Specifications Review Items
Checklist\" with final design documents for FAA review. The completed
checklist should indicate which items are non-applicable (N/A) and which
items were checked (attachment 3).

c\. Include design summary form 5100-1 and frost design.

d\. Include reference to Engineering Policy 94-03 Design of Subdrain
System for Pavements.
[(]{.underline}<http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/policy_guidance/media/94_03.pdf>[)]{.underline}

8\. Insure sponsor\'s Disadvantaged Business Enterprise (DBE) plan is
approved by Civil Rights and the project DBE goals are in conformance
with the annual DBE. For states in the Ninth Circuit Court of Appeals
(Washington, Oregon, Idaho, Montana), no DBE goals should be included in
the contract documents. Delete contract goals paragraph from FAA
Standard Construction Contract Provisions. States in the Tenth Circuit
Court of Appeals (Utah, Colorado, Wyoming) must have a DBE goal, or be
race neutral. Civil Rights Office P.O.C. - Christine Whitehead (425)
227-2095.

9\. Obtain latest Federal Wage Rates on internet at:
<http://www.access.gpo.gov/davisbacon/> and include in specifications.

10\. Include latest copy of FAA Special Provisions boiler plate in the
specification. Available on the internet at:
[http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/forms](http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/forms/)[/]{.underline}
under Plans and Specifications.

11\. Provide copy of Engineer\'s Cost Estimate of Construction on blank
bid schedule with plans and specifications for review.

12\. Sponsors provide \"Sponsor Certification\". Sample certifications
are in attachment 4 or available on the internet at:
[http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/forms/](http://www.faa.gov/airports_airtraffic/airports/regional_guidance/northwest_mountain/airports_resources/forms/ )
under Project Closeouts. The sponsor and consultant are responsible for
the design to be in accordance with current AC\'s. The FAA does not
approve designs, we \"accept\" them. Certifications are required as
follows:

+------------------------------+---------------------------------------+
| [CERTIFICATION]{.underline}  | [DUE]{.underline}                     |
|                              |                                       |
| 1\. Selection of consultants | Provide with record of negotiations   |
|                              | and fee estimates                     |
+------------------------------+---------------------------------------+
| 2\. Project Plans and        | Provide with final Plans and          |
| Specifications               | Specifications                        |
+------------------------------+---------------------------------------+
| 3\. Equipment/construction   | Provide with bid tabulations after    |
| contracts                    | opening                               |
+------------------------------+---------------------------------------+
| 4\. Real property            | Provide with Title Opinion after      |
| acquisition                  | acquiring property                    |
+------------------------------+---------------------------------------+
| 5\. Construction Project     | Provide with Final Report             |
| Final Acceptance             |                                       |
+------------------------------+---------------------------------------+

13\. Provide close-out documentation at end of project (see attachment
5). Revised as-built ALP.

14\. Provide Construction Management Plan prior to construction.

15\. Provide Construction Safety Plan if project affects operations at
the airport. Show contractor construction routes, Notices to Airmen
(NOTAMs), temporary marking and lighting, safety areas, temporary
threshold displacements, runway shutdowns, construction phasing.

16\. Advise airport users of the construction activities well in advance
in order to allow them ample time for planning operational changes.

17\. Discuss any other issues (political, zoning, legal, state
coordination, etc.) which may impact project.

U.S. DEPARTMENT OF TRANSPORTATION\
FEDERAL AVIATION ADMINISTRATION

AIRPORT IMPROVEMENT PROGRAM

PROJECT SCHEDULE

  --------------- ----------------------------------------------------------
  **LOCATION:**   **     **

  --------------- ----------------------------------------------------------

  ------------------- ---------------------------------------------------
  **PROJECT NUMBER:**      

  ------------------- ---------------------------------------------------

  ----------------------- -----------------------------------------------
  **PROJECT                    
  DESCRIPTION:**          

                          

                          

                          
  ----------------------- -----------------------------------------------

  ---------------------------------------- -------------- ---------------
  **ITEM**                                 **SCHEDULED    **ACTUAL DATE**
                                           DATE**         

  **Preapplication Submitted**             **     **      **     **

  **Advertise for Consultant**             **     **      **     **

  **Select Consultant**                    **     **      **     **

  **Pre-Design Meeting**                   **     **      **     **

  **Receive Independent Estimate**         **     **      **     **

  **Submit Workscope & Record of           **     **      **     **
  Negotiation**                                           

  **Submit Environmental Checklist**       **     **      **     **

  **Finalize Land Cost (Land)**            **     **      **     **

  **Submit Plans & Specifications to FAA** **     **      **     **

  **Advertising Dates (30-days)**          **     **      **     **

  **Open Bids (Construction)**             **     **      **     **

  **Application Submitted**                **     **      **     **

  **Grant Offer Issue**                    **     **      **     **

  **Grant Acceptance**                     **     **      **     **

  **Notice to Proceed**                    **     **      **     **

  **Construction Complete**                **     **      **     **
  ---------------------------------------- -------------- ---------------

+-----------------------------------------------------------------------+
| **COMMENTS:**                                                         |
|                                                                       |
| **[     ]{.underline}**                                               |
+-----------------------------------------------------------------------+

**TYPICAL GRANT SCHEDULE FOR DEVELOPMENT PROJECTS**

  ---------------------- -------- ------- ----------- ----------- -----------
                         TIME     (Mo.)   1ST Q       2ND Q.      3RD Q.

                                                                  

  Advertise for          0                Feb         May         Aug
  Consultant                                                      

                                                                  

  Select Consultant      1                Apr         Jun         Sep

                                                                  

  Predesign Meeting      1/2              Mar         Jun         Sep

                                                                  

  Consultant Contract    1                Apr         Jul         Aug

                                                                  

  Plans & Specs Approval 4                Aug         Nov         Feb

                                                                  

  Advertise & Open Bids  1                Sep         Dec         Mar

                                                                  

  Submit Application     1/2              Oct         Jan         Apr

                                                                  

  Grant Offer            1/2              Oct         Jan         Apr
  ---------------------- -------- ------- ----------- ----------- -----------

### TYPICAL GRANT SCHEDULE FOR MASTER PLANS

Advertise for Consultant 0 July - August or earlier

Select Consultant 1 Sep

Scoping 1 Oct

Grant Offer 1/2 Nov

Master Plan Process Scheduled to meet needs

**[GRANT QUARTERS]{.underline}**

1st Quarter Grants: October 1 - December 31

2nd Quarter Grants: January 1 - March 31

3rd Quarter Grants: April 1 - June 30

**[LAND PURCHASE GRANTS]{.underline}**

It is now the ADO policy that the sponsor, either purchase the land, or
have an option to buy the land, prior to accepting a grant.

**DESIGN REPORT**

**A Design Report must be prepared and submitted to the ADO for each
project. The report should be an explanation of the consulting
engineer\'s design based on an overall study and analysis of materials
and conditions. Since the report provides the rationale for the total
design, the plans and specifications cannot be property reviewed without
it. The Design Report must be available before or at the same time as
the plans and specifications are submitted. The report should justify
the proposed design, life cycle cost analyses, energy and resource
conservation, recycling of existing materials, and other pertinent
design/project considerations as necessary. The following is an outline
of the items to be included as appropriate in the report:**

**A. Design Analysis**

**1. Airport layout considerations**

**a. Conformance with FAA standards contained in AC 150/5300-13, AIRPORT
DESIGN.**

**(1) Width, length, area, slope, & surface texture of pavements
including safety**

**areas, separation dimensions, obstacles, and hazards.**

**(2) Conformance with Airport Layout Plan.**

**(3) Analysis of options and optimum choice.**

**(4) Environmental protection.**

**(5) FAR Part 77 Clearances.**

**2. Soils and Grading**

**a. Soil and profile, exploration, ground water table(s), and test
results (utilize Unified**

**Soil Classification System).**

**b. Internal drainage and frost conditions.**

**c. Field and/or laboratory CBR test results, or foundation modules
determination (k).**

**d. Cut and fill; borrow considerations; waste, shrink/swell factors,
disposal, haul and access**

**routes.**

**e. Special compaction requirements.**

**f. Expansive soil problems and method(s) for control**

**3. Drainage**

**a. Rainfall and runoff data.**

**(1) Design flood conditions (flood plain, design storm).**

**b. Capacity and structure design.**

**c. Ponding, erosion control, extraordinary features.**

**4. Pavements**

**a. Design** **loading basis - critical aircraft or fleet of airport
(equivalent operations).**

**b. Existing pavements**

**(1) Thickness transitions.**

**(2) Existing condition including the PCI.**

**c. Material types and sources, joint design.**

**d. Alternate construction.**

**(3) Recycling of existing materials.**

**(4) Consideration of flyash in PCC pavements.**

**e. Seal coat justification.**

**f. Pavement design form FAA 5100-1 & method.**

g\. Pavement foundation drainage.

  ----------------------------------- -----------------------------------
                                      

  ----------------------------------- -----------------------------------

**h. Frost considerations including differential heave, water table, and
subgrade material**

**transitions.**

**5. Lighting and NAVAIDS**

**a. Existing cable and equipment conditions including age, circuit
loads, and resistance**

**to ground readings.**

**b. Power supply sources including reliability, alternates, voltage
fluctuation problems.**

**c. Direct earth bury or can-in-duct cable placement.**

**d. New equipment, equipment housing, new circuit loads, electrical
designs, and**

**potential communication interference problem with ATCT or FSS for
regulators**

**specified.**

**e. Precision approach path indicators (PAPI) location and threshold
crossing height**

**calculations (including which runway end, or both and why). Submittal
of**

**pre-commissioning data.**

**f. Rotating Beacon: Which intensity is needed; location (clear Part 77
and visibility)**

**and resident shielding requirements.**

**g. Impact to existing FAA visual and electronic NAVAIDS. Shutdowns or
Relocations -- if**

**relocations require an FAA Reimbursable Agreement and impact to
project schedule.**

**B. Modifications to Standards FAA Specifications - list on separate
page and include specifications number, paragraph change, and
justification for change (See Attachment A). All Modifications must be
approved by the FAA. Early notification is needed since the turn-around
time for approval may impact project schedule.**

**C. Cost Estimates.**

**1. Quantities and unit costs.**

**2. Special considerations (competition, labor, and material
availability).**

**3. Additive alternatives.**

**D. Project Schedule**

**1. Time constraints, liquidated damages.**

**2. Critical completion dates.**

**3. Recommended schedule.**

**E. Safety (Safety Plan shall be included in the contract.)**

**1. Impact of work on Aeronautical Operations Areas (AOA).**

**2. Planned closures of AOA\'s; method of marking, lighting, detours,
etc.**

**3. Planned coordination (Airport Management, FSS, control tower),
control, and**

**communications needed for closures, crossings, etc.**

**4. Conditions for closures.**

**5. Vehicle marking.**

**FAA Project Manager**

**Minimum Plans & Specification Review Items**

**[Preliminary]{.underline}:** Design Aircraft

Aircraft Approach Category (A-E)

Airplane Design Group (I-VI)

Pavement Strength

  ------ ------------------------------ ----- --------------------------------
         **Plans:**                           **Specifications:**

  1\.    Dimensional Standards -        1\.   Presence of General Conditions &
         Figures 2-1, 3-1, & 4-1 of AC        Federal Provisions
         150/5300~~-~~13                      

                                              

  2\.    Longitudinal & Transverse      2\.   Special Provisions
         Grades of Runways & Taxiways         

                                              

  3\.    Transverse Grade of Safety     3\.   Disadvantaged Business
         Areas                                Enterprise (DBE) Goals

                                              

  4\.    Longitudinal Grade of Safety   4\.   Safety & Security Plans or
         Area Beyond Runway Ends              Equivalent Conditions Such as
                                              Shutdown of Operational Areas,
                                              Phasing of Work, etc.

                                              

  5\.    Runway Line of Sight           5\.   Contract Award Provisions
                                              Including Alternatives

                                              

  6\.    Threshold Siting for Displaced 6\.   Nonstandard Items Identified in
         or Relocated Thresholds              Engineer\'s Report

                                              

  7\.    Runway Lighting Layout & Color 7\.   P-401: Bituminous Material
                                              Specified

                                              Job Mix Formula Requirements

  8\.    Siting & Aiming Criteria for         Gradation
         VASI\'s, PAPI\'s                     

                                              Acceptance Sampling & Testing

  9\.    Siting Criteria for NAVAIDS,         
         Approach Light Systems, &            
         REILS                                

                                        8\.   P-501: Gradations

  10\.   Presence of Ineligible Work          Alkali Reactivity

                                              Portland Cement Type

  11\.   Nonstandard Items Identified         Admixtures
         in Engineer\'s Report                

                                              Flexural Strength Specified

                                              Acceptance Sampling & Testing

                                              

                                        9\.   Latest Advisory Circulars and
                                              ANM Regional Modification Notice
                                              Used
  ------ ------------------------------ ----- --------------------------------

**FAA Project Manager**

**Desired Additional Plans & Specification Review Items**

  ----- ------------------------------ ----- --------------------------------
        **Plans:**                           **Specifications:**

  1\.   Marking Layout & Colors        1\.   Liquidated Damages

                                             

  2\.   Taxiway Lights - Layout and    2\.   Contract Time
        Distance from Pavement Edge          

                                             

  3\.   Obstructions to Approaches for 3\.   Application of Order 5100.38C,
        New Runways or Runway                Paragraph 909, Solicitations
        Extensions                           Containing Both Eligible &
                                             Ineligible Work

                                             

  4\.   Pavement Jointing Design       4\.   Any Technical Specification Not
        Layout and Details                   Covered by FAA Standard
                                             Specifications (AC 150/5370-10B)

                                             

  5\.   Apron Tiedown Layout                 

                                             

  6\.   Signage -- Layout, Text, Color       
        & Distance from Pavement Edge        

                                             

  7\.   Runway Grooving - Width,             
        Depth, and Spacing Specified         
  ----- ------------------------------ ----- --------------------------------

**[Review Items for Technical Provisions from AC
150/5370-10B:]{.underline} (If sections are not listed, no review is
needed.)**

+-----+--------------------------+-----+-------------------------------+
| P-1 | Compaction Requirements  | P-2 | Gradation                     |
| 52: |                          | 12: |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     | Compaction Requirements       |
+-----+--------------------------+-----+-------------------------------+
| P-1 | Portland Cement Type     |     |                               |
| 53: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          | P-2 | Gradation                     |
|     |                          | 13: |                               |
+-----+--------------------------+-----+-------------------------------+
| P-1 | Compaction               |     | Compaction Requirements       |
| 55: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Percent Lime             |     | Percent Sand                  |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
| P-1 | Compaction               | P-2 | Gradation                     |
| 57: |                          | 17: |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Percent Kiln Dust        |     | Compaction Requirements       |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
| P-1 | Compaction               | P-3 | Portland Cement Type          |
| 58: |                          | 01: |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Percent Fly Ash          |     | Portland Cement Quantity      |
|     |                          |     | Limits                        |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
| P-2 | Gradation                | P-3 | Portland Cement Type          |
| 06: |                          | 04: |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     | Portland Cement Quantity      |
|     |                          |     | Limits                        |
+-----+--------------------------+-----+-------------------------------+
| P-2 | Gradation                |     | Gradation                     |
| 08: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Compaction Requirements  |     | Compressive Strength          |
|     |                          |     | Specified                     |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     | Acceptance Sampling & Testing |
+-----+--------------------------+-----+-------------------------------+
| P-2 | Gradation                |     |                               |
| 09: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Compaction Requirements  | P-3 | Portland Cement Type          |
|     |                          | 06: |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Percent Fractured Faces  |     | Portland Cement Quantity      |
|     |                          |     | Limits                        |
+-----+--------------------------+-----+-------------------------------+
|     | Percent Wear             |     | Gradation                     |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     | Compressive Strength          |
|     |                          |     | Specified                     |
+-----+--------------------------+-----+-------------------------------+
| P-2 | Gradation                |     | Acceptance Sampling & Testing |
| 10: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Compaction Requirements  |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
| P-2 | Gradation                |     |                               |
| 11: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Compaction Requirements  |     |                               |
+-----+--------------------------+-----+-------------------------------+
| P-4 | In Addition to Minimum   | P-6 | If Major Contract Item,       |
| 01: | Review Items             | 10: | Review:                       |
+-----+--------------------------+-----+-------------------------------+
|     | Aggregate Quality Tests  |     | ##                            |
|     |                          |     | ##### **Aggregate Gradation** |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     | Steel Reinforcement           |
+-----+--------------------------+-----+-------------------------------+
| P-4 | Bituminous Material      |     | Portland Cement Type          |
| 02: | Specified                |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Job Mix Formula          |     | Compressive Strength          |
|     | Requirements             |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Gradation                |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          | P-6 | Type of Paint                 |
|     |                          | 20: |                               |
+-----+--------------------------+-----+-------------------------------+
| P-4 | Bituminous Material      |     | Application Rate              |
| 03: | Specified                |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Job Mix Formula          |     | Colors                        |
|     | Requirements             |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Gradation                |     | Reflective Bead Type          |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
| P-5 | In Addition to Minimum   | P-6 | Gradation                     |
| 01: | Review Items             | 25: |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Aggregate Quality Tests  |     | Bituminous Material Specified |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     | Composition of Mixture        |
+-----+--------------------------+-----+-------------------------------+
| P-6 | Bituminous Material      |     |                               |
| 02: | Specified                |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Application Rate         | P-6 | Gradation                     |
|     |                          | 26: |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     | Aggregate Application Rate    |
+-----+--------------------------+-----+-------------------------------+
| P-6 | Bituminous Material      |     | Asphalt Application Rate      |
| 03: | Specified                |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Application Rate         |     | Bituminous Material Specified |
+-----+--------------------------+-----+-------------------------------+
|     |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
| P-6 | Width                    | P-6 | Composition of Mixture        |
| 04: |                          | 30: |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Joint Preparation        |     |                               |
|     | Requirements             |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          | P-6 | Composition of Mixture        |
|     |                          | 31: |                               |
+-----+--------------------------+-----+-------------------------------+
| P-6 | Type Specified           |     |                               |
| 05: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     |                          | F-1 | Gauge and Mesh of Wire        |
|     |                          | 62: | Specified                     |
+-----+--------------------------+-----+-------------------------------+
| P-6 | Aggregate Quality Tests  |     |                               |
| 09: |                          |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | ##### Bituminous Ma      | D-7 | Type of Pipe                  |
|     | terial Application Rates | 01: |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Aggregate Application    |     | Backfill Compaction           |
|     | Rates                    |     | Requirements                  |
+-----+--------------------------+-----+-------------------------------+
|     | Gradation                |     |                               |
+-----+--------------------------+-----+-------------------------------+
|     | Bituminous Material      | L-1 | Adequate Lid Loading Design   |
|     | Specified                | 15: |                               |
+-----+--------------------------+-----+-------------------------------+

**Note: For Electrical Specifications, L-Series, Check to see if Each
Component of a System is Present and the Applicable Equipment
Specifications (AC No.) are Referenced.**

U.S. DEPARTMENT OF TRANSPORTATION\
FEDERAL AVIATION ADMINISTRATION

AIRPORT IMPROVEMENT PROGRAM

MODIFICATIONS TO STANDARDS

## SPECIFICATION & PARA. REQUESTED MODIFICATION & JUSTIFICATION

  ---------------------------- ------------------------ --------------------------- --
  **     **                                                                         

                               **[DATE]{.underline}**   **[SPONSOR]{.underline}**   

                               **[DATE]{.underline}**   **[APPROVED BY              
                                                        (FAA)]{.underline}**        
  ---------------------------- ------------------------ --------------------------- --

Attachment A

<table>
<colgroup>
<col style="width: 9%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 12%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 8%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="24"><strong>AIRPORT PAVEMENT DESIGN</strong></td>
</tr>
<tr class="even">
<td colspan="6"><p>STATE</p>
<p>     </p></td>
<td colspan="10"><p>CITY</p>
<p>     </p></td>
<td colspan="8"><p>AIRPORT</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="6"><p>PROJECT NUMBER</p>
<p>     </p></td>
<td colspan="10"><p>SPONSOR</p>
<p>     </p></td>
<td colspan="8"><p>DESIGN NUMBER</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="24"><p>PROJECT DESCRIPTION</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="24"><p><strong>GROSS ALLOWABLE AIRCRAFT WEIGHT
(KIPS)</strong></p>
<p>(Gear configuration or aircraft type)     </p></td>
</tr>
<tr class="even">
<td colspan="4"><p>SINGLE WHEEL</p>
<p>     </p></td>
<td colspan="3"><p>DUAL WHEEL</p>
<p>     </p></td>
<td colspan="7"><p>DUAL TANDEM</p>
<p>     </p></td>
<td colspan="3"><p>B-747</p>
<p>     </p></td>
<td colspan="4"><p>L 1011</p>
<p>     </p></td>
<td colspan="3"><p>DC-10-</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="24"><strong>DESIGN CRITERIA</strong></td>
</tr>
<tr class="even">
<td colspan="2">DESIGN A/C</td>
<td colspan="6">EQUIV. DEPARTURES</td>
<td colspan="2">CBR</td>
<td colspan="2">K</td>
<td colspan="4"><p>GROSS A/C WEIGHT</p>
<p>(Kips)</p></td>
<td colspan="2">USC</td>
<td colspan="4">FLEX STRENGTH</td>
<td>Cb or Cr</td>
<td>F</td>
</tr>
<tr class="odd">
<td colspan="24"><p><strong>TYPICAL SECTIONS</strong></p>
<p>(Show and number each course)</p></td>
</tr>
<tr class="even">
<td colspan="14">NONCRITICAL AREAS</td>
<td colspan="10">CRITICAL AREAS</td>
</tr>
<tr class="odd">
<td colspan="14"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td colspan="10"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="24"><strong>DESIGN DETAILS</strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td colspan="17">THICKNESS OF PAVEMENT</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td>NO.</td>
<td colspan="2">COURSE</td>
<td colspan="2">RUNWAY</td>
<td colspan="4">NONCRITICAL RUNWAY</td>
<td colspan="4">TAXIWAY</td>
<td colspan="2">NONCRITICAL TAXIWAY</td>
<td colspan="4">APRON</td>
<td></td>
<td colspan="4">SPECIFICATION</td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td>     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td colspan="11"></td>
<td colspan="13"></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="29"><strong>SOIL ANALYSIS</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="18">GRADATION (% PASSING)</td>
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">TEST HOLE</td>
<td colspan="2"><p>DEPTH OF</p>
<p>SAMPLE</p></td>
<td>3"</td>
<td colspan="3">2"</td>
<td>1"</td>
<td>3/4"</td>
<td>1/2"</td>
<td>3/8"</td>
<td colspan="2">4</td>
<td>10</td>
<td colspan="4">40</td>
<td>100</td>
<td>200</td>
<td colspan="3"><p>% FINER1</p>
<p>THAN .02 MM</p></td>
<td>L.L.</td>
<td colspan="3">P.I.</td>
<td>USC</td>
</tr>
<tr class="even">
<td colspan="2"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td colspan="2"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td colspan="3"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td colspan="2"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td colspan="4"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td colspan="3"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td colspan="3"><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
<td><p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="29"><strong>SUBGRADE CHARACTERISTICS</strong></td>
</tr>
<tr class="even">
<td colspan="7">AVERAGE FROST PENETRATION</td>
<td colspan="6">SUBSURFACE DRAINAGE</td>
<td colspan="16">FROST DESIGN METHOD2</td>
</tr>
<tr class="odd">
<td colspan="6">     </td>
<td colspan="7">     </td>
<td colspan="4">CP </td>
<td colspan="3">LSP </td>
<td colspan="3">RSP </td>
<td colspan="3">RSS </td>
<td colspan="3">NONE </td>
</tr>
<tr class="even">
<td colspan="17">COMMENTS3</td>
<td colspan="12"><p>NOTES:</p>
<p>1. Applies only when material is used above frost line.</p>
<p>2. Select one.</p>
<p>3. Attach sketch showing location of borings.</p></td>
</tr>
<tr class="odd">
<td colspan="16">     </td>
<td colspan="6"><p>SUBMITTED BY</p>
<p>     </p></td>
<td colspan="5"><p>TITLE</p>
<p>     </p></td>
<td colspan="2"><p>DATE</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="16">     </td>
<td colspan="6"><p>APPROVED BY</p>
<p>     </p></td>
<td colspan="5"><p>FAA REGIONAL</p>
<p>PAVING ENGINEER</p></td>
<td colspan="2"><p>DATE</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="16">     </td>
<td colspan="6"><p>APPROVED BY</p>
<p>     </p></td>
<td colspan="5"><p>FAA STATE</p>
<p>AIRPORT ENGINEER</p></td>
<td colspan="2"><p>DATE</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="18"></td>
<td colspan="11"></td>
</tr>
</tbody>
</table>

**[CONSTRUCTION MANAGEMENT PLAN]{.underline}**

A special condition is required in all grants, which contain paving work
estimated to exceed \$250,000. The special condition requires the
sponsor to furnish a detailed construction management plan to the
Federal Aviation Administration (FAA) for approval before the start of
construction. The paving work estimated cost includes the subgrade, base
courses, and pavement course(s). The plan should detail the measures and
procedures to be used to comply with the quality control provisions of
the construction contract, including, but not limited to, all quality
control and acceptance tests required by the Sponsor Certified
Specifications for the particular project.

The construction management plan shall be submitted to the Airports
District Office (ADO) for approval a minimum of ten (10) working days
before the start of construction.

The following is the accepted format to meet this requirement:

#### CONSTRUCTION MANAGEMENT PLAN GRANT NO. 00-00-0000-00

A. Introduction

B. Personnel

1\. Name of Sponsor representative who has responsibility and authority
for contract administration.

2\. Consulting Engineer and staff\--list and show qualifications,
experience, and project responsibilities (a summary flow diagram should
also be provided, see pages 2 and 3.

3\. Contractor\--list personnel and responsibilities.

4\. Testing Laboratory\--list personnel and responsibilities.

C. Inspection Procedures and Frequencies

1\. For Surveying and grade control.

2\. By Contractor

3\. By Consulting Engineer

a\. Inspection procedures

b\. Daily reporting/diary

D. Submittal Process

1\. List submittal.

2\. Test procedure, short title, and project specification for each
submittal.

3\. Include a diagram showing the path for review and approval of
submittals.

E. Quality Control Testing.

1\. For each specification list ASTM/AASHTO standard, short title,
frequency, sampling method (if any).

2\. Flow chart of responsibility between Testing Lab, Contractor, and
Project Engineer.

3\. Actions to be taken when tests indicate specification deficiency.

F. Acceptance Testing

1\. For each specification list ASTM/AASHTO standard, short title,
frequency, sampling method.

2\. Flow chart of responsibility between Testing Lab, Project Engineer,
and Contractor.

3\. Pay factors for each specification.

G. Test Results

1\. Documentation

a.  Quality control tests daily.

b.  Acceptance daily summary by specification.

c\. Documentation of failing tests and actions taken.

H. Final Test and Quality Control Report

1\. See Handout for Final Construction Report. The format for this
report between the Contractor and Engineer should be similar to the
final report requirements. The report must contain a summary of all
tests by lot or pay item, highlighted failed or reduced pay results, and
reference to any approved change order that accepted any out of
tolerance material.

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**RESPONSIBILITY (SAMPLE)**

Job Superintendent 1. Monitory quality control plan.

2.  Analyze test results.

3.  Transmit test results to office.

4\. Make and implement corrective decisions.

Office Manager 1. Log test results and prepare in final form.

2\. Transmit test results weekly to Sponsor\'s Engineer

Quality Control Technician 1. Administer quality control plan.

2.  Perform tests, such as temperature recording.

3.  Obtain random sample locations.

4\. Assemble and review test data, make statistical and trend analysis,
provide corrective recommendations to Superintendent.

Testing Laboratory 1. Perform quality control tests.

2.  Provide test results to Quality Control Technician.

3\. Analyze results and provide analysis and corrective recommendations
to Quality Control Technician.

Plant Foreman 1. Control gradation, cement content, and temperature of
the mix.

2\. Report all test data plus mix and cement quantities periodically (at
least twice daily) to Superintendent or Quality Control Technician.

Paving Foreman 1. Control thickness, joints, density, and surface
tolerance.

2\. Monitor yield.

Sponsor\'s Engineer 1. Monitor all aspects of job.

2\. Review and analyze all test results.

3\. Assure work is within specification limits.

4\. Advise Superintendent of nonconformance and possible corrective
actions.

+---------------------+---+-----------------------+---+--------------------+
| U.S. DEPARTMENT OF  |   |                       |   |                    |
| TRANSPORTATION\     |   |                       |   |                    |
| FEDERAL AVIATION    |   |                       |   |                    |
| ADMINISTRATION      |   |                       |   |                    |
|                     |   |                       |   |                    |
| AIRPORT IMPROVEMENT |   |                       |   |                    |
| PROGRAM\            |   |                       |   |                    |
| SPONSOR             |   |                       |   |                    |
| CERTIFICATION       |   |                       |   |                    |
|                     |   |                       |   |                    |
| SELECTION OF        |   |                       |   |                    |
| CONSULTANTS         |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
|                     |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
| *(Sponsor)*         |   | *(Airport)*           |   | *(Project Number)* |
+---------------------+---+-----------------------+---+--------------------+
|       *(Work        |   |                       |   |                    |
| Description)*       |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+

Title 49, United States Code, section 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 standards for
selection of consultant services within Federal grant programs are
described in Title 49, Code of Federal Regulations (CFR), Part 18.36.
Sponsors may use other qualifications-based procedures provided they are
equivalent to specific standards in 49 CFR 18 and FAA Advisory Circular
150/5100-14, Architectural, Engineering, and Planning Consultant
Services for Airport Grant Projects.

Except for the certified items below marked not applicable (N/A), the
list includes major requirements for this aspect of project
implementation, although it is not comprehensive, nor does it relieve
the sponsor from fully complying with all applicable statutory and
administrative standard.

+----------------------------------------------------+-----+-----+-----+
|                                                    | Yes | No  | N/A |
+====================================================+=====+=====+=====+
| 1.  Solicitations were (will be) made to ensure    |     |     |     |
|     fair and open competition from a wide area of  |     |     |     |
|     interest.                                      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 2.  Consultants were (will be) selected using      |     |     |     |
|     competitive procedures based on                |     |     |     |
|     qualifications, experience, and disadvantaged  |     |     |     |
|     enterprise requirements with the fees          |     |     |     |
|     determined through negotiations.               |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 3.  A record of negotiations has been (will be)    |     |     |     |
|     prepared reflecting considerations involved in |     |     |     |
|     the establishment of fees, which are not       |     |     |     |
|     significantly above the sponsor's independent  |     |     |     |
|     cost estimate.                                 |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 4.  If engineering or other services are to be     |     |     |     |
|     performed by sponsor force account personnel,  |     |     |     |
|     prior approval was (will be) obtained from the |     |     |     |
|     FAA.                                           |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 5.  The consultant services contracts clearly      |     |     |     |
|     establish (will establish) the scope of work   |     |     |     |
|     and delineate the division of responsibilities |     |     |     |
|     between all parties engaged in carrying out    |     |     |     |
|     elements of the project.                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 6.  Costs associated with work ineligible for AIP  |     |     |     |
|     funding are (will be) clearly identified and   |     |     |     |
|     separated from eligible items in               |     |     |     |
|     solicitations, contracts, and related project  |     |     |     |
|     documents.                                     |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 7.  Mandatory contact provisions for               |     |     |     |
|     grant-assisted contracts have been (will be)   |     |     |     |
|     included in consultant services contracts.     |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 8.  The cost-plus-percentage-of-cost methods of    |     |     |     |
|     contracting prohibited under Federal standards |     |     |     |
|     were not (will not be) used.                   |     |     |     |
+----------------------------------------------------+-----+-----+-----+

+----------------------------------------------------+-----+-----+-----+
| 9.  If the services being procured cover more than |     |     |     |
|     the single grant project referenced in this    |     |     |     |
|     certification, the scope of work was (will be) |     |     |     |
|     specifically described in the advertisement,   |     |     |     |
|     and future work will not be initiated beyond   |     |     |     |
|     five years.                                    |     |     |     |
+----------------------------------------------------+-----+-----+-----+

I certify, for the project identified herein, responses to the forgoing
items are accurate as marked and have prepared documentation attached
hereto for any item marked "no" that is correct and complete.

  -----------------------------------------------------------------------
       

  *(Name of Sponsor)*

  *(Signature of Sponsor's Designated Official Representative)*

       

  *(Typed Name of Sponsor's Designated Official Representative)*

       

  *(Typed Title of Sponsor's Designated Official Representative)*

       

  *(Date)*
  -----------------------------------------------------------------------

+---------------------+---+-----------------------+---+--------------------+
| U.S. DEPARTMENT OF  |   |                       |   |                    |
| TRANSPORTATION\     |   |                       |   |                    |
| FEDERAL AVIATION    |   |                       |   |                    |
| ADMINISTRATION      |   |                       |   |                    |
|                     |   |                       |   |                    |
| AIRPORT IMPROVEMENT |   |                       |   |                    |
| PROGRAM\            |   |                       |   |                    |
| SPONSOR             |   |                       |   |                    |
| CERTIFICATION       |   |                       |   |                    |
|                     |   |                       |   |                    |
| PROJECT PLANS AND   |   |                       |   |                    |
| SPECIFICATIONS      |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
|                     |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
| *(Sponsor)*         |   | *(Airport)*           |   | *(Project Number)* |
+---------------------+---+-----------------------+---+--------------------+
|       *(Work        |   |                       |   |                    |
| Description)*       |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+

Title 49, United States Code, section 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). AIP standards are generally
described in FAA Advisory Circular (AC) 150/5100-6, Labor Requirements
for the Airport Improvement Program, AC 150/5100-15, Civil Rights
Requirements for the Airport Improvement Program, and AC 150/5100-16,
Airport Improvement Program Grant Assurance One\--General Federal
Requirements. A list of current advisory circulars with specific
standards for design or construction of airports as well as
procurement/installation of equipment and facilities is referenced in
standard airport sponsor Grant Assurance 34 contained in the grant
agreement.

Except for the certified items below marked not applicable (N/A), the
list includes major requirements for this aspect of project
implementation, although it is not comprehensive, nor does it relieve
the sponsor from fully complying with all applicable statutory and
administrative standards.

+----------------------------------------------------+-----+-----+-----+
|                                                    | Yes | No  | N/A |
+====================================================+=====+=====+=====+
| 1.  The plans and specifications were (will be)    |     |     |     |
|     prepared in accordance with applicable Federal |     |     |     |
|     standards and requirements, so no deviation or |     |     |     |
|     modification to standards set forth in the     |     |     |     |
|     advisory circulars, or State standard, is      |     |     |     |
|     necessary other than those previously approved |     |     |     |
|     by the FAA.                                    |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 2.  Specifications for the procurement of          |     |     |     |
|     equipment are not (will not be) proprietary or |     |     |     |
|     written so as to restrict competition. At      |     |     |     |
|     least two manufacturers can meet the           |     |     |     |
|     specification.                                 |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 3.  The development included (to be included) in   |     |     |     |
|     the plans is depicted on the airport layout    |     |     |     |
|     plan approved by the FAA.                      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 4.  Development that is ineligible for AIP funding |     |     |     |
|     has been (will be) omitted from the plans and  |     |     |     |
|     specifications.                                |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 5.  The process control and acceptance tests       |     |     |     |
|     required for the project by standards          |     |     |     |
|     contained in Advisory Circular 150/5370-10 are |     |     |     |
|     (will be) included in the project              |     |     |     |
|     specifications.                                |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 6.  If a value engineering clause is incorporated  |     |     |     |
|     into the contract, concurrence was (will be)   |     |     |     |
|     obtained from the FAA.                         |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 7.  The plans and specifications incorporate (will |     |     |     |
|     incorporate) applicable requirements and       |     |     |     |
|     recommendations set forth in the Federally     |     |     |     |
|     approved environmental finding.                |     |     |     |
+----------------------------------------------------+-----+-----+-----+

+----------------------------------------------------+-----+-----+-----+
| 8.  For construction activities within or near     |     |     |     |
|     aircraft operational areas, the requirements   |     |     |     |
|     contained in Advisory Circular 150/5370-2 have |     |     |     |
|     been (will be) discussed with the FAA as well  |     |     |     |
|     as incorporated into the specifications, and a |     |     |     |
|     safety/phasing plan has FAA's concurrence, if  |     |     |     |
|     required.                                      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 9.  The project was (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.                        |     |     |     |
+----------------------------------------------------+-----+-----+-----+

I certify, for the project identified herein, responses to the forgoing
items are accurate as marked and have prepared documentation attached
hereto for any item marked "no" that is correct and complete.

  -----------------------------------------------------------------------
       

  *(Name of Sponsor)*

  *(Signature of Sponsor's Designated Official Representative)*

       

  *(Typed Name of Sponsor's Designated Official Representative)*

       

  *(Typed Title of Sponsor's Designated Official Representative)*

       

  *(Date)*
  -----------------------------------------------------------------------

+---------------------+---+-----------------------+---+--------------------+
| U.S. DEPARTMENT OF  |   |                       |   |                    |
| TRANSPORTATION\     |   |                       |   |                    |
| FEDERAL AVIATION    |   |                       |   |                    |
| ADMINISTRATION      |   |                       |   |                    |
|                     |   |                       |   |                    |
| AIRPORT IMPROVEMENT |   |                       |   |                    |
| PROGRAM\            |   |                       |   |                    |
| SPONSOR             |   |                       |   |                    |
| CERTIFICATION       |   |                       |   |                    |
|                     |   |                       |   |                    |
| EQU                 |   |                       |   |                    |
| IPMENT/CONSTRUCTION |   |                       |   |                    |
| CONTRACTS           |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
|                     |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
| *(Sponsor)*         |   | *(Airport)*           |   | *(Project Number)* |
+---------------------+---+-----------------------+---+--------------------+
|       *(Work        |   |                       |   |                    |
| Description)*       |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+

> Title 49, United States Code (USC), section 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
> standards for equipment and construction contracts within Federal
> grant programs are described in Title 49, Code of Federal Regulations
> (CFR), Part 18.36. AIP standards are generally described in FAA
> Advisory Circular (AC) 150/5100-6, Labor Requirements for the Airport
> Improvement Program, AC 150/5100-15, Civil Rights Requirements for the
> Airport Improvement Program, and AC 150/5100-16, Airport Improvement
> Program Grant Assurance One\--General Federal Requirements. Sponsors
> may use State and local procedures provided procurements conform to
> these Federal standards.
>
> Except for the certified items below marked not applicable (N/A), the
> list includes major requirements for this aspect of project
> implementation, although it is not comprehensive, nor does it relieve
> the sponsor from fully complying with all applicable statutory and
> administrative standards.

+----------------------------------------------------+-----+-----+-----+
|                                                    | Yes | No  | N/A |
+====================================================+=====+=====+=====+
| 1.  A code or standard of conduct is (will be) in  |     |     |     |
|     effect governing the performance of the        |     |     |     |
|     sponsor's officers, employees, or agents in    |     |     |     |
|     soliciting and awarding procurement contracts. |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 2.  Qualified personnel are (will be) engaged to   |     |     |     |
|     perform contract administration, engineering   |     |     |     |
|     supervision, construction inspection, and      |     |     |     |
|     testing.                                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 3.  The procurement was (will be) publicly         |     |     |     |
|     advertised using the competitive sealed bid    |     |     |     |
|     method of procurement.                         |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 4.  The bid solicitation clearly and accurately    |     |     |     |
|     describes (will describe):                     |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  The current Federal wage rate determination    |     |     |     |
|     for all construction projects, and             |     |     |     |
|                                                    |     |     |     |
| b.  All other requirements of the equipment and/or |     |     |     |
|     services to be provided.                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 5.  Concurrence was (will be) obtained from FAA    |     |     |     |
|     prior to contract award under any of the       |     |     |     |
|     following circumstances:                       |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  Only one qualified person/firm submits a       |     |     |     |
|     responsive bid,                                |     |     |     |
|                                                    |     |     |     |
| b.  The contract is to be awarded to other than    |     |     |     |
|     the lowest responsible bidder,                 |     |     |     |
|                                                    |     |     |     |
| c.  Life cycle costing is a factor in selecting    |     |     |     |
|     the lowest responsive bidder, or               |     |     |     |
|                                                    |     |     |     |
| d.  Proposed contract prices are more than 10      |     |     |     |
|     percent over the sponsor's cost estimate.      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 6.  All contracts exceeding \$100,000 require      |     |     |     |
|     (will require) the following provisions:       |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  A bid guarantee of 5 percent, a performance    |     |     |     |
|     bond of 100 percent, and a payment bond of 100 |     |     |     |
|     percent;                                       |     |     |     |
|                                                    |     |     |     |
| b.  Conditions specifying administrative,          |     |     |     |
|     contractual, and legal remedies, including     |     |     |     |
|     contract termination, for those instances in   |     |     |     |
|     which contractors violate or breach contact    |     |     |     |
|     terms; and                                     |     |     |     |
|                                                    |     |     |     |
| c.  Compliance with applicable standards and       |     |     |     |
|     requirements issued under Section 306 of the   |     |     |     |
|     Clean Air Act (42 USC 1857(h)), Section 508 of |     |     |     |
|     the Clean Water Act (33 USC 1368), and         |     |     |     |
|     Executive Order 11738.                         |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 7.  All construction contracts contain (will       |     |     |     |
|     contain) provisions for:                       |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  Compliance with the Copeland "Anti-Kick Back"  |     |     |     |
|     Act, and                                       |     |     |     |
|                                                    |     |     |     |
| b.  Preference given in the employment of labor    |     |     |     |
|     (except in executive, administrative, and      |     |     |     |
|     supervisory positions) to honorably discharged |     |     |     |
|     Vietnam era veterans and disabled veterans.    |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 8.  All construction contracts exceeding \$2,000   |     |     |     |
|     contain (will contain) the following           |     |     |     |
|     provisions:                                    |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  Compliance with the Davis-Bacon Act based on   |     |     |     |
|     the current Federal wage rate determination;   |     |     |     |
|     and                                            |     |     |     |
|                                                    |     |     |     |
| b.  Compliance with the Contract Work Hours and    |     |     |     |
|     Safety Standards Act (40 USC 327-330),         |     |     |     |
|     Sections 103 and 107.                          |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 9.  All construction contracts exceeding \$10,000  |     |     |     |
|     contain (will contain) appropriate clauses     |     |     |     |
|     from 41 CFR Part 60 for compliance with        |     |     |     |
|     Executive Orders 11246 and 11375 on Equal      |     |     |     |
|     Employment Opportunity.                        |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 10. All contracts and subcontracts contain (will   |     |     |     |
|     contain) clauses required from Title VI of the |     |     |     |
|     Civil Rights Act and 49 CFR 23 and 49 CFR 26   |     |     |     |
|     for Disadvantaged Business Enterprises.        |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 11. Appropriate checks have been (will be) made to |     |     |     |
|     assure that contracts or subcontracts are not  |     |     |     |
|     awarded to those individuals or firms          |     |     |     |
|     suspended, debarred, or voluntarily excluded   |     |     |     |
|     from doing business with any U.S. Department   |     |     |     |
|     of Transportation (DOT) element and appearing  |     |     |     |
|     on the DOT Unified List.                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+

> I certify, for the project identified herein, responses to the
> forgoing items are accurate as marked and have prepared documentation
> attached hereto for any item marked "no" that is correct and complete.

  -----------------------------------------------------------------------
       

  *(Name of Sponsor)*

  *(Signature of Sponsor's Designated Official Representative)*

       

  *(Typed Name of Sponsor's Designated Official Representative)*

       

  *(Typed Title of Sponsor's Designated Official Representative)*

       

  *(Date)*
  -----------------------------------------------------------------------

+---------------------+---+-----------------------+---+--------------------+
| U.S. DEPARTMENT OF  |   |                       |   |                    |
| TRANSPORTATION\     |   |                       |   |                    |
| FEDERAL AVIATION    |   |                       |   |                    |
| ADMINISTRATION      |   |                       |   |                    |
|                     |   |                       |   |                    |
| AIRPORT IMPROVEMENT |   |                       |   |                    |
| PROGRAM\            |   |                       |   |                    |
| SPONSOR             |   |                       |   |                    |
| CERTIFICATION       |   |                       |   |                    |
|                     |   |                       |   |                    |
| REAL PROPERTY       |   |                       |   |                    |
| ACQUISITION         |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
|                     |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
| *(Sponsor)*         |   | *(Airport)*           |   | *(Project Number)* |
+---------------------+---+-----------------------+---+--------------------+
|       *(Work        |   |                       |   |                    |
| Description)*       |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+

> Title 49, United States Code, section 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 real property acquisition and relocation assistance
> are in Title 49, Code of Federal Regulations (CFR), Part 24. The AIP
> project grant agreement contains specific requirements and assurances
> on the Uniform Relocation Assistance and Real Property Acquisition Act
> of 1970 (Uniform Act), as amended.
>
> Except for the certified items below marked not applicable (N/A), the
> list includes major requirements for this aspect of project
> implementation, although it is not comprehensive, nor does it relieve
> the sponsor from fully complying with all applicable statutory and
> administrative standards.

+----------------------------------------------------+-----+-----+-----+
|                                                    | Yes | No  | N/A |
+====================================================+=====+=====+=====+
| 1.  The sponsor's attorney or other official has   |     |     |     |
|     (will have) good and\                          |     |     |     |
|     sufficient title as well as title evidence on  |     |     |     |
|     property in the project.                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 2.  If defects and/or encumbrances exist in the    |     |     |     |
|     title that adversely\                          |     |     |     |
|     impact the sponsor's intended use of property  |     |     |     |
|     in the project, they\                          |     |     |     |
|     have been (will be) extinguished, modified, or |     |     |     |
|     subordinated.                                  |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 3.  If property for airport development is (will   |     |     |     |
|     be) leased, the\                               |     |     |     |
|     following conditions have been met:            |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  The term is for 20 years or the useful life of |     |     |     |
|     the project,                                   |     |     |     |
|                                                    |     |     |     |
| b.  The lessor is a public agency, and             |     |     |     |
|                                                    |     |     |     |
| c.  The lease contains no provisions that prevent  |     |     |     |
|     full compliance with the grant agreement.      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 4.  Property in the project is (will be) in        |     |     |     |
|     conformance with\                              |     |     |     |
|     the current Exhibit A property map, which is   |     |     |     |
|     based on deeds,\                               |     |     |     |
|     title opinions, land surveys, the approved     |     |     |     |
|     airport layout plan, and\                      |     |     |     |
|     project documentation.                         |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 5.  For any acquisition of property interest in    |     |     |     |
|     noise sensitive approach\                      |     |     |     |
|     zones and related areas, property interest was |     |     |     |
|     (will be) obtained to\                         |     |     |     |
|     ensure land is used for purposes compatible    |     |     |     |
|     with noise levels\                             |     |     |     |
|     associated with operation of the airport.      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 6.  For any acquisition of property interest in    |     |     |     |
|     runway protection zones and areas related to   |     |     |     |
|     14 CFR 77 surfaces, property interest was      |     |     |     |
|     (will be)obtained for the following:           |     |     |     |
|                                                    |     |     |     |
|     a.  The right of flight,                       |     |     |     |
|                                                    |     |     |     |
|     b.  The right of ingress and egress to remove  |     |     |     |
|         obstructions, and                          |     |     |     |
|                                                    |     |     |     |
|     c.  The right to restrict the establishment of |     |     |     |
|         future obstructions.                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 7.  Appraisals prepared by qualified real estate   |     |     |     |
|     appraisers hired by the sponsor include (will  |     |     |     |
|     include) the following:                        |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  Valuation data to estimate the current market  |     |     |     |
|     value for the property interest acquired on    |     |     |     |
|     each parcel, and                               |     |     |     |
|                                                    |     |     |     |
| b.  Verification that an opportunity has been      |     |     |     |
|     provided the property owner or representative  |     |     |     |
|     to accompany appraisers during inspections.    |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 8.  Each appraisal has been (will be) reviewed by  |     |     |     |
|     a qualified review appraiser to recommend an   |     |     |     |
|     amount for the offer of just compensation, and |     |     |     |
|     the written appraisals as well as review       |     |     |     |
|     appraisal are available to FAA for review.     |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 9.  A written offer to acquire each parcel was     |     |     |     |
|     (will be) presented to the property owner for  |     |     |     |
|     not less than the approved amount of just      |     |     |     |
|     compensation.                                  |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 10. Effort was (will be) made to acquire each      |     |     |     |
|     property through the following negotiation     |     |     |     |
|     procedures:                                    |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  No coercive action to induce agreement, and    |     |     |     |
|                                                    |     |     |     |
| b.  Supporting documents for settlements included  |     |     |     |
|     in the project files.                          |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 11. If a negotiated settlement is not reached, the |     |     |     |
|     following procedures were (will be) used:      |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  Condemnation initiated and a court deposit not |     |     |     |
|     less than the just compensation made prior to  |     |     |     |
|     possession of the property, and                |     |     |     |
|                                                    |     |     |     |
| b.  Supporting documents for awards included in    |     |     |     |
|     the project files.                             |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 12. If displacement of persons, businesses, farm   |     |     |     |
|     operations, or non-profit organizations is     |     |     |     |
|     involved, a relocation assistance program was  |     |     |     |
|     (will be) established, with displaced parties  |     |     |     |
|     receiving general information on the program   |     |     |     |
|     in writing, including relocation eligibility,  |     |     |     |
|     and a 90-day notice to vacate.                 |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 13. Relocation assistance services, comparable     |     |     |     |
|     replacement housing, and payment of necessary  |     |     |     |
|     relocation expenses were (will be) provided    |     |     |     |
|     within a reasonable time period for each       |     |     |     |
|     displaced occupant in accordance with the      |     |     |     |
|     Uniform Act.                                   |     |     |     |
+----------------------------------------------------+-----+-----+-----+

> I certify, for the project identified herein, responses to the
> forgoing items are accurate as marked and have prepared documentation
> attached hereto for any item marked "no" that is correct and complete.

  -----------------------------------------------------------------------
       

  *(Name of Sponsor)*

  *(Signature of Sponsor's Designated Official Representative)*

       

  *(Typed Name of Sponsor's Designated Official Representative)*

       

  *(Typed Title of Sponsor's Designated Official Representative)*

       

  *(Date)*
  -----------------------------------------------------------------------

+---------------------+---+-----------------------+---+--------------------+
| U.S. DEPARTMENT OF  |   |                       |   |                    |
| TRANSPORTATION\     |   |                       |   |                    |
| FEDERAL AVIATION    |   |                       |   |                    |
| ADMINISTRATION      |   |                       |   |                    |
|                     |   |                       |   |                    |
| AIRPORT IMPROVEMENT |   |                       |   |                    |
| PROGRAM\            |   |                       |   |                    |
| SPONSOR             |   |                       |   |                    |
| CERTIFICATION       |   |                       |   |                    |
|                     |   |                       |   |                    |
| CONSTRUCTION        |   |                       |   |                    |
| PROJECT FINAL       |   |                       |   |                    |
| ACCEPTANCE          |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
|                     |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
| *(Sponsor)*         |   | *(Airport)*           |   | *(Project Number)* |
+---------------------+---+-----------------------+---+--------------------+
|       *(Work        |   |                       |   |                    |
| Description)*       |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+

> Title 49, United States Code, section 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. General standards
> for final acceptance and close out of federally funded construction
> projects are in Title 49, Code of Federal Regulations, Part 18.50. The
> sponsor shall determine that project costs are accurate and proper in
> accordance with specific requirements of the grant agreement and
> contract documents.
>
> Except for the certified items below marked not applicable (N/A), the
> list includes major requirements for this aspect of project
> implementation, although it is not comprehensive, nor does it relieve
> the sponsor from fully complying with all applicable statutory and
> administrative standards.

+----------------------------------------------------+-----+-----+-----+
|                                                    | Yes | No  | N/A |
+====================================================+=====+=====+=====+
| 1.  The personnel engaged in project               |     |     |     |
|     administration, engineering supervision,       |     |     |     |
|     construction inspection and testing were (will |     |     |     |
|     be) determined to be qualified as well as      |     |     |     |
|     competent to perform the work.                 |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 2.  Daily construction records were (will be) kept |     |     |     |
|     by the resident engineer/construction          |     |     |     |
|     inspector as follows:                          |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  Work in progress,                              |     |     |     |
|                                                    |     |     |     |
| b.  Quality and quantity of materials delivered,   |     |     |     |
|                                                    |     |     |     |
| c.  Test locations and results,                    |     |     |     |
|                                                    |     |     |     |
| d.  Instructions provided the contractor,          |     |     |     |
|                                                    |     |     |     |
| e.  Weather conditions,                            |     |     |     |
|                                                    |     |     |     |
| f.  Equipment use,                                 |     |     |     |
|                                                    |     |     |     |
| g.  Labor requirements,                            |     |     |     |
|                                                    |     |     |     |
| h.  Safety problems, and                           |     |     |     |
|                                                    |     |     |     |
| i.  Changes required.                              |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 3.  Weekly payroll records and statements of       |     |     |     |
|     compliance were (will be) submitted by the     |     |     |     |
|     prime contractor and reviewed by the sponsor   |     |     |     |
|     for Federal labor and civil rights             |     |     |     |
|     requirements (Advisory Circulars 150/5100-6    |     |     |     |
|     and 150/5100-15).                              |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 4.  Complaints regarding the mandated Federal      |     |     |     |
|     provisions set forth in the contract documents |     |     |     |
|     have been (will be) submitted to the FAA.      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 5.  All tests specified in the plans and           |     |     |     |
|     specifications were (will be) performed and    |     |     |     |
|     the test results documented as well as made    |     |     |     |
|     available to the FAA.                          |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 6.  For any test results outside of allowable      |     |     |     |
|     tolerances, appropriate corrective actions     |     |     |     |
|     were (will be) taken.                          |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 7.  Payments to the contractor were (will be) made |     |     |     |
|     in compliance with contract provisions as      |     |     |     |
|     follows:                                       |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| a.  Payments are verified by the sponsor's         |     |     |     |
|     internal audit of contract records kept by the |     |     |     |
|     resident engineer, and                         |     |     |     |
|                                                    |     |     |     |
| b.  If appropriate, pay reduction factors required |     |     |     |
|     by the specifications are applied in computing |     |     |     |
|     final payments and a summary of pay reductions |     |     |     |
|     made available to the FAA.                     |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 8.  The project was (will be) accomplished without |     |     |     |
|     significant deviations, changes, or            |     |     |     |
|     modifications from the approved plans and      |     |     |     |
|     specifications, except where approval is       |     |     |     |
|     obtained from the FAA.                         |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 9.  A final project inspection was (will be)       |     |     |     |
|     conducted with representatives of the sponsor  |     |     |     |
|     and the contractor and project files contain   |     |     |     |
|     documentation of the final inspection.         |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 10. Work in the grant agreement was (will be)      |     |     |     |
|     physically completed and corrective actions    |     |     |     |
|     required as a result of the final inspection   |     |     |     |
|     is completed to the satisfaction of the        |     |     |     |
|     sponsor.                                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 11. If applicable, the as-built plans, an          |     |     |     |
|     equipment inventory, and a revised airport     |     |     |     |
|     layout plan have been (will be) submitted to   |     |     |     |
|     the FAA.                                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 12. Applicable close out financial reports have    |     |     |     |
|     been (will be) submitted to the FAA.           |     |     |     |
+----------------------------------------------------+-----+-----+-----+

> I certify, for the project identified herein, responses to the
> forgoing items are accurate as marked and have prepared documentation
> attached hereto for any item marked "no" that is correct and complete.

+-----------------------------------------------------------------------+
| >                                                                     |
+-----------------------------------------------------------------------+
| > *(Name of Sponsor)*                                                 |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| > *(Signature of Sponsor's Designated Official Representative)*       |
+-----------------------------------------------------------------------+
| >                                                                     |
+-----------------------------------------------------------------------+
| > *(Typed Name of Sponsor's Designated Official Representative)*      |
+-----------------------------------------------------------------------+
| >                                                                     |
+-----------------------------------------------------------------------+
| > *(Typed Title of Sponsor's Designated Official Representative)*     |
+-----------------------------------------------------------------------+
| >                                                                     |
+-----------------------------------------------------------------------+
| > *(Date)*                                                            |
+-----------------------------------------------------------------------+

+---------------------+---+-----------------------+---+--------------------+
| U.S. DEPARTMENT OF  |   |                       |   |                    |
| TRANSPORTATION\     |   |                       |   |                    |
| FEDERAL AVIATION    |   |                       |   |                    |
| ADMINISTRATION      |   |                       |   |                    |
|                     |   |                       |   |                    |
| AIRPORT IMPROVEMENT |   |                       |   |                    |
| PROGRAM\            |   |                       |   |                    |
| SPONSOR             |   |                       |   |                    |
| CERTIFICATION       |   |                       |   |                    |
|                     |   |                       |   |                    |
| DRUG-FREE WORKPLACE |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
|                     |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+
| *(Sponsor)*         |   | *(Airport)*           |   | *(Project Number)* |
+---------------------+---+-----------------------+---+--------------------+
|       *(Work        |   |                       |   |                    |
| Description)*       |   |                       |   |                    |
+---------------------+---+-----------------------+---+--------------------+

> Title 49, United States Code, section 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 Title 49, Code of Federal Regulations, Part 29.
> 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.
>
> Except for the certified items below marked not applicable (N/A), the
> list includes major requirements for this aspect of project
> implementation, although it is not comprehensive, nor does it relieve
> the sponsor from fully complying with all applicable statutory and
> administrative standards.

+----------------------------------------------------+-----+-----+-----+
|                                                    | Yes | No  | N/A |
+====================================================+=====+=====+=====+
| 1.  A statement has been (will be) published       |     |     |     |
|     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.  An ongoing drug-free awareness program has     |     |     |     |
|     been (will be)\                                |     |     |     |
|     established to inform employees about:         |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| 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.                              |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 3.  Each employee to be engaged in the performance |     |     |     |
|     of the work has been (will be) given a copy of |     |     |     |
|     the statement required within item 1 above.    |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 4.  Employees have been (will be) notified in the  |     |     |     |
|     statement required by item 1 above that, as a  |     |     |     |
|     condition employment under the grant, the      |     |     |     |
|     employee will:                                 |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| 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. |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 5.  The FAA will be notified in writing within ten |     |     |     |
|     calendar days after receiving notice under     |     |     |     |
|     item 4b above from an employee or otherwise    |     |     |     |
|     receiving actual notice of such conviction.    |     |     |     |
|     Employers of convicted employees must provide  |     |     |     |
|     notice, including position title of the        |     |     |     |
|     employee, to the FAA. Notices shall include    |     |     |     |
|     the project number of each affected grant.     |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 6.  One of the following actions will be taken     |     |     |     |
|     within 30 calendar days of receiving a notice  |     |     |     |
|     under item 4b above with respect to any        |     |     |     |
|     employee who is so convicted:                  |     |     |     |
|                                                    |     |     |     |
| ```{=html}                                         |     |     |     |
| <!-- -->                                           |     |     |     |
| ```                                                |     |     |     |
| 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; or     |     |     |     |
|                                                    |     |     |     |
| b.  Require such employee to participate           |     |     |     |
|     satisfactorily in a drug abuse assistance or   |     |     |     |
|     rehabilitation program approved for such       |     |     |     |
|     purposes by a Federal, State, or local health, |     |     |     |
|     law enforcement, or other appropriate agency.  |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 7.  A good faith effort will be made to continue   |     |     |     |
|     to maintain a drug-free workplace through      |     |     |     |
|     implementation of items 1 through 6 above.     |     |     |     |
+----------------------------------------------------+-----+-----+-----+

> I have prepared documentation attached hereto with site(s) for
> performance of work (street address, city, county, state, zip code).
> There are no such workplaces that are not identified in the
> attachment. I have prepared additional documentation for any above
> items marked "no" and attached it hereto. I certify that, for the
> project identified herein, responses to the forgoing items are
> accurate as marked and attachments are correct and complete.

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  *(Name of Sponsor)*

  *(Signature of Sponsor's Designated Official Representative)*

       

  *(Typed Name of Sponsor's Designated Official Representative)*

       

  *(Typed Title of Sponsor's Designated Official Representative)*

       

  *(Date)*
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