June 28, 2005 Order 5100.38C 

Appendices 

June 28, 2005 Appendix 1. Non-Allowable Items Order 5100.38C

Page 241

Listed below are items that have been found to be non-allowable under the grant program. While some 

have been declared non-allowable through a legal opinion, most have been found non-allowable because of 

policy determination: 

 1. Computer hardware in planning projects; 

 2. Wildlife hazard management plans, except where airport development may result; 

 3. Surface transportation origin-destination surveys; 

 4. Acquisition of communication systems, except that used for safety/security; 

 5. Installation of airport surface detection systems, except relocation for an approved AIP project; 

 6. Installation of an instrument landing system, except after coordination with APP-520. 

 7. Installation of hangars or fuel farms at other than nonprimary and Military Airport Program airports; 

 8. Constructing roads, whatever length, exclusively for the purpose of connecting public parking facilities to 

an access road; 

 9. Construction of roads serving principally industrial or non-aviation areas or facilities; 

10. Construction of maintenance/service facilities, except that allowed to service snow removal equipment 

and required aircraft rescue and fire fighting equipment; 

11. Landscaping, unless an incidental part of an eligible project; and 

12. Demonstration programs for noise compatibility purposes. 

Page 1 of 1 
Order 5100.38C Appendix 1. Non-Allowable Items June 28, 2005

Page 242 

This page left intentionally blank. 
June 28, 2005 Appendix 2. Reserved Order 5100.38C

Page 243

Reserved 

Page 1 of 1 
Order 5100.38C Appendix 2. Reserved June 28, 2005

Page 244 

This page left intentionally blank. 
June 28, 2005 Appendix 3. Standard Form 424 Order 5100.38C

Page 245

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf424.pdf.

Page 1 of 2 
Order 5100.38C Appendix 3. Standard Form 424 June 28, 2005

Page 246 

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf424.pdf.

Page 2 of 2 
June 28, 2005 Appendix 4. Part II – Project Approval Information (FAA Form 

5100-100) (Development Projects) Order 5100.38C

Page 247

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

PART II 

PROJECT APPROVAL INFORMATION 

SECTION A 

Item 1. 

Does this assistance request require State, 

local, regional, or other priority rating?

Yes No 

Name of Governing Body 

Priority 

Item 2. 

Does this assistance request require State, local 

advisory, educational or health clearances?

Yes No 

Name of Agency or Board 

(Attach Documentation) 

Item 3. 

Does this assistance request require clearinghouse 

review in accordance with OMB Circular A-95?

Yes No 

(Attach Comments) 

Item 4. 

Does this assistance request require State, 

local, regional, or other planning approval?

Yes No 

Name of Approving Agency 

Date / / 

Item 5. 

Is the proposed project covered by an approved 

comprehensive plan?

Yes No 

Check One: State 

 Local 

 Regional 

Location of plan 

Item 6. 

Will the assistance requested serve a 

Federal installation?

Yes No 

Name of Federal Installation 

Federal Population benefiting from Project 

Item 7. 

Will the assistance requested be on Federal land 

or installation?

Yes No 

Name of Federal Installation 

Location of Federal Land 

Percent of Project 

Item 8. 

Will the assistance requested have an impact 

or effect on the environment?

Yes No 

See instructions for additional information to be 

provided. 

Item 9. 

Will the assistance requested cause the displacement 

of individuals, families, businesses, or farms? 

Number of: 

 Individuals 

 Families 

 Businesses 

Yes No Farms 

See instructions for additional information to be 

provided. 

Item 10. 

Is there other related Federal assistance on this 

project previous, pending, or anticipated?

Yes No 

FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 Page 2 

Note: You can find a fillable PDF version of this form at http://forms.faa.gov/. To access this form, type in the form number. Please be sure to 

view the form processing instructions by selecting the “Information” icon link.

Page 1 of 10 
Order 5100.38C Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) June 28, 2005

Page 248 

INSTRUCTIONS 

PART II 

SECTION A 

Negative answers will not require an explanation unless the Federal agency requests more information at a later date. Provide 

supplementary data for all “Yes” answers in the space provided in accordance with the following instructions. 

Item 1. – Provide the name of the governing body 

establishing the priority system and the priority rating 

assigned to this project. 

Item 2. – Provide the name of the agency or board which 

issued the clearance and attach the documentation of 

status or approval. 

Item 3. – Attach the clearinghouse comments for the 

application in accordance with the instructions contained 

in Office of Management and Budget Circular No. A-95. If 

comments were submitted previously with a 

preapplication, do not submit them again but any 

additional comments received from the clearinghouse 

should be submitted with this application. 

Item 4. – Furnish the name of the approving agency and 

the approval date. 

Item 5. – Show whether the approved comprehensive plan 

is State, local or regional, or if none of these, explain the 

scope of the plan. Give the location where the approved 

plan is available for examination and state whether this 

project is in conformance with the plan. 

Item 6. – Show the Federal population residing or working 

on the federal installation who will benefit from this project. 

Item 7. – Show the percentage of the project work that will 

be conducted on federally owned or leased land. Give the 

name of the Federal installation and its location. 

Item 8. – Briefly describe the possible beneficial and/or 

harmful impact on the environment because of the 

proposed project. If an adverse environmental impact is 

anticipated, explain what action will be taken to minimize 

the impact. Federal agencies will provide separate 

instructions if additional data is needed. 

Item 9. – State the number of individuals, families, 

businesses, or farms this project will displace. Federal 

agencies will provide separate instructions if additional 

data is needed. 

Item 10. – Show the Federal Domestic Assistance Catalog 

number, the program name, the type of assistance, the 

status and amount of each project where there is related 

previous, pending, or anticipated assistance. Use 

additional sheets, if needed. 

Paperwork Reduction Act Statement: The information collected on this form allows sponsors of public 

use airports or public agencies to apply for one or more projects in a form prescribed by the Secretary of 

Transportation. 

Title 49, United States Code (U.S.C.), Section 47105, identifies the information required to apply for this 

program. The forms prescribed to meet this requirement are developed to provide a comprehensive 

format that allows sponsors to provide the data needed to evaluate the request for funds. The burden for 

each response is estimated to be 28 hours. Approved applications benefit the sponsor by providing 

Federal funding to protect the Federal interest in safety, efficiency, and utility of the Nation’s airport 

system. No assurance of confidentiality can be given since these become public records. If you wish to 

make any comments concerning the accuracy of this burden estimate or any suggestions for reducing 

this burden, send to Federal Aviation Administration, ARP-10, 800 Independence AVE, SW, Washington, 

DC 20591. Please note that an agency may not conduct or sponsor, and a person is not required to 

respond to, a collection of information unless it displays a currently valid OMB control number, which is 

2120-0569 for this collection. 

Page 2 of 10 
June 28, 2005 Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) Order 5100.38C

Page 249

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

PART II – SECTION C 

The Sponsor hereby represents and certifies as follows: 

1. Compatible Land Use. – The Sponsor has taken the following actions to assure compatible usage of land 

adjacent to or in the vicinity of the airport: 

2. Defaults. – The Sponsor is not in default on any obligation to the United States or any agency of the United 

States Government relative to the development, operation, or maintenance of any airport, except as stated 

herewith: 

3. Possible Disabilities. – There are no facts or circumstances (including the existence of effective or proposed 

leases, use agreements or other legal instruments affecting use of the Airport or the existence of pending 

litigation or other legal proceedings) which in reasonable probability might make it impossible for the Sponsor to 

carry out and complete the Project or carry out the provisions of Part V of this Application, either by limiting its 

legal or financial ability or otherwise, except as follows: 

4. Land. – (a) The sponsor holds the following property interest in the following areas of land* which are to be 

developed or used as part of or in connection with the Airport subject to the following exceptions, 

encumbrances, and adverse interests, all of which areas are identified on the aforementioned property map 

designated as Exhibit “A”: 

*State character of property interest in each area and list and identify for each all exceptions, encumbrances, and 

adverse interests of every kind and nature, including liens, easements, leases, etc. The separate areas of land 

need only be identified here by the area numbers shown on the property map. 

FAA Form 5100-100 (4-76) Page 3a 

Page 3 of 10 
Order 5100.38C Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) June 28, 2005

Page 250 

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

PART II – SECTION C (CONTINUED)

The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company 

and that such attorney or title company has determined that the Sponsor holds the above property interests. 

 (b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any 

construction work under the Project, the following property interest in the following areas of land* on which such 

construction work is to be performed, all of which areas are identified on the aforementioned property map 

designated as Exhibit “A”: 

 (c) The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all 

construction work under the Project, the following property interest in the following areas of land* which are to 

be developed or used as part of or in connection with the Airport as it will be upon completion of the Project, all 

of which areas are identified on the aforementioned property map designated as Exhibit “A”: 

5. Exclusive Rights. – There is no grant of an exclusive right for the conduct of any aeronautical activity at 

any airport owned or controlled by the Sponsor except as follows: 

*State character of property interest in each area and list and identify for each all exceptions, encumbrances, and 

adverse interests of every kind and nature, including liens, easements, leases, etc. The separate areas of land 

need only be identified here by the area numbers shown on the property map. 

FAA Form 5100-100 (4-76) Page 3b 

Page 4 of 10 
June 28, 2005 Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) Order 5100.38C

Page 251

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

PART III – BUDGET INFORMATION – CONSTRUCTION 

SECTION A – GENERAL 

1. Federal Domestic Assistance Catalog No. 

2. Functional or Other Breakout 

SECTION B - CALCULATION OF FEDERAL GRANT 

Use only for revisions 

Cost Classification Latest Approved 

amount Adjustment + or (-) 

Total Amount 

Required

1. Administration expense $ $ $ 

2. Preliminary expense 

3. Land, structures, right-of-way 

4. Architectural engineering basic fees 

5. Other architectural engineering fees 

6. Project inspection fees 

7. Land development 

8. Relocation expenses 

9. Relocation payments to individuals and 

businesses 

10. Demolition and removal 

11. Construction and project improvement 

12. Equipment 

13. Miscellaneous 

14. Total (Lines 1 through 13) 

15. Estimated Income (if applicable) 

16. Net Project Amount (Line 14 minus 15) 

17. Less: Ineligible Exclusions 

18. Add: Contingencies 

19. Total Project Amt. (Excluding Rehabilitation 

Grants) 

20. Federal Share requested of Line 19 

21. Add Rehabilitation Grants Requested 

(100 percent) 

22. Total Federal grant requested (Lines 20 & 21) 

23. Grantee share 

24. Other shares 

25. Total project (Lines 22, 23, & 24) $ $ $ 

FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 Page 4 

Page 5 of 10 
Order 5100.38C Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) June 28, 2005

Page 252

INSTRUCTIONS 

PART III 

SECTION A. GENERAL

1. Show the Federal Domestic Assistance Catalog Number 

from which the assistance is requested. When more than 

one program or Catalog Number is involved and the amount 

cannot be distributed to the Federal grant program or catalog 

number on an over-all percentage basis, prepare a separate 

set of Part III forms for each program or Catalog Number. 

However, show the total amounts for all programs in Section 

B of the basic application form. 

2. Show the functional or other categorical breakouts, if 

required by the Federal grantor agency. Prepare a separate 

set of Part III forms for each category. 

SECTION B. CALCULATION OF FEDERAL GRANT

When applying for a new grant, use the Total Amount Column only. When requesting revisions of previously awarded 

amounts, use all columns. 

Line 12 - Enter amounts for equipment both fixed and 

movable exclusive of equipment used in construction. For 

example, include amounts for permanently attached laboratory tables, built-in audio visual systems, movable desks, 

chairs, and laboratory equipment. 

Line 1 - Enter amounts needed for administration expenses 

including such items as travel, legal fees, rental of vehicles 

and any other expense items expected to be incurred to 

administer the grant. Include the amount of interest expense 

when authorized by program legislation and also show this 

amount under Section E Remarks. Line 13 - Enter amounts for items not specifically mentioned 

Line 2 - Enter amounts pertaining to the work of locating and above. 

designing, making surveys and maps, sinking test holes, and 

all other work required prior to actual construction. Line 14 - Enter the sum of Lines 1-13. 

Line 15 - Enter the estimated amount of program income that 

will be earned during the grant period and applied to the 

program. 

Line 3 - Enter amounts directly associated with the 

acquisition of land, existing structures, and related right-ofway. 

Line 16 - Enter the difference between the amount on Line 

14 and the estimated income shown on Line 15. Line 4 - Enter basic fees for architectural engineering 

services. 

Line 17 - Enter the amounts for those items which are a part 

of the project but not subject to Federal participation (See 

Section C, Line 26g, Column (1)). 

Line 5 - Enter amounts for other architectural engineering 

services, such as surveys, tests, and borings. 

Line 6 - Enter fees for inspection and audit of construction 

and related programs. Line 18 - Enter the estimated amount for contingencies. 

Compute this amount as follows. Subtract from the net 

project amount shown on Line 16 the ineligible project 

exclusions shown on Line 17 and the amount which is 

excluded from the contingency provisions shown in Section 

C, Line 26g, Column (2). Multiply the computed amount by 

the percentage factor allowed by the grantor agency in 

accordance with the Federal program guidance. For those 

grants which provide for a fixed dollar allowance in lieu of a 

percentage allowance, enter the dollar amount of this 

allowance. 

Line 7 - Enter amounts associated with the development of 

land where the primary purpose of the grant is land 

improvement. Site work normally associated with major 

construction should be excluded from this category and 

shown on line 11. 

Line 8 - Enter the dollar amounts needed to provide relocation 

advisory assistance, and the net amounts for replacement (last 

resort) housing. Do not include relocation administration 

expenses on this Line; include them on Line 1. 

Line 19 - Show the total amount of Lines 16, 17, and 18. 

(This is the amount to which the matching share ratio prescribed in program legislation is applied.) 

Line 9 - Enter the estimated amount of relocation payments 

to be made to displaced persons, business concerns, and 

non-profit organizations for moving expenses and 

replacement housing. Line 20 - Show the amount of Federal funds requested 

exclusive of funds for rehabilitation purposes. Line 10 - Enter the gross salaries and wages of employees 

of the grantee who will be directly engaged in performing 

demolition or removal of structures from developed land. 

This line should show also the cost of demolition or 

removal of improvements on developed land under a third 

party contract. Reduce the costs on this line by the amount 

of expected proceeds from the sale of salvage, if so 

instructed by the Federal grantor agency. Otherwise, show 

the proceeds on Line 15. 

Line 21 - Enter the estimated amounts needed for 

rehabilitation expense if rehabilitation grants to individuals 

are made for which grantees are reimbursed 100 percent by 

the Federal grantor agency in accordance with program 

legislation. If the grantee shares in part of this expense, 

show the total amount on Line 13 instead of on Line 21 and 

explain in Section E. 

Line 22 - Show the total amount of the Federal grant reLine 11 - Enter amounts for the actual construction of, quested. 

addition to, or restoration of a facility. Also, include in this 

category the amounts of project improvements such as 

sewers, streets, landscaping, and lighting. 

Line 23 - Show the amount from Section D, Line 27h. 

Line 24 - Show the amount from Section D, Line 28c. 

Line 25 - Self-explanatory. 

Page 6 of 10 
June 28, 2005 Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) Order 5100.38C

Page 253

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

SECTION C - EXCLUSIONS 

Ineligible for 

Participation 

Excluded from 

Contingency Provision 

26. Classification (1) (2) 

a. $ $ 

b. 

c. 

d. 

e. 

f. 

g. Totals $ $ 

SECTION D - PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE 

27. Grantee Share $ 

a. Securities 

b. Mortgages 

c. Appropriations (By Applicant) 

d. Bonds 

e. Tax Levies 

f. Non Cash 

g. Other (Explain) 

h. Total – Grantee Share 

28. Other Shares 

a. State 

b. Other 

c. Total Other Shares 

29. TOTAL $ 

SECTION E - REMARKS 

 

PART IV - PROGRAM NARRATIVE (ATTACH – SEE INSTRUCTIONS)

FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 PAGE 5 

Page 7 of 10 
Order 5100.38C Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) June 28, 2005

Page 254

INSTRUCTIONS 

PART III

SECTION C. EXCLUSIONS Line 27h - Show the total of Lines 27 a-g. This amount must 

equal the amount shown in Section B, Line 23. Line 26 a-g - Identify and list those costs in Column (1) 

which are part of the project cost but are not subject to 

Federal participation because of program legislation or 

Federal grantor agency instructions. The total amount on 

Line g should agree with the amount shown on Line 17 of 

Section B. Show in Column (2) those project costs that are 

subject to Federal participation but are not eligible for 

inclusion in the amount used to compute contingency 

amounts as provided in the Federal grantor agency 

instructions. 

Line 28a - Show the amount that will be contributed by a 

State or state agency, only if the applicant is not a State or 

state agency. If there is a noncash contribution, explain what 

the contribution will consist of under Section E Re-marks. 

Line 28b - Show the amount that will be contributed from 

other sources. If there is a noncash contribution, explain 

what the contribution will consist of under Section E Remarks. 

SECTION D. PROPOSED METHOD OF FINANCING 

NON-FEDERAL SHARE

Line 28c - Show the total of Lines 28a and 28b. This amount 

must be the same as the amount shown in Section B, 

Line 27 a-g - Line 24. Show the source of the grantee’s share. If 

cash is not immediately available, specify the actions 

completed to date and those actions remaining to make cash 

available under Section E Remarks. Indicate also the period 

of time that will be required after execution of the grant 

agreement to obtain the funds. If there is a noncash 

contribution, explain what this contribution will consist of. 

Line 29 - Enter the totals of Line 27h and 28c. 

SECTION E. OTHER REMARKS

Make any remarks pertinent to the project and provide any 

other information required by these instructions or the grantor 

agency. Attach additional sheets, if necessary. 

Page 8 of 10 
June 28, 2005 Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) Order 5100.38C

Page 255

PART IV 

PROGRAM NARRATIVE 

(Suggested Format) 

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

PROJECT: 

AIRPORT: 

1. Objective: 

2. Benefits Anticipated: 

3. Approach: (See approved Scope of Work in final Application)

 

4. Geographic Location: 

5. If Applicable, Provide Additional Information: 

6: Sponsor’s Representative: (incl. address & tel. no.)

 

FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 PAGE 6 

Page 9 of 10 
Order 5100.38C Appendix 4. Part II – Project Approval Information 

(FAA Form 5100-100) (Development Projects) June 28, 2005

Page 256 

INSTRUCTIONS 

PART IV 

PROGRAM NARRATIVE

Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests 

for supplemental assistance should be responsive to Item 5b only. Requests for continuation or refunding or other changes of 

an approved project should be responsive to Item 5c only.

1. OBJECTIVES AND NEED FOR THIS ASSISTANCE. 4. GEOGRAPHIC LOCATION. 

Pinpoint any relevant physical, economic, social, financial, 

institutional, or other problems requiring a solution. 

Give a precise location of the project and area to be served 

by the proposed project. Maps or other graphic aids may be 

attached. 

Demonstrate the need for assistance and state the principal and 

subordinate objectives of the project. Supporting documentation 

or other testimonies from concerned interests other than the 

applicant may be used. Any relevant data based on 

planning studies should be included or footnoted. 

5. IF APPLICABLE, PROVIDE THE FOLLOWING 

INFORMATION: 

a. Describe the relationship between this project and other 

work planned, anticipated, or underway under the Federal 

2. RESULTS OR BENEFITS EXPECTED. Assistance listed under Part II, Section A, Item 10. 

b. Explain the reason for all requests for supplemental 

assistance and justify the need for additional funding. 

Identify results and benefits to be derived. For example, 

include a description of who will occupy the facility and show 

how the facility will be used. For land acquisition or 

development projects, explain how the project will benefit 

the public. 

c. Discuss accomplishments to date and list in 

chronological order a schedule of accomplishments, 

progress, or milestones anticipated with the new funding request. If there have been significant changes in the project 

objectives, location, approach or time delays, explain and 

justify. For other requests for changes or amendments, 

explain the reason for the change(s). If the scope or 

objectives have changed or an extension of time is 

necessary, explain the circumstances and justify. If the total 

budget has been exceeded or if individual budget items 

have changed more than the prescribed limits contained in 

Attachment K, Office of Management and Budget Circular 

No. A-102, explain and justify the change and its effect on 

the project. 

APPROACH 

a. Outline a plan of action pertaining to the scope and 

detail of how the proposed work will be accomplished for 

each grant program. Cite factors which might accelerate or 

decelerate the work, and your reason for taking this approach 

as opposed to others. Describe any unusual features of the 

project such as design or technological innovations, 

reductions in cost or time, or extraordinary social and 

community involvements. 

b. Provide each grant program monthly or quarterly 

quantitative projections of the accomplishments to be 

achieved, if possible. When accomplishments cannot be 

quantified, list the activities in chronological order to show 

the schedule of accomplishments and their target dates. 

c. Identify the kinds of data to be collected and maintained, 

and discuss the criteria to be used to evaluate the results 

and success of the project. Explain the methodology that 

will be used to determine if the needs identified and 

discussed are being met and if the results and benefits 

identified in Item 2 are being achieved. 

d. List each organization, cooperator, consultant, or other 

key individuals who will work on the project along with a 

short description of the nature of their effort or contribution. 

Page 10 of 10 
June 28, 2005 Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) Order 5100.38C

Page 257

DEPARTMENT OF TRANSPORTATION – FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

PART II 

PROJECT APPROVAL INFORMATION 

Item 1. Name of Governing Body 

Does this assistance request require State, 

local, regional, or other priority rating? 

Priority 

Yes No 

Item 2. Name of Agency or Board 

Does this assistance request require State, local 

advisory, educational or health clearances? 

(Attach Documentation) 

Yes No 

Item 3. (Attach Comments) 

Does this assistance request require clearinghouse 

review in accordance with OMB Circular A-95? 

Yes No 

Name of Approving Agency 

Date 

Item 4. 

Does this assistance request require State, 

local, regional, or other planning approval? 

Yes No 

Check One: State 

 Local 

Item 5. 

 Regional Is the proposed project covered by an approved 

comprehensive plan? 

Yes No Location of plan 

Item 6. Name of Federal Installation 

Will the assistance requested serve a Federal Population benefiting from Project 

Federal installation? 

Yes No 

Item 7. Name of Federal Installation 

Will the assistance requested be on Federal land 

or installation? 

Location of Federal Land 

Percent of Project 

Yes No 

See instructions for additional information to be 

provided. 

Item 8. 

Will the assistance requested have an impact 

or effect on the environment? 

Yes No 

Item 9. Number of: 

Will the assistance requested cause the displacement Individuals 

of individuals, families, businesses, or farms? Families 

 Businesses 

Yes No Farms 

See instructions for additional information to be 

provided. 

Item 10. 

Is there other related Federal assistance on this 

project previous, pending, or anticipated? 

Yes No 

FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 59 10-1 and 59 20-1 Page 2 

Note: You can find a fillable PDF version of this form at http://forms.faa.gov/. To access this form, type in the form number. Please be sure to 

view the form processing instructions by selecting the “Information” icon link.

Page 1 of 8 
Order 5100.38C Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) June 28, 2005

Page 258 

INSTRUCTIONS 

PART II 

Negative answers will not require an explanation unless the Federal agency requests more information at a later date. Provide 

supplementary data for all “Yes” answers in the space provided in accordance with the following instructions. 

Item 6. – Show the Federal population residing or working 

on the federal installation that will benefit from this project. 

Item 1. – Provide the name of the governing body 

establishing the priority system and the priority rating 

assigned to this project. Item 7. – Show the percentage of the project work that will 

be conducted on federally-owned or leased land. Give the 

name of the Federal installation and its location. 

Item 2. – Provide the name of the agency or board which 

issued the clearance and attach the documentation of 

status or approval. Item 8. – Briefly describe the possible beneficial and/or 

harmful impact on the environment because of the 

proposed project. If an adverse environmental impact is 

anticipated, explain what action will be taken to minimize 

the impact. Federal agencies will provide separate 

instructions if additional data is needed. 

Item 3. – Attach the clearinghouse comments for the 

application in accordance with the instructions contained 

in Office of Management and Budget Circular No. A-95. If 

comments were submitted previously with a 

preapplication, do not submit them again but any 

additional comments received from the clearinghouse 

should be submitted with this application. Item 9. – State the number of individuals, families, 

businesses, or farms this project will displace. Federal 

agencies will provide separate instructions if additional 

data is needed. 

Item 4. – Furnish the name of the approving agency and 

the approval date. 

Item 5. – Show whether the approved comprehensive plan 

is State, local or regional, or if none of these, explain the 

scope of the plan. Give the location where the approved 

plan is available for examination and state whether this 

project is in conformance with the plan. 

Item 10. – Show the Federal Domestic Assistance Catalog 

number, the program name, the type of assistance, the 

status, and amount of each project where there is related 

previous, pending, or anticipated assistance. Use 

additional sheets, if needed. 

Paperwork Reduction Act Statement: The information collected on this form allows sponsors of public 

use airports or public agencies to apply for one or more projects in a form prescribed by the Secretary of 

Transportation. 

Title 49, United States Code (U.S.C.), Section 47105, identifies the information required to apply for this 

program. The forms prescribed to meet this requirement are developed to provide a comprehensive 

format that allows sponsors to provide the data needed to evaluate the request for funds. The burden for 

each response is estimated to be 28 hours. Approved applications benefit the sponsor by providing 

Federal funding to protect the Federal interest in safety, efficiency, and utility of the Nation’s airport 

system. No assurance of confidentiality can be given since these become public records. If you wish to 

make any comments concerning the accuracy of this burden estimate or any suggestions for reducing 

this burden, send to Federal Aviation Administration, ARP-10, 800 Independence AVE, SW, Washington, 

DC 20591. Please note that an agency may not conduct or sponsor, and a person is not required to 

respond to, a collection of information unless it displays a currently valid OMB control number, which is 

2120-0569 for this collection. 

Page 2 of 8 
June 28, 2005 Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) Order 5100.38C

Page 259

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569

PART III - BUDGET INFORMATION 

SECTION A - BUDGET SUMMARY 

Grant Program, 

Function 

or Activity 

Federal 

Catalog No. Estimated Unobligated Funds New or Revised Budget 

Federal Non-Federal Federal Non-Federal Total 

(a) (b) (c) (d) (e) (f) (g) 

1. $ $ $ $ $ 

2. 

3. 

4. 

5. TOTALS $ $ $ $ $ 

SECTION B - BUDGET CATEGORIES 

6. Object Class Grant Program, Function or Activity Total 

 Categories (1) (2) (3) (4) (5) 

a. Personnel $ $ $ $ $ 

b. Fringe Benefits 

c. Travel 

d. Equipment 

e. Supplies 

f. Contractual 

g. Construction 

h. Other 

i. Total Direct Charges 

j. Indirect Charges 

k. TOTALS $ $ $ $ $ 

l. Program Income $ $ $ $ $ 

FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1 Page 3

Page 3 of 8 
Order 5100.38C Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) June 28, 2005

Page 260 

INSTRUCTIONS 

PART III 

GENERAL INSTRUCTIONS

This form is designed so that application can be made for funds from one or more grant programs. In preparing the budget, 

adhere to any existing Federal grantor agency guidelines which prescribe how and whether budgeted amounts should be 

separately shown for different functions or activities within the program. For some programs, grantor agencies may require 

budgets to be separately shown by function or activity. For other programs, grantor agencies may not require a breakdown by 

function or activity. Sections A, B, C, and D should include budget estimates for the whole project except when applying for 

assistance which requires Federal authorization in annual or other funding period increments. In the latter case, Sections A, 

B, C, and D should provide the budget for the first budget period (usually a year) and Section E should present the need for 

Federal assistance in the subsequent budget periods. All applications should contain a breakdown by the object class 

categories shown in Lines a-k of Section B.

SECTION A. BUDGET SUMMARY

Lines 1-4, Columns (a) and (b). 

For applications pertaining to a single Federal grant program (Federal Domestic Assistance Catalog number) and 

not requiring a functional or activity breakdown, enter on 

Line 1 under Column (a) the catalog program title and the 

catalog number in Column (b). 

For applications pertaining to a single program requiring 

budget amounts by multiple functions of activities, enter 

the name of each activity or function on each line in 

Column (a), and enter the catalog number in Column (b). 

For applications pertaining to multiple programs where 

none of the programs requires a breakdown by function or 

activity, enter the catalog program title on each line in 

Column (a) and the respective catalog number on each 

line in Column (b). 

For applications pertaining to multiple programs where 

one or more programs require a breakdown by function or 

activity, prepare a separate sheet for each program 

requiring the breakdown. Additional sheets should be 

used when one form does not provide adequate space for 

all breakdown of data required. However, when more than 

one sheet is used, the first page should provide the 

summary totals by programs. 

Lines 1-4, Columns (c) through (g). 

For new applications, leave Columns (c) and (d) blank. 

For each line entry in Columns (a) and (b), enter in 

Columns (e), (f), and (g) the appropriate amounts of funds 

needed to support the project for the first funding period 

(usually a year). 

For continuing grant program applications, submit these 

forms before the end of each funding period as required 

by the grantor agency. Enter in Columns (c) and (d) the 

estimated amounts of funds that will remain unobligated at 

the end of the grant funding period only if the Federal 

grantor agency instructions provide for this. Otherwise, 

leave these columns blank. Enter in columns (e) and (f) 

the amounts of funds needed for the upcoming period. 

The amount(s) in Column (g) should be the sum of 

amounts in Columns (e) and (f). 

For supplemental grants and changes to existing grants,

do not use Columns (c) and (d). Enter in Column (e) the 

amount of the increase or decrease of Federal funds and 

enter in Column (f) the amount of the increase or decrease 

of non-Federal funds. In Column (g) enter the new total 

budgeted amount (Federal and non-Federal) which 

includes the total previous authorized budgeted amounts 

plus of minus, as appropriate, the amounts shown in 

Columns (e) and (f). The amount(s) in Column (g) should 

not equal the sum of amounts in Columns (e) and (f). 

Line 5 - Show the totals for all columns used. 

SECTION B. BUDGET CATEGORIES

In the column headings (1) through (4), enter the titles of the same programs, functions, and activities shown on Lines 1-4, 

Column (a), Section A. When additional sheets were prepared for Section A, provide similar column headings on each sheet. 

For each program, function, or activity, fill in the total requirements for funds (both Federal and non-Federal) by object class 

categories. 

For supplemental grants and changes to grants, the total 

amount of the increase or decrease as shown in 

Columns (1) - (4), Line 6k should be the same as the sum 

of the amounts in Section A, Column (e) and (f) on Line 5. 

When additional sheets were prepared, the last two 

sentences apply only to the first page with summary totals. 

Lines 6 a-h - Show the estimated amount for each direct 

cost budget (object class) category for each column with 

program, function, or activity heading. 

Line 6i - Show the totals of Lines 6a to 6h in each column. 

Line 6j - Show the amount of indirect cost. Refer to Office 

of Management and Budget Circular No. A-87. Line 7 - Enter the estimated amount of income, if any, 

expected to be generated from this project. Do not add or 

subtract this amount from the total project amount. Show 

under the program narrative statement the nature and 

source of income. The estimated amount of program 

income may be considered by the Federal grantor agency 

in determining the total amount of the grant. 

Line 6k - Enter the total amounts on Lines 6i and 6j. For 

all applications for new grants and continuation grants the 

total amount in column (5), Line 6k, should be the same as 

the total amount shown in Section A, Column (g), Line 5. 

Page 4 of 8 
June 28, 2005 Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) Order 5100.38C

Page 261

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 

SECTION C - NON-FEDERAL RESOURCES

(d) OTHER 

SOURCES (a) Grant Program (b) APPLICANT (c) STATE (e) TOTALS 

 8. $ $ $ $ 

 9. 

10. 

11. 

12. TOTALS $ $ $ $ 

SECTION D - FORECASTED CASH NEEDS 

Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 

13. Federal $ $ $ $ $ 

14. Non-Federal 

15. TOTAL $ $ $ $ $ 

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF 

THE PROJECT

(a) Grant Program FUTURE FUNDING PERIODS (YEARS)

(b) FIRST (c) SECOND (d) THIRD (e) FOURTH 

16 . $ $ $ $ 

17. 

18. 

19. 

20. TOTALS $ $ $ $ 

SECTION F - OTHER BUDGET INFORMATION 

(Attach additional sheets if necessary)

21 Direct Charges: 

22. Indirect Charges: 

23. Remarks: 

PART IV - PROGRAM NARRATIVE (ATTACH PER INSTRUCTION)

FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1 Page 4 

Page 5 of 8 
Order 5100.38C Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) June 28, 2005

Page 262 

INSTRUCTIONS 

PART III (CONTINUED) 

SECTION C. SOURCE OF NON-FEDERAL RESOURCES

Line 8-11 - Enter amounts of non-Federal resources that will 

be used on the grant. If in-kind contributions are included, 

provide a brief explanation on a separate sheet. (See 

Attachment F, Office of Management and Budget Circular 

No. A-102.) 

 Column (c) - Enter the State contribution if the applicant is 

not a State or State agency. Applicants that are a State or 

State agencies should leave this column blank. 

 Column (d) - Enter the amount of cash and inn-kind 

 Column (a) - Enter the program titles identical to Column contributions to be made from all other sources. 

(a), Section A, A breakdown by function or activity is not 

necessary. Column (e) - Enter the totals of Columns (b), (c), and (d). 

 Column (b) - Enter the amount of cash and in-kind 

contributions to be made by the applicant as shown in 

Section A. (See also Attachment F, Office of Management 

and Budget Circular No. A-102). 

Line 12 - Enter the total for each of Columns (b)-(e). The 

amount in Column (e) should be equal to the amount on 

Line 5, Column (f), Section A.

SECTION D. FORECASTED CASH NEEDS

Line 13 - Enter the amount of cash needed by quarter from 

the grantor agency during the first year. 

Line 14 - Enter the amount of cash from all other sources 

needed by quarter during the first year. 

Line 15 - Enter the totals of amounts on Lines 13 and 14. 

SECTION E. BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT

Lines 16 - 19 - Enter in Column (a) the same grant program title

s shown in Column (a), Section A. A breakdown by function or activity is not necessa

ry. For new applications and continuing grant applications, 

enter in the proper columns amounts of Federal funds which 

will be needed to complete the program or project over the 

succeeding funding periods (usually in years). This Section 

need not be completed for amendments, changes, or 

supplements to funds for the current year of existing grants. 

If more than four lines are needed to list the program titles, 

submit additional schedules, as needed. 

Line 20 - Enter the total for each of the Columns (b) - (e). 

When additional schedules are prepared for this Section, 

annotate accordingly and show the overall totals on this line. 

SECTION F - OTHER BUDGET INFORMATION. 

Line 21 - Use this space to explain amounts for individual 

direct object cost categories that may appear to be out of the 

ordinary or to explain the details as required by the Federal 

grantor agency. 

Line 22 - Enter the type of indirect rate (provisional, 

predetermined, final or fixed) that will be in effect during the 

funding period, the estimated amount of the base to which 

the rate is applied, and the total indirect expense. 

Line 23 - Provide any other explanations required herein or 

any other comments deemed necessary. 

Page 6 of 8 
June 28, 2005 Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) Order 5100.38C

Page 263

PART IV 

PROGRAM NARRATIVE 

(Suggested Format) 

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569

PROJECT: 

AIRPORT: 

1. Objective: 

2. Benefits Anticipated: 

3. Approach: (See approved Scope of Work in final Application)

 

4. Geographic Location: 

5. If Applicable, Provide Additional Information: 

6: Sponsor’s Representative: (incl. address & tel. no.)

 

FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1 PAGE 6 

Page 7 of 8 
Order 5100.38C Appendix 5. Part II - Project Approval Information 

(FAA Form 5100-101) (Planning Projects) June 28, 2005

Page 264 

INSTRUCTIONS 

PART IV 

PROGRAM NARRATIVE 

Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests 

for continuation or refunding and changes on an approved project should respond to item 5b only. Requests for supplemental 

assistance should respond to question 5c only. 

4. GEOGRAPHIC LOCATION. 1. OBJECTIVES AND NEED FOR THIS ASSISTANCE. Give a precise location of the project and area to be served 

by the proposed project. Maps or other graphic aids may be 

attached. 

Pinpoint any relevant physical, economic, social, financial, 

institutional, or other problems requiring a solution. 

Demonstrate the need for assistance and state the principal and 

subordinate objectives of the project. Supporting documentation 

or other testimonies from concerned interests other than the 

applicant may be used. Any relevant data based on planning 

studies should be included or footnoted. 

5. IF APPLICABLE, PROVIDE THE FOLLOWING 

INFORMATION: 

a. Describe the relationship between this project and other 

work planned, anticipated, or underway under the Federal 

Assistance listed under Part II, Section A, Item 10. 2. RESULTS OR BENEFITS EXPECTED. 

b. Explain the reason for all requests for supplemental 

assistance and justify the need for additional funding. Identify results and benefits to be derived. For example, 

include a description of who will occupy the facility and show 

how the facility will be used. For land acquisition or 

development projects, explain how the project will benefit the 

public. 

c. Discuss accomplishments to date and list in chronological 

order a schedule of accomplishments, progress, or 

milestones anticipated with the new funding request. If 

there have been significant changes in the project 

objectives, location, approach or time delays, explain and 

justify. For other requests for changes or amendments, 

explain the reason for the change(s). If the scope or 

objectives have changed or an extension of time is 

necessary, explain the circumstances and justify. If the 

total budget has been exceeded or if individual budget 

items have changed more than the prescribed limits 

contained in Attachment K, Office of Management and 

Budget Circular No. A-102, explain and justify the change 

and its effect on the project. 

APPROACH 

a. Outline a plan of action pertaining to the scope and detail 

of how the proposed work will be accomplished for each 

grant program. Cite factors which might accelerate or 

decelerate the work and your reason for taking this 

approach as opposed to others. Describe any unusual 

features of the project such as design or technological 

innovations, reductions in cost or time, or extraordinary 

social and community involvements. 

b. Provide each grant program monthly or quarterly 

quantitative projections of the accomplishments to be 

achieved, if possible. When accomplishments cannot be 

quantified, list the activities in chronological order to show 

the schedule of accomplishments and their target dates. 

.

c. Identify the kinds of data to be collected and maintained, 

and discuss the criteria to be used to evaluate the results 

and success of the project. Explain the methodology 

that will be used to determine if the needs identified 

and discussed are being met and if the results and 

benefits identified in Item 2 are being achieved. 

d. List each organization, cooperator, consultant, or other 

key individuals who will work on the project along with a 

short description of the nature of their effort or 

contribution. 

Page 8 of 8 
Order 5100.38C Appendix 6. Grant Agreement (FAA Form 5100-37) June 28, 2005

Page 265

U.S. Department 

of Transportation 

Federal Aviation 

Administration

GRANT AGREEMENT 

PART I – OFFER

 

Date of Offer 

 

Airport/Planning Area

 

Project No 

 

Contract No 

 

DUNS No 

TO: 

(herein called the “Sponsor”) 

FROM: The United States of America (acting through the Federal Aviation Administration, herein called the “FAA”)

WHEREAS, the Sponsor has submitted to the FAA a Project Application dated , for a grant of Federal 

funds for a project at or associated with the Airport (or Planning Area), which Project 

Application, as approved by the FAA, is hereby incorporated herein and made a part hereof; and 

WHEREAS, the FAA has approved a project for the Airport (or Planning Area) (herein called the “Project”) 

consisting of the following: 

 

all as more particularly described in the Project Application. 

(Add the following for a Multi-Year Grant) 

WHEREAS, this project will not be completed during Fiscal Year ; and the total United States’ share of 

the estimated costs of the completion will be $ . 

FAA Form 5100-37 (10-89) Page 1 

Page 1 of 3 
Order 5100.38C Appendix 6. Grant Agreement (FAA Form 5100-37) June 28, 2005

Page 266 

NOW THEREFORE, pursuant to and for the purpose of carrying out the provisions of Title 49, United States 

Code, as amended, herein called “the Act,” and in consideration of (a) the Sponsor’s adoption and 

ratification of the representations and assurances contained in said Project Application and its acceptance of 

this Offer as hereinafter provided, and (b) the benefits to accrue to the United States and the public from the 

accomplishment of the Project and compliance with the assurances and conditions as herein provided, THE 

FEDERAL AVIATION ADMINISTRATION, FOR AND ON BEHALF OF THE UNITED STATES, HEREBY 

OFFERS AND AGREES to pay, as the United States share of the allowable costs incurred in accomplishing 

the Project, per centum thereof. 

This Offer is made on and SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS: 

CONDITIONS

1. The maximum obligation of the United States payable under this Offer shall be $ . For the 

purposes of any future grant amendments which may increase the foregoing maximum obligation of the 

United States under the provisions of Section 47108(b) of the Act, the following amounts are being 

specified for this purpose: 

$ for planning 

$ for airport development or noise program implementation. 

2. The allowable costs of the project shall not include any costs determined by the FAA to be ineligible for 

consideration as to allowability under the Act. 

3. Payment of the United States’ share of the allowable project costs will be made pursuant to and in 

accordance with the provisions of such regulations and procedures as the Secretary shall prescribe. 

Final determination of the United States’ share will be based upon the final audit of the total amount of 

allowable project costs and settlement will be made for any upward or downward adjustments to the 

Federal share of costs. 

4. The Sponsor shall carry out and complete the Project without undue delays and in accordance with the 

terms hereof, and such regulations and procedures as the Secretary shall prescribe, and agrees to 

comply with the assurances which were made part of the project application. 

5. The FAA reserves the right to amend or withdraw this offer at any time prior to its acceptance by the 

Sponsor. 

6. This offer shall expire and the United States shall not be obligated to pay any part of the costs of the 

project unless this offer has been accepted by the Sponsor on or before *, or such subsequent date as 

may be prescribed in writing by the FAA. 

7. The Sponsor shall take all steps, including litigation if necessary, to recover Federal funds spent 

fraudulently, wastefully, or in violation of Federal antitrust statutes, or misused in any other manner in 

any project upon which Federal funds have been expended. For the purposes of this grant agreement, 

the term “Federal funds” means funds however used or dispersed by the Sponsor that were originally 

paid pursuant to this or any other Federal grant agreement. It shall obtain the approval of the Secretary 

as to any determination of the amount of the Federal share of such funds. It shall return the recovered 

Federal share, including funds recovered by settlement, order, or judgment, to the Secretary. It shall 

furnish to the Secretary, upon request, all documents and records pertaining to the determination of the 

amount of the Federal share or to any settlement, litigation, negotiation, or other efforts taken to recover 

such funds. All settlements or other final positions of the Sponsor, in court or otherwise, involving the 

recovery of such Federal share shall be approved in advance by the Secretary. 

8. The United States shall not be responsible or liable for damage to property or injury to persons which 

may arise from, or be incident to, compliance with this grant agreement. 

FAA Form 5100-37 (10-89) Page 2 

Page 2 of 3 
Order 5100.38C Appendix 6. Grant Agreement (FAA Form 5100-37) June 28, 2005

Page 267

The Sponsor’s acceptance of this Offer and ratification and adoption of the Project Application incorporated 

herein shall be evidenced by execution of this instrument by the Sponsor, as hereinafter provided, and this 

Offer and Acceptance shall comprise a Grant Agreement, as provided by the Act, constituting the 

contractual obligations and rights of the United States and the Sponsor with respect to the accomplishment 

of the Project and compliance with the assurances and conditions as provided herein. Such Grant 

Agreement shall become effective upon the Sponsor’s acceptance of this Offer. 

UNITED STATES OF AMERICA 

FEDERAL AVIATION ADMINISTRATION

(Signature)

 

(Typed Name) 

 

(Title) 

PART II - ACCEPTANCE

The Sponsor does hereby ratify and adopt all assurances, statements, representations, warranties, 

covenants, and agreements contained in the Project Application and incorporated materials referred to in the 

foregoing Offer and does hereby accept this Offer and by such acceptance agrees to comply with all of the 

terms and conditions in this Offer and in the Project Application. 

Executed this day of , . 

 

(Name of Sponsor) 

(SEAL) (Signature of Sponsor’s Designated Official Representative)

By: 

(Typed Name of Sponsor’s Designated Official Representative) 

Title: 

Attest: (Typed Title of Sponsor’s Designated Official Representative)

 

CERTIFICATE OF SPONSOR’S ATTORNEY 

I, , acting as Attorney for the Sponsor do hereby certify: 

That in my opinion the Sponsor is empowered to enter into the foregoing Grant Agreement under the laws of 

the State of . Further, I have examined the foregoing Grant Agreement and the actions taken by said 

Sponsor and Sponsor’s official representative has been duly authorized and that the execution thereof is in 

all respects due and proper and in accordance with the laws of the said State and the Act. In addition, for 

grants involving projects to be carried out on property not owned by the Sponsor, there are no legal 

impediments that will prevent full performance by the Sponsor. Further, it is my opinion that the said Grant 

Agreement constitutes a legal and binding obligation of the Sponsor in accordance with the terms thereof. 

Dated at this day of , . 

By

(Signature of Sponsor’s Attorney) 

FAA Form 5100-37 (10-89) Page 3 

Page 3 of 3 
Order 5100.38C Appendix 6. Grant Agreement (FAA Form 5100-37) June 28, 2005

Page 268 

This page left intentionally blank. 
June 28, 2005 Appendix 7. Grant Special Conditions Order 5100.38C

Page 269

GENERAL GRANT SPECIAL CONDITIONS: 

A. LETTER OF CREDIT: The Sponsor agrees to request cash drawdowns on the letter of credit only 

when actually needed for its disbursements and to timely reporting of such disbursements as required. 

It is understood that failure to adhere to this provision may cause the letter of credit to be revoked. 

B. TAKEOVER INSTRUMENT LANDING SYSTEM AND ASSOCIATED EQUIPMENT IN PROJECT: 

When the Federal Aviation Administration has agreed to takeover the instrument landing system and 

associated equipment, the sponsor must check the facility prior to its commissioning to assure it meets 

the operational standards. The sponsor must also remove, relocate, or lower each obstruction on the 

approach or provide for the adequate lighting or marking of the obstruction if any aeronautical study 

conducted under FAR part 77 determines that to be acceptable; and mark and light the runway, as 

appropriate. 

C. AIRPORT-OWNED VISUAL OR ELECTRONIC NAVAIDS IN PROJECT: The Sponsor must provide 

for the continuous operation and maintenance of any navigational aid funded under the AIP during the 

useful life of the equipment and check the facility prior to its commissioning to assure it meets the 

operational standards. The Sponsor must also remove, relocate, or lower each obstruction on the 

approach or provide for the adequate lighting or marking of the obstruction if any aeronautical study 

conducted under FAR Part 77 determines that to be acceptable, and mark and light the runway, as 

appropriate. The Federal Aviation Administration will not take over the ownership, operation, or 

maintenance of any Sponsor-acquired equipment. 

D. NON-AIP WORK IN APPLICATION: It is understood and agreed by and between the parties hereto 

that notwithstanding the fact that the Project Application includes therein the construction , said 

work shall not be a part of this project and, if or to the extent accomplished by the Sponsor, such 

accomplishment shall be without any participation in the costs thereof by the United States under this 

project; it is further understood and agreed that, in the event the work which is excluded from the 

project is accomplished by the Sponsor, the Sponsor shall maintain as a portion of the cost records 

covering this project, separable cost records pertaining to the above-identified work excluded from 

Federal participation under this project, which records shall be made available for inspection and audit 

by the FAA to the end that the cost of the excluded work may be definitely determined. 

It is further understood and agreed that, within 90 days of acceptance of this Offer, the Sponsor will 

submit a revised Program Statement/cost estimate depicting the excluded costs or a revised cost 

estimate depicting only those costs eligible for Federal participation in this project. 

E. BUILDING AIP PRORATION: For purposes of computing the United States’ share of the allowable 

project costs of the project, the allowable cost of the included in the project shall not exceed 

 percent of the actual cost of the entire building. 

F. UTILITIES AIP PRORATION: For purposes of computing the United States’ share of the allowable 

project costs, the allowable cost of the included in the project shall not exceed percent. 

G. UTILITY RELOCATION IN PROJECT: It is understood and agreed by and between the parties 

hereto that the United States shall not participate in the cost of any utility relocation unless and until 

the Sponsor has submitted evidence satisfactory to the FAA that the Sponsor is legally responsible for 

payment of such costs. FAA participation will be limited to those utilities located on private right-ofway or utilities that exclusively serve the Airport. 

H. REVENUE FROM REAL PROPERY – LAND IN PROJECT: The Sponsor agrees that all net 

revenues produced from real property purchased in part with Federal funds in this grant shall be used 

on the airport for airport planning, development or operating expenses, except that all income from 

real property purchased for noise compatibility purposes or for future aeronautical use be used only to 

fund projects which would be eligible for grants under the Act. Income from noise or future use 

property may not be used for the Sponsor’s matching share of any airport grant. Airport fiscal and 

accounting records shall clearly identify actual sources and uses of these funds. 

Page 1 of 7
Order 5100.38C Appendix 7. Grant Special Conditions June 28, 2005

Page 270 

I. FUTURE DEVELOPMENT LAND: The Sponsor agrees to perform within years of this Grant 

the airport development which requires this land acquisition, and further agrees not to dispose of the 

land by sale or lease without prior consent and approval of the Federal Aviation Administration. In the 

event the land is not used within the years for the purpose for which it was acquired, the 

Sponsor will refund the Federal share of acquisition cost or the current fair market value of the land, 

whichever is greater. 

J. RUNWAY PROTECTION ZONES: The Sponsor agrees to take the following actions to maintain 

and/or acquire a property interest, satisfactory to the FAA, in the Runway Protection Zones: 

a. Existing Fee Title Interest in the Runway Protection Zone: The Sponsor agrees to prevent the 

erection or creation of any structure or place of public assembly in the Runway Protection Zone, 

except for NAVAIDS that are fixed by their functional purposes or any other structure approved by 

the FAA. Any existing structures or uses within the Runway Protection Zone will be cleared or 

discontinued unless approved by the FAA. 

b. Existing Easement Interest in the Runway Protection Zone: The Sponsor agrees to take any 

and all steps necessary to ensure that the owner of the land within the designated Runway 

Protection Zone will not build any structure in the Runway Protection Zone that is a hazard to air 

navigation or which might create glare or misleading lights or lead to the construction of 

residences, fuel handling and storage facilities, smoke generating activities, or places of public 

assembly, such as churches, schools, office buildings, shopping centers, and stadiums. 

c. Future Interest in the Runway Protection Zone: The Sponsor agrees that it will acquire fee title 

or less-than-fee interest in the Runway Protection Zones for runways that presently are not under 

its control within ___ years of this Grant Agreement. Said interest shall provide the protection 

noted in above Subparagraphs a and b. 

K. NOISE PROJECTS ON PRIVATELY OWNED PROPERTY: No payment shall be made under the 

terms of this Grant Agreement for work accomplished on privately owned land until the Sponsor 

submits the agreement with the owner of the property required by Assurance 5d of the Assurances, 

Airport Sponsors, and such agreement is determined to be satisfactory. As a minimum, the 

agreement with the private owner must contain the following provisions: 

a. The property owner shall subject the construction work on the project to such inspection and 

approval during the construction or installation of the noise compatibility measures and after 

completion of the measures as they may reasonably be requested by the Secretary or the 

Sponsor. 

b. The property owner shall assume the responsibility for maintenance and operation of the items 

installed, purchased, or constructed under this Grant Agreement. Neither the Federal Aviation 

Administration nor the Sponsor bears any responsibility for the maintenance and operation of 

these items. 

c. If Federal funds for the noise compatibility measures are transferred by the sponsor to the owner 

of the private property, or the owner’s agent, the property owner shall agree to maintain and make 

available to the Secretary or the Sponsor, upon reasonable request, records disclosing the 

amount of funds received and the disposition of those funds. 

d. The property owner’s right to sue the owner of Airport for adverse noise impacts will be 

abrogated if the property owner deliberately or willfully acts to reduce or destroy the effectiveness 

of the noise compatibility measures during the useful life of such measures. This obligation shall 

remain in effect throughout the useful life of the noise compatibility measures, but not to exceed 

20 years from the date of the Sponsor’s acceptance of federal aid for the project. 

L. UPDATE APPROVED EXHIBIT “A” FOR LAND IN PROJECT: It is understood and agreed by and 

between the parties hereto that notwithstanding the fact that this Grant Offer is made and accepted 

upon the basis of the current Exhibit “A” Property Map, the Sponsor hereby covenants and agrees that 

upon completion of the land acquisition in this project, it will update said Exhibit “A” Property Map to 

standards satisfactory to the Federal Aviation Administration (FAA) and submit said documentation in 

final form to the FAA. It is further mutually agreed that the reasonable cost of developing said Exhibit 

“A” Property Map is an eligible administrative cost for participation within the scope of this project. 

Page 2 of 7 
June 28, 2005 Appendix 7. Grant Special Conditions Order 5100.38C

Page 271

M. FRICTION MEASURING DEVICES: The Sponsor assures that it will properly calibrate, operate, and 

maintain the friction measuring equipment in accordance with the manufacturer’s guidelines and 

instructions and Advisory Circular 150/5320-12. The friction measuring equipment and tow vehicle (if 

applicable) shall not be used for any other purpose other than for conducting friction measuring tests 

on airport pavement surfaces and directly related activities, such as training and calibration. 

N. MULTI-YEAR GRANTS - LETTER OF AGREEMENT: The maximum obligation for the current fiscal 

year stated in Condition 1 of this agreement may be increased by the additional amounts, if any, 

added by the document issued under the subparagraph below, but may not exceed the United States’ 

share of the total estimated cost of completion, except as provided in Section 47108(b) of the Act. 

Under Section 47108 of the Act, as amended, and at the Sponsor’s request, the FAA commits the 

United States to obligate an additional amount to this project for FY- pursuant to Section 47114 

of said Act, and subject to the restrictions on the use of such apportionments now or hereafter 

imposed on FAA by statute now or hereafter enacted by any regulation. It is further understood by the 

parties that this commitment does not in itself obligate, preclude, nor restrict the FAA in the use of any 

funds made available for discretionary use under Section 47114 of said Act to further aid the Sponsor 

in meeting the cost of this project under the terms of this agreement and limitations of the law. 

The exact amount of this commitment will be established for each fiscal year by the FAA in a letter to 

the Sponsor stating the current maximum obligation for this project. This letter will be issued to the 

Sponsor by FAA when such computation and obligation can be made in FY- . The parties agree 

that upon its issuance, this letter shall be considered incorporated by reference into, and part of, this 

agreement. 

O. INFORMAL LETTER AMENDMENT OF AIP PROJECTS: It is mutually understood and agreed that 

if, during the life of the project, the FAA determines that the maximum grant obligation of the United 

States exceeds the expected needs of the Sponsor by $25,000.00 or five percent (5%), whichever is 

greater, the maximum obligation of the United States can be unilaterally reduced by letter from the 

FAA advising of the budget change. Conversely, if there is an overrun in the total actual eligible and 

allowable project costs, FAA may increase the maximum grant obligation of the United States to cover 

the amount of the overrun not to exceed the statutory percent limitation and will advise the Sponsor by 

letter of the increase. It is further understood and agreed that if, during the life of the project, the FAA 

determines that a change in the grant description is advantageous and in the best interests of the 

United States, the change in grant description will be unilaterally amended by letter from the FAA. 

Upon issuance of the aforementioned letter, either the grant obligation of the United States is adjusted 

to the amount specified or the grant description is amended to the description specified. 

P. GRANTS ISSUED ON ESTIMATES: It is understood and agreed by and between the parties hereto 

that this Grant Offer is made and accepted based on estimates for ; and the parties hereby 

covenant and agree that within days from the date of acceptance of this Grant Offer, the 

Sponsor shall receive bids for contained within the grant description. 

Q. PRIVATE SPONSOR AUDITS: The Sponsor shall provide for an audit of this grant project to be 

made at the completion of the grant objective in accordance with accepted standard audit practices. 

Copies of the audit will be sent to the Department of Transportation Office of Inspector General 

designated by the Federal Aviation Administration office responsible for administering the grant. 

R. PAVEMENT MAINTENANCE MANAGEMENT PROGRAM: For a project to replace or reconstruct 

pavement at the airport, the Sponsor shall implement an effective airport pavement maintenance 

management program as is required by Airport Sponsor Assurance Number C-11. The Sponsor shall 

use such program for the useful life of any pavement constructed, reconstructed, or repaired with 

federal financial assistance at the airport. As a minimum, the program must conform with the 

provisions outlined below: 

Page 3 of 7 
Order 5100.38C Appendix 7. Grant Special Conditions June 28, 2005

Page 272 

PAVEMENT MAINTENANCE MANAGEMENT PROGRAM

An effective pavement maintenance management program is one that details the procedures to be followed 

to assure that proper pavement maintenance, both preventive and repair, is performed. An airport sponsor 

may use any form of inspection program it deems appropriate. The program must, as a minimum, include 

the following: 

a. Pavement Inventory. The following must be depicted in an appropriate form and level of detail: 

(1) location of all runways, taxiways, and aprons; 

(2) dimensions; 

(3) type of pavement, and; 

(4) year of construction or most recent major rehabilitation. 

For compliance with the Airport Improvement Program (AIP) assurances, pavements that have been 

constructed, reconstructed, or repaired with federal financial assistance shall be so depicted. 

b. Inspection Schedule. 

(1) Detailed Inspection. A detailed inspection must be performed at least once a year. If a 

history of recorded pavement deterioration is available, i.e., Pavement Condition Index (PCI) 

survey as set forth in Advisory Circular 150/5380-6, “Guidelines and Procedures for 

Maintenance of Airport Pavements,” the frequency of inspections may be extended to three 

years. 

(2) Drive-By Inspection. A drive-by inspection must be performed a minimum of once per 

month to detect unexpected changes in the pavement condition. 

c. Record Keeping. Complete information on the findings of all detailed inspections and on the 

maintenance performed must be recorded and kept on file for a minimum of five years. The types 

of distress, their locations, and remedial action, scheduled or performed, must be documented. 

The minimum information to be recorded is listed below: 

(1) inspection date, 

(2) location, 

(3) distress types, and 

(4) maintenance scheduled or performed. 

For drive-by inspections, the date of inspection and any maintenance performed must be recorded. 

d. Information Retrieval. An airport sponsor may use any form of record keeping it deems 

appropriate, so long as the information and records produced by the pavement survey can be 

retrieved to provide a report to the FAA as may be required. 

e. Reference. Refer to Advisory Circular 150/5380-6, “Guidelines and Procedures for Maintenance 

of Airport Pavements,” for specific guidelines and procedures for maintaining airport pavements 

and establishing an effective maintenance program. Specific types of distress, their probable 

causes, inspection guidelines, and recommended methods of repair are presented. 

S. PROJECTS WHICH CONTAIN PAVING WORK IN EXCESS OF $250,000: The Sponsor agrees to 

perform the following: 

a. Furnish a construction management program to FAA prior to the start of construction which shall 

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 provisions and tests required 

by the Federal specifications. The program shall include as a minimum: 

(1) The name of the person representing the Sponsor who has overall responsibility for contract 

administration for the project and the authority to take necessary actions to comply with the 

contract. 

(2) Names of testing laboratories and consulting engineer firms with quality control 

responsibilities on the project, together with a description of the services to be provided. 

Page 4 of 7 
June 28, 2005 Appendix 7. Grant Special Conditions Order 5100.38C

Page 273

(3) Procedures for determining that testing laboratories meet the requirements of the American 

Society of Testing and Materials standards on laboratory evaluation, referenced in the 

contract specifications (D 3666, C 1077). 

(4) Qualifications of engineering supervision and construction inspection personnel. 

(5) A listing of all tests required by the contract specifications, including the type and frequency of 

tests to be taken, the method of sampling, the applicable test standard, and the acceptance 

criteria or tolerances permitted for each type of test. 

(6) Procedures for ensuring that the tests are taken in accordance with the program, that they are 

documented daily, and that the proper corrective actions, where necessary, are undertaken.

b. Submit at completion of the project, a final test and quality control report documenting the results 

of all tests performed, highlighting those tests that failed or that did not meet the applicable test 

standard. The report shall include the pay reductions applied and the reasons for accepting any 

out-of-tolerance material. An interim test and quality control report shall be submitted, if requested 

by the FAA. 

c. Failure to provide a complete report as described in paragraph b, or failure to perform such tests, 

shall, absent any compelling justification, result in a reduction in Federal participation for costs 

incurred in connection with construction of the applicable pavement. Such reduction shall be at 

the discretion of the FAA and will be based on the type or types of required tests not performed or 

not documented and will be commensurate with the proportion of applicable pavement with 

respect to the total pavement constructed under the grant agreement. 

d. The FAA, at its discretion, reserves the right to conduct independent tests and to reduce grant 

payments accordingly if such independent tests determine that sponsor test results are inaccurate. 

T. BUY AMERICAN REQUIREMENT: Unless otherwise approved by the FAA, the Sponsor will not 

acquire or permit any contractor or subcontractor to acquire any steel or manufactured products 

produced outside the United States to be used for any project for airport development or noise 

compatibility for which funds are provided under this grant. The Sponsor will include in every contract 

a provision implementing this special condition. 

U. MAXIMUM OBLIGATION INCREASE FOR NONPRIMARY AIRPORTS: In accordance with Section 

47108(b) of the Act, as amended, the maximum obligation of the United States, as stated in Condition 

No. 1 of this Grant Offer: 

a. may not be increased for a planning project; 

b. may be increased by not more than 15 percent for development projects; 

c. may be increased by not more than 15 percent or by an amount not to exceed 25 percent of the 

total increase in allowable costs attributable to the acquisition of land or interests in land, 

whichever is greater, based on current credible appraisals or a court award in a condemnation 

proceeding. 

V. MAXIMUM OBLIGATION INCREASE FOR PRIMARY AIRPORTS: In accordance with Section 

47108(b) of the Act, as amended, the maximum obligation of the United States, as stated in Condition 

No. 1 of this Grant Offer: 

a. may not be increased for a planning project; 

b. may be increased by not more than 15 percent for development projects; 

c. may be increased by not more than 15 percent for land projects. 

W. LOW EMISSION SYSTEMS: The sponsor agrees to the following conditions under the Voluntary 

Airport Low Emission (VALE) program:

a. Vehicles and equipment purchased with assistance from this grant shall be maintained and used 

for their useful life at the airport for which they were purchased. Moreover, any vehicles or 

equipment replaced under this program shall not be transferred to another airport or location 

within the same or any other nonattainment or maintenance area. No airport-owned vehicles or 

equipment may be transferred to, taken to, or used at another airport without the consent of the 

Page 5 of 7 
Order 5100.38C Appendix 7. Grant Special Conditions June 28, 2005

Page 274 

Federal Aviation Administration in consultation with the United States Environmental Protection 

Agency and State air quality agency.

b. All vehicles and equipment purchased with assistance from this grant shall be clearly labeled 

using the VALE program emblem designed by the Federal Aviation Administration.

c. The sponsor shall maintain annual reporting records of all vehicles and equipment purchased with 

assistance from this grant. These public records shall contain detailed information involving 

individual vehicles and equipment, project expenditures, cost effectiveness, and emission 

reductions.

d. The sponsor certifies that it shall replace any disabled or seriously damaged vehicle or equipment 

purchased with assistance from this grant, at any time during its useful life, with an equivalent 

vehicle or unit that produces an equal or lower level of emissions. The sponsor assumes all 

financial responsibility for replacement costs. The sponsor also certifies that it shall fulfill this 

replacement obligation, beyond the useful life of the affected vehicle or equipment, for the possible 

longer life of Airport Emission Reduction Credits that were granted to the sponsor for this vehicle 

or equipment.

Page 5 of 12 
June 28, 2005 Appendix 7. Grant Special Conditions Order 5100.38C

Page 275

PLANNING GRANT SPECIAL CONDITIONS: 

PA. COORDINATION: The Sponsor agrees to coordinate this master planning study with the metropolitan 

planning organizations, other local planning agencies, and with the State Airport System Plan 

prepared by the State’s Department of Transportation and consider any pertinent information, data, 

projections, and forecasts which are currently available or as will become available. The Sponsor 

agrees to consider all Clearinghouse comments and to furnish a copy of the final report to the State’s 

Department of Transportation. 

PB. GRANT OFFER BASED ON PRELIMINARY WORK PROGRAM: It is understood and agreed by and 

between the parties hereto that this Grant Offer is made and accepted upon the basis of the 

preliminary Work Program; and the parties hereto covenant and agree that the Sponsor shall furnish a 

revised Work Program to the FAA and that a notice to proceed will not be issued until the revised 

Work Program has been approved by the FAA. 

PC. EXCESS COST: It is understood and agreed that notwithstanding that the Application includes 

therein planning work that the Sponsor has estimated at a total cost of $ , the total allowable cost 

for purposes of determining federal participation shall not exceed $ . Any project costs in excess 

of the federal allowable costs shall be the sole responsibility of the Sponsor. 

PD. DISALLOWED WORK: It is understood and agreed by and between the parties hereto that 

notwithstanding the fact that the Project Application includes therein the planning of , said work 

shall not be a part of this project and, if or to the extent accomplished by the Sponsor, said 

accomplishment shall be without any participation in the costs thereof by the United States under this 

project; it is further understood and agreed that, in the event the work which is excluded from the 

project is accomplished by the Sponsor, the Sponsor shall maintain as a portion of the cost records 

covering this project, separable cost records pertaining to the above-identified work excluded from 

Federal participation under this project, which records shall be made available for inspection and audit 

by the FAA to the end that the cost of the excluded work may be definitely determined. 

It is further understood and agreed that, within days of acceptance of this Office, the Sponsor 

will submit a revised Program Statement/Cost Estimate depicting the excluded costs or a revised 

Program Statement/ Cost Estimate depicting only those costs eligible for Federal participation in this 

project. 

PE. SITE SELECTION: It is understood and agreed by and between the parties hereto that the Project 

shall not proceed beyond a) Phase I until the Sponsor and the have formally approved the 

feasibility and need for an airport or system of airports for the and have requested and received 

written approval of the Federal Aviation Administration to proceed with Phase II of the Project; and b) 

Phase II until the Sponsor and have formally selected a tentative site for -owned airport, 

subject to further environmental assessment, and have requested and received written approval of the 

Federal Aviation Administration to proceed with Phases III and IV of the Project. 

PF. INFORMAL LETTER AMENDMENT OF AIP PROJECTS: It is mutually understood and agreed that 

if, during the life of the project, the FAA determines that the maximum grant obligation of the United 

States exceeds the expected needs of the Sponsor by $25,000.00 or five percent (5%), whichever is 

greater, the maximum obligation of the United States can be unilaterally reduced by letter from the 

FAA advising of the budget change. It is further understood and agreed that if, during the life of the 

project, the FAA determines that a change in the grant description is advantageous and in the best 

interests of the United States, the change in grant description will be unilaterally amended by letter 

from the FAA. Upon issuance of the aforementioned letter, either the grant obligation of the United 

States is adjusted to the amount specified or the grant description is amended to the description 

specified. 

Page 7 of 7 
Order 5100.38C Appendix 7. Grant Special Conditions June 28, 2005

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June 28, 2005 Appendix 8. Project Evaluation Review and Development 

Analysis Checklist (FAA Form 5100-109) Order 5100.38C

Page 277

AIRPORT IMPROVEMENT PROGRAM 

PROJECT EVALUATION REVIEW AND DEVELOPMENT ANALYSIS 

Airport Name/Associated City State Project No. Date 

 

Meets 

Req. 

See 

Part III PART 1 – CHECKLIST N/A N/A Meets 

Req. 

See 

Part III

1. ACIP Project Checklist 15. Intergovernmental Review 

2. Sponsor Eligibility 16. Compatible Land Use 

3. Consistent with Local Plans 17. Public Hearing 

4. Designation of Instrument Runway 18. Usable Unit of Work 

5. Prior Grant Projects 19. Information on Specific Opposition 

6. Runway Marking 20. Flood Insurance 

7. Runway Safety Areas, Protection Zones, 

and Approaches 21. Consultation with Airport Users 

8. Runway Lighting 22. Uniform Act Requirements 

23. Terminal Development/ Bond 

Retirement 9. Navigation Aid Requirements 

10. Good Title and Exhibit A 24. Noise Compatibility Projects 

11. Donations 25. Pavement Reconstruction 

12. Force Account 26. Sponsor Certifications 

13. Unreasonable Costs 27. Washington Approval Required 

14. Runway Surface Treatment 

PART II – DESCRIPTION AND JUSTIFICATION OF WORK ITEMS (USE ADDITIONAL PAGES AS NEEDED)

 

PART III - EXPLANATION OF CHECKLIST ITEMS (USE ADDITIONAL PAGES AS NEEDED)

 

FAA Form 5100-109 (Revised 7-01) 

Page 1 of 1 
Order 5100.38C Appendix 8. Project Evaluation Review and Development 

Analysis Checklist (FAA Form 5100-109) June 28, 2005

Page 278 

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June 28, 2005 Appendix 9. Construction Progress and Inspection Report 

(FAA Form 5370-1) Order 5100.38C

Page 279

Note: You can find a fillable PDF version of this form at http://forms.faa.gov/. To access this form, type in the form number. Please be sure to 

view the form processing instructions by selecting the “Information” icon link.

Page 1 of 2 
Order 5100.38C Appendix 9. Construction Progress and Inspection Report 

(FAA Form 5370-1) June 28, 2005

Page 280 Page 2 of 2 
June 28, 2005 Appendix 10. Final Inspection Report 

(FAA Form 5110-17) Order 5100.38C

Page 281

Reports Identification Symbol: AS 5100-4 

AIP FINAL INSPECTION REPORT PROJECT NO. 

 

DATE COMPLETED 

 

DATE INSPECTED 

 

SPONSOR’S NAME 

 

NUMBER OF CONTRACTS THIS PROJECT 

 

SPONSOR’S ADDRESS 

 

FUNDS 

FAAP / ADAP OTHER 

AIRPORT NAME 

 TOTAL BID 

LOCATION 

 

TOTAL AMOUNT 

CHANGE ORDERS 

CONTRACTOR’S NAME 

 

TENTATIVE 

TOTAL COST 

1. DESCRIPTION OF WORK (Indicate portion of project description applicable to the contract inspected. Additional description may be 

given to define the scope of the contract and to indicate eligible work and ineligible work.) 

 

2. QUALITY OF WORK 

ALL ELIGIBLE FAAP / ADAP WORK IS: SATISFACTORY UNSATISFACTORY (Explain in item 3)

3 SUMMARY OF TEST RESULTS Describe any unusual construction or installation conditions. If unsatisfactory ineligible work which can 

adversely affect eligible work exists, explain in detail. If previous inspection reports indicate unsatisfactory work, give date of inspection 

and comment on conditions found at the time of this inspection. 

 

4. COMMENTS 

 

5. NAMES AND TITLES OF PERSONS PRESENT DURING INSPECTION 

 

DATE TITLE SIGNATURE 

 

FAA Form 5100-17 (7-70) SUPERSEDES FAA FORM 1627

Page 1 of 1 
Order 5100.38C Appendix 10. Final Inspection Report 

(FAA Form 5110-17) June 28, 2005

Page 282 

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June 28, 2005 Appendix 11. Title VI Reverter Clauses Order 5100.38C

Page 283

Below are the reverter clauses to be placed in Grant agreements, as necessary, in accordance with Title 

VI requirements. See Chapter 14. 

1. TO BE INCLUDED IN LICENSES, LEASES, PERMITS, ETC. 

“That in the event of breach of any of the above nondiscrimination covenants, (name of sponsor) shall 

have the right to terminate the (license, lease, permit, etc.) and to reenter and repossess said land and 

facilities thereon, and hold the same as if said (license, lease, permit, etc.) had never been made or 

issued; provided, however, that the (licensee, lessee, permitee, etc.) allegedly in breach shall have the 

right to contest said alleged breach under applicable Federal Aviation Administration procedures, and 

any sanctions under or termination of (license, lease, permit, etc.), shall be withheld pending completion 

of such procedures.” 

2. TO BE INCLUDED IN DEEDS. 

“That in the event of breach of any of the above nondiscrimination covenants, (name of sponsor) shall 

have the right to reenter said lands and facilities thereon, and the above described lands and facilities 

shall thereupon revert to and vest in and become the absolute property of (name of sponsor) and its 

assigns; provided, however, that the party allegedly in breach shall have the right to contest said alleged 

breach under applicable Federal Aviation Administration procedures, and the right of reverter shall not 

be exercised until completion of such procedures.” 

Page 1 of 1 
Order 5100.38C Appendix 11. Title VI Reverter Clauses June 28, 2005

Page 284 

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June 28, 2005 

Appendix 12. Labor Standards Interview and Summary of 

Labor Standards Investigation Report 

(Forms DOT F 4220.5 and 4220.6) 

Order 5100.38C

Page 285

DEPARTMENT OF TRANSPORTATION

LABOR STANDARDS INTERVIEW

(Routine & Special) 

CONTRACT NUMBER OR PROJECT NUMBER

 

PRIME CONTRACTOR

 

EMPLOYER

 

ADDRESS

TEMPORARY: 

NAME OF EMPLOYEE

PERMANENT: 

DATES EMPLOYED ON THE PROJECT WORK CLASSIFICATION

 

 NAME OF SUPERVISOR

 FROM

 

TO

 

DO YOU WORK OVER

8 HOURS PER DAY

HOURS OF WORK WAGE RATE

 

HOW PAID

 YES NO S.T.: O.T.: 

 CASH CHECK

IS ANY MONEY DEDUCTED FROM YOUR PAY EXCEPT INCOME TAX AND SOCIAL SECURITY

 YES NO (If “yes,” state what types of deductions are made) 

WHAT KIND OF WORK DO YOU DO ON THIS PROJECT: 

 

TOOLS USED APPRENTICES

 

DATE YOU STARTED DOINGTHIS 

WORK ON THIS PROJECT

 

DATE OF REGISTRATION 

CARD

 CRAFT

 

STEP

 

RATE

 

DO YOU HAVE PAYMENT RECORDS? YES NO; RECORDS OF HOURS WORKED? YES NO; LIST NAMES AND ADDRESSES

OF OTHERS DOING SAME WORK: 

 

ADDITIONAL COMMENTS: 

 

IS PERMISSION GIVEN TO DIVULGE TO YOUR EMPLOYER THE INFORMATION IN THIS STATEMENT? YES NO

CERTIFICATION OF EMPLOYEE

I HAVE READ THE INFORMATION REPORTED AS OBTAINED FROM ME AND CERTIFY IT TO BE CORRECT TO THE BEST OF MY BELIEF. 

DATE AND SIGNATURE OF EMPLOYEE

 

DATE AND SIGNATURE OF INTERVIEWER

 

INTERVIEWER’S EVALUATION: IS THE EMPLOYEE PROPERLY CLASSIFIED? YES NO 

PROPERLY PAID? YES NO 

REMARKS: 

 

FOR USE OF PAYROLL CHECKER: IS THE ABOVE INFORMATION IN AGREEMENT WITH PAYROLL DATA AND CONTRACT REQUIREMENTS? 

 YES NO

COMMENTS: 

 

DATE

 

TITLE

 

SIGNATURE

Form DOT F 4220.5 GPO 910-270 

Page 1 of 2 
Order 5100.38C

Appendix 12. Labor Standards Interview and Summary of 

Labor Standards Investigation Report 

(Forms DOT F 4220.5 and 4220.6) 

June 28, 2005

Page 286 

DEPARTMENT OF TRANSPORTATION

SUMMARY OF LABOR STANDARDS INVESTIGATION 

REPORT

CONTRACT OR PROJECT NUMBER 

 

1. PROJECT DESCRIPTION 

 

3a. CONTRACT PRICE 

 

3b. DATE OF CONTRACT 

 

2. PROJECT LOCATION 

 

4a. CONTRACT WAGE DETERMINATION

NUMBER: 

4b. WAGE DETERMINATION DATE 

 

6. PERCENT OF COMPLETION OF 

CONTRACT WORK: 

5. TYPE OF CONTRACT 

 FIXED PRICE CPFF OTHER 

7. HAS FINAL PAYMENT BEEN MADE TO CONTRACTOR? 

 YES NO 

8. NAME OF CONTRACTOR 

 

9. DOES THE REPORT PERTAIN TO EMPLOYEES OF THE PRIME CONTRACTOR 

 YES NO 

10. NAME(S) OF SUBCONTRACTOR(S) INVOLVED 

 

11. TOTAL NUMBER OF EMPLOYEES 

AFFECTED BY VIOLATIONS? 

12. TOTAL UNDERPAYMENT UNDER DAVIS-BACON ACT 

 $ 

CWHSA* 

 

13. NUMBER OF CWHSA VIOLATIONS 

 

14. TOTAL RESTITUTION MADE UNDER DAVIS-BACON 

ACT 

 $ 

CWHSA* 

 

15. TOTAL AMOUNT OF CONTRACT FUNDS BEING RETAINED TO COVER DAVIS-BACON ACT AND 

 CWHSA UNDERPAYMENT 

 $ 

CWHSA* LIQUIDATED 

DAMAGES 

 

16. IS NON ASSESSMENT OF CWHSA LIQUIDATED DAMAGES RECOMMENDED? 

 YES NO (IF YES, JUSTIFY FULLY IN REPORT) 

18. DATE 

INVESTIGATION 

BEGAN 

17. DOES REPORT CONTAIN EMPLOYER”S SIGNED STATEMENT OF REASONS FOR 

NONCOMPLIANCE? 

 YES NO (IF NO, JUSTIFY IN REPORT 

18. REMARKS: 

DATE 

 

*CONTRACT WORK HOURS STANDARDS ACT SIGNATURE AND TITLE OF INVESTIGATOR 

Form DOT F4220.6 (4-71) GPO 910.273 

Page 2 of 2 
June 28, 2005 Appendix 13. Examples of Increasing Maximum Obligation Order 5100.38C

Page 287

Examples of Increasing Maximum Obligation 

This Appendix applies to grants issued in any of three time periods: on or before September 30, 1987; 

between October 1, 1987, and, September 30, 1992; and grants issued on or after October 1, 1992. In 

reviewing the legislative intent, we have concluded that the examples now reflect the way development and 

land increases should be handled. The effects are reflected in the following examples for each period. 

Throughout, where the terms “costs” or “project costs” are used, they are meant to read as allowable costs. 

SCENARIO: A project includes land acquisition and development other than land. Total project costs are 

estimated to be $1 million, and the total grant amount is $900,000 (assuming a 90 percent participation 

rate); these are broken down as follows: 

ITEM PROJECT COSTS GRANT AMOUNT

Development $800,000 $720,000

Land $200,000 $180,000

Totals $1,000,000 $900,000

Five examples of changes in project costs are shown to compare the effects of legislative changes. Each 

example is calculated for the three specific time periods covered by legislative changes. In considering 

changes in project costs and subsequent grant changes, we have considered the projects for land and 

development as if they were separate grants. The resulting grant changes are a combination of allowable 

increases for each portion of the grant. The following chart reflects final project costs for each example 

considered: 

ITEM EXAMPLE 1 EXAMPLE 2 EXAMPLE 3 EXAMPLE 4 EXAMPLE 5 

Development $800,000 $700,000 $850,000 $950,000 $950,000

Land $260,000 $260,000 $260,000 $260,000 $400,000

Totals $1,060,000 $960,000 $1,110,000 $1,210,000 $1,350,000

A. GRANTS ISSUED ON OR BEFORE SEPTEMBER 30, 1987 

For grants issued during this period, the maximum obligation (grant amount) may be increased by not more 

than 10 percent for airport development (other than a project for land acquisition). In land only grants, or in 

the land portion of mixed grants, the grant may be increased by an amount not to exceed 50 percent of the 

total increase in allowable project costs attributable to acquisition of land or interests in land, based upon 

credible appraisals. Although this set of examples assumes the Federal share of costs to be 90 percent, this 

provision makes no distinction as to the type of airport to which it applied. The effect of this provision on 

each of the examples is as follows: 

Note: The maximum allowable increase for development other than land is 10 percent of $720,000 

($72,000). Therefore, the original grant amount can be increased to a maximum of $792,000 for 

development. Land costs are based on the 50 percent limit and are added to the development. 

Example A1

 Development: No change in development cost. Therefore, grant amount portion remains at 

$720,000. 

 Land: Total cost of land increases by $60,000. The grant can be adjusted by 50 percent of the 

increase, or $30,000. Consequently, the $180,000 original grant amount for land can be increased to 

$210,000. 

 New Total: $720,000 + $210,000 = $930,000 

Page 1 of 4 
Order 5100.38C Appendix 13. Examples of Increasing Maximum Obligation June 28, 2005

Page 288 

Example A2

 Development: Development cost decreases by $100,000. Therefore, this portion of the grant 

amount decreases by $90,000, resulting in a revised amount of $630,000. 

 Land: Same as in Example A1. 

 New Total: $630,000 + $210,000 = $840,000 

Note: The revised Federal amount for development is decreased, but the decrease is partly offset by the 

increase in land costs ($90,000 versus $60,000). Since the statute treats land separately from development, 

the original grant amount must be reduced. The result is that the total grant amount is less than 90 percent 

of total costs. To allow otherwise, however, would require that reimbursement for land costs be higher than 

the $210,000 cost permitted, thereby exceeding authority contained in the statute. 

Example A3

 Development: Development cost increases by $50,000. Therefore, the development portion of the 

grant amount can be increased by $45,000. This results in a new grant amount for development of 

$765,000. 

 Land: Same as in Example A1. 

 New Total: $765,000 + $210,000 = $975,000 

Example A4

 Development: Development cost increases by $150,000. The development portion of the grant 

amount can be increased by a maximum of 10 percent. Therefore, the maximum increase for this portion is 

$72,000. The amended grant amount for development is $792,000. 

 Land: Same as in Example A1. 

 New Total: $792,000 + $210,000 = $1,002,000 

Note: In this case, the maximum Federal obligation is increased by an amount which is more than 10 

percent of the original total amount. This is because the provision allowing a 10 percent increase in the 

maximum Federal obligation does not apply to the total original grant amount of $900,000. Rather, the 

provision must be read to require that each component be treated separately. 

Example A5

 Development: Same as in Example A4. 

 Land: Total cost of land increases by $200,000. The grant can be adjusted by 50 percent of the 

increase, or $100,000. Consequently, the $180,000 original grant amount for land can be increased to 

$280,000. 

 New Total: $792,000 + $280,000 = $1,072,000 

Note: In this case, the maximum Federal obligation is increased by an amount which is more than 10 

percent of the original total amount. This is because the provision allowing a 10 percent increase in the 

maximum Federal obligation does not apply to the total original grant amount of $900,000. Rather, the 

provision must be read to require that each component be treated separately. 

B. GRANTS ISSUED OCTOBER 1, 1987, THROUGH SEPTEMBER 30, 1992 

For grants issued during this period, the maximum obligation may be increased by not more than 15 percent 

in the case of a project for airport development. By definition contained in former Section 503(a)(2)(C), land 

is considered airport development. Therefore, a project for land acquisition and a project for development 

other than land acquisition are treated the same. In each example, therefore, there is no requirement to 

separate the development and land costs to compute the changed grant amounts. Also, there is no 

prohibition against using lower development costs to cover increased land costs. The effect of this provision 

on each example is as follows: 

Note: The maximum allowable increase is 15 percent of $900,000 ($135,000). Therefore, the original grant 

amount can be increased to a maximum of $1,035,000. 

Page 2 of 4 
June 28, 2005 Appendix 13. Examples of Increasing Maximum Obligation Order 5100.38C

Page 289

Example B1

 Development: No change in development cost. 

 Land: Total cost of land increases by $60,000. 

 New Total: $800,000 + $260,000 = $1,060,000 * 90% = $954,000. This is less than the 

maximum amount of $1,035,000 and may be used as the amended grant amount. 

Example B2

 Development: Development cost decreases by $100,000. 

 Land: Total cost of land increases by $60,000. 

 New Total: $700,000 + $260,000 = $960,000 * 90% = $864,000. The amended grant amount is 

reduced from the original amount. 

Example B3

 Development: Development cost increases by $50,000. 

 Land: Total cost of land increases by $60,000. 

 New Total: $850,000 + $260,000 = $1,110,000 * 90% = $999,000. This is less than the 

maximum amount of $1,035,000 and may be used as the amended grant amount. 

Example B4

 Development: Development cost increases by $150,000. 

 Land: Total cost of land increases by $60,000. 

 New Total: $950,000 + $260,000 = $1,210,000 * 90% = $1,089,000. The increase is more than 

the maximum of $1,035,000. Therefore, the new grant amount is limited to $1,035,000. 

Example B5

 Development: Development cost increases by $150,000. 

 Land: Total cost of land increases by $200,000. 

 New Total: $950,000 + $400,000 = $1,350,000 * 90% = $1,215,000. The increase is more than 

the maximum of $1,035,000. Therefore, the new grant amount is limited to $1,035,000. 

C. GRANTS ISSUED ON OR AFTER OCTOBER 1, 1992 

Amendments for grants issued to primary airports during this period are computed as for grants issued 

October 1, 1987 through September 30, 1992; i.e., with a maximum of 15 percent for combined land and 

development. Grants at non-primary airports are treated differently, however. The maximum obligation can 

be increased by not more than 15 percent for airport development (other than a project for land acquisition). 

In land only grants, or in the land portion of mixed grants, the grant amount attributable to land costs can be 

increased by an amount not to exceed 15 percent of the original grant amount for land or by an amount not 

to exceed 25 percent of the total increase in costs attributable to acquisition of land or interests in land, 

based upon credible appraisals or a court award in a condemnation proceeding, whichever is greater. The 

effect of this provision on non-primary airports in each of the examples is as follows: 

Example C1 Non-primary

 Development: No change in development cost. Therefore, grant amount portion remains at 

$720,000. 

 Land: Total cost of land increases by $60,000. The grant amount may be increased by 25 percent 

of the increase ($15,000), or by 15 percent of the original grant portion pertaining to the land ($27,000), 

whichever is greater. Consequently, the land portion of the original grant amount $180,000 can be 

increased by $27,000 to $207,000. 

 New Total: $720,000 + $207,000 = $927,000 

Page 3 of 4 
Order 5100.38C Appendix 13. Examples of Increasing Maximum Obligation June 28, 2005

Page 290 

Example C2 Non-primary

 Development: Development cost decreases by $100,000. Therefore, the grant amount portion 

decreases by $90,000, resulting in a revised amount of $630,000. 

 Land: Same as in Example C1. 

 New Total: $630,000 + $207,000 = $837,000 

Note: The revised Federal amount for development is decreased, but the decrease is partly offset by the 

increase in land costs ($90,000 versus $60,000). Since the statute treats land separately from development, 

the original grant amount must be reduced. As in example A2, the result is that the total grant amount is 

reduced and is less than 90 percent of total costs. Further, in this case, the amended grant amount is less 

than in example A2 because the adjustment is based on 25 percent, not 50 percent, of the increase in land 

cost. 

Example C3 Non-primary

 Development: Development cost increases by $50,000. Therefore, the development portion of the 

grant amount can be increased by $45,000. This results in a new grant amount for development of 

$765,000. 

 Land: Same as in Example C1. 

 New Total: $765,000 + $207,000 = $972,000 

Example C4 Non-primary

 Development: Development cost increases by $150,000. The development portion of the grant 

amount can be increased by a maximum of 15 percent. Therefore, the maximum increase is $108,000. The 

amended grant amount for development is $828,000. 

 Land: Same as in Example C1. 

 New Total: $828,000 + $207,000 = $1,035,000 

Note: In this example, the amended total grant amount is increased by an amount which is exactly equal to 

15 percent of the original grant amount. 

Example C5 Non-primary

 Development: Development cost increases by $150,000. As in example C4, the amended grant 

amount for development is $828,000. 

 Land: Total cost of land increases by $200,000. The original grant amount for land may be 

increased by the greater of 25 percent of the increase ($50,000), or by 15 percent of the original grant 

amount for land ($27,000). Consequently, the original grant amount for land ($180,000) can be increased to 

$230,000. 

 New Total: $828,000 + $230,000 = $1,058,000 

Note: In this case, the amended total grant amount is increased by an amount which is more than 15 

percent of the original grant amount. 

Page 4 of 4 
June 28, 2005 Appendix 14. Grant Amendment (FAA Form 5100-38) Order 5100.38C

Page 291

U.S. Department 

of Transportation 

Federal Aviation 

Administration

Page of Pages

 

Contract No 

 

DUNS No 

 

Airport/Planning Area 

 

(Location) 

AMENDMENT NO. TO GRANT AGREEMENT AIP PROJECT NO. 

WHEREAS, the Federal Aviation Administration (hereinafter referred to as the “FAA”) has determined it to 

be in the interest of the United States that the Grant Agreement between the FAA, acting for and on behalf 

of the United States, and the [Sponsor Name] (hereinafter referred to as the “Sponsor”), accepted by 

said Sponsor on [Acceptance Date], be amended in conformance with the Sponsor’s letter dated 

and as hereinafter provided. 

NOW THEREFORE, WITNESSETH: 

That in consideration of the benefits to accrue to the parties hereto, the FAA on behalf of the United States, 

on the one part, and the Sponsor, on the other part, do hereby mutually agree that the said Grant 

Agreement be and hereby is amended as follows: 

 

All other terms and conditions of the Grant Agreement remain in full force and effect. 

IN WITNESS WHEREOF, the parties hereto have caused this amendment to said Grant Agreement to be 

duly executed as of the day of , . 

UNITED STATES OF AMERICA 

FEDERAL AVIATION ADMINISTRATION

(Signature)

 

(Typed Name) 

 

(Title) 

FAA Form 5100-38 (10-89) Supersedes FAA Form 5100-38 pages 1 and 2 

Page 1 of 2 
Order 5100.38C Appendix 14. Grant Amendment (FAA Form 5100-38) June 28, 2005

Page 292 

Page of Pages

 

Contract No 

 

DUNS No

 

Airport/Planning Area

 

(Location)

 

(Name of Sponsor) 

(SEAL) (Signature of Sponsor’s Designated Official Representative)

 

(Typed Name of Sponsor’s Designated Official Representative) 

 

(Typed Title of Sponsor’s Designated Official Representative)

Attest: 

Title: (Date) 

CERTIFICATE OF SPONSOR’S ATTORNEY 

I, , acting as Attorney for the Sponsor do hereby certify: 

That I have examined the foregoing Amendment to the Grant Agreement and the proceedings taken by said 

Sponsor relating thereto, and find that the execution thereof by said Sponsor has been duly authorized and 

is in all respects due and proper and in accordance with the laws of the State of and further that, in 

my opinion, said Amendment to the Grant Agreement constitutes a legal and binding obligation of the 

Sponsor in accordance with the terms thereof. 

Dated at this day of , . 

By

(Signature of Sponsor’s Attorney) 

FAA Form 5100-38 (10-89) Supersedes FAA Form 5100-38 pages 1 and 2 

Page 2 of 2 
June 28, 2005 Appendix 15. Informal Letter Amendment Order 5100.38C

Page 293

U.S. Department 

of Transportation 

Federal Aviation 

Administration

Region/Airports District Office 

Address 

City, State Zip 

Sponsor 

Address 

City, State Zip 

Dear: 

 Airport 

AIP Project No 

Contract No 

DUNS No 

Letter Amendment (Amendment No. ) 

This is in response to your letter dated , requesting an amendment to the Grant Agreement for the 

subject AIP project to: (1) revise the project description, and (2) increase (*OR decrease) the maximum 

obligation of the United States, as set forth in the Grant Agreement accepted by the Sponsor (OR) CoSponsors on (use last co-sponsor acceptance date). (IF APPLICABLEÎ) , as amended on . 

USE FOLLOWING PARAGRAPH IF: REVISING PROJECT DESCRIPTION

NOT REVISING MAXIMUM OBLIGATION

This letter, together with your letter, effects the amendment, as requested, and commits the Federal Aviation 

Administration, acting for and on behalf of the United States of America, to delete the project description, as 

shown in the above referenced Grant Agreement, and to substitute the following project description: 

 

USE FOLLOWING PARAGRAPH(S) IF: REVISING PROJECT DESCRIPTION

INCREASING MAXIMUM OBLIGATION

This letter, together with your letter, effects the amendment, as requested, and commits the Federal Aviation 

Administration, acting for and on behalf of the United States of America, to delete the project description, as 

shown in the above referenced Grant Agreement, and to substitute the following project description: 

 

Furthermore, this letter commits the Federal Aviation Administration, acting for and on behalf of the United 

States of America, to increase the maximum obligation of the United States by $ (from $ to 

$ ) to cover the Federal share of the total actual eligible and allowable project costs. 

USE FOLLOWING PARAGRAPH(S) IF: REVISING PROJECT DESCRIPTION

DECREASING MAXIMUM OBLIGATION

This letter, together with your letter, effects the amendment, as requested, and commits the Federal Aviation 

Administration, acting for and on behalf of the United States of America, to delete the project description, as 

shown in the above referenced Grant Agreement, and to substitute the following project description: 

 

Furthermore, this letter commits the Federal Aviation Administration, acting for and on behalf of the United 

States of America, to decrease the maximum obligation of the United States by $ (from $ to 

$ ) to cover the Federal share of the total actual eligible and allowable project costs. 

Page 1 of 2 
Order 5100.38C Appendix 15. Informal Letter Amendment June 28, 2005

Page 294 

USE FOLLOWING PARAGRAPH IF: NOT REVISING PROJECT DESCRIPTION

INCREASING MAXIMUM OBLIGATION

This letter, together with your letter, effects the amendment, as requested, and commits the Federal Aviation 

Administration, acting for and on behalf of the United States of America, to increase the maximum obligation 

of the United States by $ (from $ to $ ) to cover the Federal share of the total actual 

eligible and allowable project costs of the above referenced Grant Agreement. 

Under the terms of the Grant Agreement, this document is incorporated into and constitutes Amendment No. 

 to the above referenced Grant Agreement. All other terms and conditions of the Grant Agreement 

remain in full force and effect. 

Sincerely, 

(Typed Name) 

(Title) 

Page 2 of 2 
June 28, 2005 Appendix 16. Entitlement Transfer Agreement Order 5100.38C

Page 295

U.S. Department 

of Transportation 

Federal Aviation 

Administration

AGREEMENT FOR TRANSFER OF ENTITLEMENTS 

In accordance with section 47117(c)(2) of Title 49 U.S.C. (hereinafter called the “Act). 

(Name of Transferor Sponsor) 

Hereby waives receipt of the following amount of funds apportioned to it for each fiscal year specified under 

section 47114(c) or 47114(d)(3)(A) of the Act. 

Amount Fiscal Year

$ 20 

$ 20 

$ 20 

TOTAL $ 

On the condition that the Federal Aviation Administration makes the waived amount available to: 

(Name of Transferee Sponsor) 

for eligible projects under section 47104(a) Act. This waiver shall expire on earlier of (date) or when 

the availability of apportioned funds would lapse under section 47117(b) of the Act. 

FOR THE UNITED STATES OF 

AMERICA 

FEDERAL AVIATION ADMINISTRATION

FOR 

(Signature) (Signature)

 

(Typed Name) (Typed Name) 

 

(Title) (Title) 

 

(Date) (Date) 

CERTIFICATE OF SPONSOR’S ATTORNEY 

I, acting as Attorney for the Sponsor do hereby certify: 

That I have examined the foregoing Agreement and find that the Sponsor has been duly authorized to make 

such transfer and that the execution thereof is in all respects due and proper and in accordance with the 

laws of the State of and the Act. 

Dated at this day of , . 

By

(Signature of Sponsor’s Attorney) 

FAA Form 5100-110 (10/89) 

Page 1 of 1 
Order 5100.38C Appendix 16. Entitlement Transfer Agreement June 28, 2005

Page 296 

This page left intentionally blank. 
June 28, 2005 Appendix 17. Multi-Year Letter Amendment 

(Suggested Text) Order 5100.38C

Page 297

U.S. Department 

of Transportation 

Federal Aviation 

Administration

Region/Airports District Office 

Address 

City, State Zip 

Sponsor 

Address 

City, State Zip 

Dear: 

 Airport 

AIP Project No 

Contract No 

DUNS No 

Letter Amendment (Multi-Year Amendment No. ) 

This letter transmits the FAA’s current Fiscal Year statement of the maximum obligation for the MultiYear Grant agreement for Project No. . 

The above-captioned grant agreement commits the Federal Aviation Administration (FAA), acting for and on 

behalf of the United States of America, to increase the maximum obligation of the United States, as 

authorized by Section 47108(a) of the Act, as amended. The maximum obligation is increased by $ 

(from $ to $ ) to include the current Fiscal Year (FY- ) obligation of the multi-year 

Grant Agreement for the subject project. 

(Insert specific description of changes to be incorporated by this Amendment.) 

Sincerely, 

(Typed Name) 

(Title) 

Page 1 of 1 
Order 5100.38C Appendix 17. Multi-Year Letter Amendment 

(Suggested Text) June 28, 2005

Page 298 

This page left intentionally blank.
June 28, 2005 Appendix 18. Federal Cash Transactions Report (SF 272) Order 5100.38C

Page 299

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf272.pdf.

Page 1 of 3 
Order 5100.38C Appendix 18. Federal Cash Transactions Report (SF 272) June 28, 2005

Page 300 

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf272.pdf.

Page 2 of 3 
June 28, 2005 Appendix 18. Federal Cash Transactions Report (SF 272) Order 5100.38C

Page 301

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf272a.pdf.

Page 3 of 3 
Order 5100.38C Appendix 18. Federal Cash Transactions Report (SF 272) June 28, 2005

Page 302 

This page left intentionally blank. 
June 28, 2005 Appendix 19. Request for Advance or Reimbursement 

(SF 270) Order 5100.38C

Page 303

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf270.pdf.

Page 1 of 2 
Order 5100.38C Appendix 19. Request for Advance or Reimbursement 

(SF 270) June 28, 2005

Page 304 

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf270.pdf.

Page 2 of 2 
June 28, 2005 Appendix 20. Outlay Report and Request for Reimbursement 

for Construction Programs (SF 271) Order 5100.38C

Page 305

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf271.pdf.

Page 1 of 2 
Order 5100.38C Appendix 20. Outlay Report and Request for Reimbursement 

for Construction Programs (SF 271) June 28, 2005

Page 306 

Note: You can find a fillable PDF version of this form at http://www.whitehouse.gov/omb/grants/sf271.pdf.

Page 2 of 2 
June 28, 2005 Appendix 21. Letter of Intent and Amendment Order 5100.38C

Page 307

LETTER OF INTENT - - 

 Airport 

 

(Location)

The Federal Aviation Administration (“FAA”) hereby announces its intention, effective this date, in 

accordance with the provisions of section 47110(e) of title 49, United States Code (ACT), to obligate 

funds from future budget authority to issue grants to pay the [airport sponsor] (“Sponsor”) for the United 

States share of allowable costs at the [airport] for the project described as follows: 

 [project description]

as more fully described in the Sponsor’s [revised] application for a Letter of Intent, dated 

(“Project”). 

The maximum United States obligation pursuant to this Letter of Intent for the Project described above 

shall be an amount not to exceed $ . [This amount is in addition to $ covered by a grant to 

be issued from fiscal year 20 budget authority for work which will commence after the date of 

execution of the grant agreement.] Upon application by the Sponsor, the FAA shall issue grants from 

future budget authority, as funds become available, according to the following schedule: 

Federal Funds 

Fiscal Year Discretionary 

[amount]

Total 

[amount]

Apportionment 

[amount]

Year 10 20 $ 30

Year 10 20 $ 30

Year 10 20 $ 30

Year 10 20 $ 30

Year 10 20 $ 30

Year 50 50 $ 100

Year $ 0

Year $ 0

Year $ 0

Year $ 0

Totals $ 100 $ 150 $ 250

(Note: Enter Federal funds in Apportioned and Discretionary fields. When completed, highlight all fund entries, including 

Totals, and press F9 to calculate Totals) 

It is expressly understood by the FAA and the Sponsor that the amounts set forth above under 

“apportionment” are estimated, and that the actual apportionment amounts will vary with the actual 

levels of passenger enplanements, the aggregate annual landed weight of all-cargo aircraft, total 

program level for the Airport Improvement Program and with any revision of the existing statutory 

formula for calculating such apportionments. Should the amount actually apportioned to the Sponsor in 

any fiscal year be less than the amount estimated above for such fiscal year, the amount listed above 

under “discretionary” for such fiscal year shall not be increased to supplement the lesser amount actually 

apportioned to the Sponsor. If, in any fiscal year, funds apportioned to a sponsor are greater than those 

listed in this Letter of Intent, the FAA, at its option, may adjust the payment schedule to increase the 

amount listed for apportionments with a corresponding reduction in the amount listed for discretionary 

funds. 

Page 1 of 3 
Order 5100.38C Appendix 21. Letter of Intent and Amendment June 28, 2005

Page 308 

The announcement of this intention shall not be deemed an obligation of the United States Government 

under section 1501 of Title 31, United States Code, nor shall this Letter of Intent be deemed an 

administrative commitment for funding. This Letter of Intent shall be regarded as an intention to obligate 

funds from future budget authority. No obligation or administrative commitment may be made pursuant 

to this Letter of Intent except as funds are provided in authorization and appropriation acts. 

The FAA may, from time to time, following consultation with the Sponsor, amend this Letter of Intent to 

adjust the payment schedule or the maximum United States obligation specified above, or both. Such 

adjustment may be made by the Federal Aviation Administrator when occasioned by changes in the 

actual allowable costs of the Project, in the actual time required to complete the Project, in actual or 

estimated future obligating authority, or otherwise, when determined at the Administrator’s discretion to 

be in the best interests of the United States. 

The FAA will give full consideration to the aggregate amount of future obligations and the payments 

scheduled under all outstanding Letters of Intent in formulating its annual budget requests. A statutory 

restriction on total obligating authority in a future fiscal year, however, may necessitate a reduction in 

funds to be apportioned for that year, pursuant to section 47115(g) of the Act, or in discretionary funds 

available for obligation under section 47115 of the Act, or both. This may result in a concurrent 

reduction in a payment scheduled under this Letter of Intent. In such event, the ratio of the discretionary 

fund component of a scheduled payment, as reduced, to such component prior to reduction, shall be not 

less than the ratio of discretionary funds newly available for obligation in the fiscal year in which such 

reduction occurs, to the total discretionary funds made available for obligation in the fiscal year in which 

this Letter of Intent was executed. 

If, in any given year and for whatever reason (including such reasons as inability of sponsor to make 

sufficient progress for the project or a lapse in obligating authority under chapter 471 of the Act), a 

payment is deferred in whole or in part, any later reimbursement for the deferred amounts will be subject 

to negotiation between the parties, subject again to the availability of funds and statutory authority. No 

amendment to this Letter of Intent shall impair the Sponsor’s eligibility for future reimbursement of the 

United States share of allowable Project costs pursuant to section 47110(e) of the Act, as funds become 

available. 

The Sponsor should understand that, having proceeded with the Project without the aid of funds under 

the Act, in order to receive reimbursement as specified in the schedule set forth above, it must comply 

with all statutory and administrative requirements that would be applicable to the Project were the 

Project carried out with funds made available under the Act. Failure to comply with all such 

requirements, or failure to proceed with the Project in a timely manner, may lead to revocation of this 

Letter of Intent. 

Further, in the event of default on the part of the Sponsor, or any other action by the Sponsor which 

threatens the Federal investment in the Project, the FAA will pursue all remedies available in law or 

equity, including but not limited to the withholding of future financial assistance (provided that applicable 

hearing requirements are complied with) and termination or suspension of all or part of the violated grant 

agreement. 

UNITED STATES OF AMERICA 

FEDERAL AVIATION ADMINISTRATION

(Signature)

 

(Typed Name) 

(Title) 

 

(Date) 

Page 2 of 3 
June 28, 2005 Appendix 21. Letter of Intent and Amendment Order 5100.38C

Page 309

LETTER OF INTENT - - 

 Airport 

 

(Location) 

Letter of Intent Number - - , by which the Federal Aviation Administration (“FAA”) 

announced its intention to obligate funds from future budget authority to reimburse the [sponsor] 

(“Sponsor”) for the Federal share of allowable costs for the project described therein, is hereby amended 

to revise the project description as follows: 

[revised project description] 

Letter of Intent Number - - is hereby further revised to amend the maximum United 

States obligation and the payment schedule as follows: 

[revised language on maximum obligation and payment schedule] 

[additional revisions may be included if necessary] 

All other provisions set forth in Letter of Intent - - continue to remain in force. 

UNITED STATES OF AMERICA 

FEDERAL AVIATION ADMINISTRATION

(Signature)

 

(Typed Name) 

 

(Title) 

 

(Date) 

Page 3 of 3 
Order 5100.38C Appendix 21. Letter of Intent and Amendment June 28, 2005

Page 310 

This page left intentionally blank. 
June 28, 2005 Appendix 22. Agreement on State Sponsorship 

and Airport Sponsor Obligations Order 5100.38C

Page 311

U.S. DEPARTMENT OF TRANSPORTATION 

FEDERAL AVIATION ADMINISTRATION 

AIRPORT IMPROVEMENT PROGRAM

AGREEMENT ON STATE SPONSORSHIP

AND AIRPORT SPONSOR OBLIGATIONS

 Airport 

 (Associated City) 

In accordance with Title 49, United States Code, section 47105(a)(1)(B), 

 (Name of Airport Sponsor) 

hereinafter called the “Airport Sponsor,” hereby consents to Project sponsorship by the State of 

 (Name of State) 

for the Project at the above airport and associated city described as follows: 

 (Project Description) 

I assure and certify, for the Project identified herein, Airport Sponsor will comply with terms, Conditions, 

and Assurances contained in the Project Application submitted to the Federal Aviation Administration by 

the State and to Grant Agreement Conditions required by the Federal Aviation Administration. A copy of 

the Project Application Assurances and Grant Agreement Conditions is attached and made part of this 

Agreement on State Sponsorship and Airport Sponsor Obligations. 

 

(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)

Page 1 of 2 
Order 5100.38C Appendix 22. Agreement on State Sponsorship and Airport 

Sponsor Obligations June 28, 2005

Page 312 

CERTIFICATE OF AIRPORT SPONSOR’S ATTORNEY

 

(Name of Sponsor) 

I, , acting as Attorney for the Airport Sponsor, do certify that I have examined the foregoing 

Agreement and find the execution thereof by said Airport Sponsor has been duly authorized and is in all 

respects due and proper in accordance with laws of the State, and that in my opinion said Agreement 

constitutes a legal and binding obligation of the Airport Sponsor in accordance with the terms thereof. 

Dated at this day of , . 

By

(Signature of Sponsor’s Attorney) 

Page 2 of 2 
June 28, 2005 Appendix 23. Adjustments of Federal Shares at 

Certain Airports Order 5100.38C

Page 313

Listed below are various upward adjustments in the percentage Federal shares of allowable project 

costs applicable to some airports where different than typically used for states with certain nontaxable 

and public land areas. See Table 3 on types of airports. For purposes of this appendix, the term 

“smaller airports” means nonprimary (except commercial service) and other than the passenger classes 

listed within Table 3. See Paragraph 26 for typical Federal shares or further adjustments. Contact 

APP-520 for assistance on making the adjustments or changes in hub types. 

Percentage Federal Share of Project Costs 

State Airport Fiscal Year 2004-2007 After Fiscal Year 2007

Alaska Large and Medium Hub Airports 93.75 93.75 

Other Airports 95.00 93.75 

Arizona Small Hub and Nonhub Airports 95.00 93.75 

Smaller Airports 95.00 91.06 

California Large and Medium Hub Airports 80.59 80.59 

Small Hub and Nonhub Airports 95.00 90.66 

Idaho Small Hub and Nonhub Airports 95.00 93.75 

Nevada Small/Nonhubs and Smaller Airports 95.00 93.75 

New Mexico Large and Medium Hub Airports 84.29 84.29 

Small Hub and Nonhub Airports 95.00 93.75 

Oregon Large and Medium Hub Airports 83.33 83.33 

Small Hub and Nonhub Airports 95.00 93.75 

Utah Large and Medium Hub Airports 90.63 90.63 

Small Hub and Nonhub Airports 95.00 93.75 

Other Airports 95.00 90.94 

Wyoming Small Hub and Nonhub Airports 95.00 93.75 

Page 1 of 1 
Order 5100.38C Appendix 23. Adjustments of Federal Shares at 

Certain Airports June 28, 2005

Page 314 

This page left intentionally blank. 
June 28, 2005 Appendix 24. Reserved Order 5100.38C

Page 315

Reserved 

Page 1 of 1 
Order 5100.38C Appendix 24. Reserved June 28, 2005

Page 316 

This page left intentionally blank. 
June 28, 2005 Appendix 25. Standard Sponsor Certification Forms Order 5100.38C

Page 317

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. 

Page 1 of 12 
Order 5100.38C Appendix 25. Standard Sponsor Certification Forms June 28, 2005

Page 318 

Yes No N/A 

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) 

Page 2 of 12 
June 28, 2005 Appendix 25. Standard Sponsor Certification Forms Order 5100.38C

Page 319

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. 

Page 3 of 12 
Order 5100.38C Appendix 25. Standard Sponsor Certification Forms June 28, 2005

Page 320 

Yes No N/A 

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) 

Page 4 of 12 
June 28, 2005 Appendix 25. Standard Sponsor Certification Forms Order 5100.38C

Page 321

U.S. DEPARTMENT OF TRANSPORTATION 

FEDERAL AVIATION ADMINISTRATION 

AIRPORT IMPROVEMENT PROGRAM 

SPONSOR CERTIFICATION 

EQUIPMENT/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): 

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: 

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. 

Page 5 of 12 
Order 5100.38C Appendix 25. Standard Sponsor Certification Forms June 28, 2005

Page 322 

Yes No N/A 

6. All contracts exceeding $100,000 require (will require) the following 

provisions: 

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: 

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: 

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) 

Page 6 of 12 
June 28, 2005 Appendix 25. Standard Sponsor Certification Forms Order 5100.38C

Page 323

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:

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.

Page 7 of 12 
Order 5100.38C Appendix 25. Standard Sponsor Certification Forms June 28, 2005

Page 324 

Yes No N/A 

7. Appraisals prepared by qualified real estate appraisers hired by the sponsor 

include (will include) the following:

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: 

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: 

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) 

Page 8 of 12 
June 28, 2005 Appendix 25. Standard Sponsor Certification Forms Order 5100.38C

Page 325

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: 

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.

Page 9 of 12 
Order 5100.38C Appendix 25. Standard Sponsor Certification Forms June 28, 2005

Page 326 

Yes No N/A 

7. Payments to the contractor were (will be) made in compliance with contract 

provisions as follows:

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) 

Page 10 of 12 
June 28, 2005 Appendix 25. Standard Sponsor Certification Forms Order 5100.38C

Page 327

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: 

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: 

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. 

Page 11 of 12
Order 5100.38C Appendix 25. Standard Sponsor Certification Forms June 28, 2005

Page 328 

Yes No N/A 

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: 

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. 

 

(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) 

Page 12 of 12 
June 28, 2005 Appendix 26. Block Grant Application Order 5100.38C

Page 329

PART II – APPLICATION FORM 

STATE INFORMATION 

AVIATION BLOCK GRANT PROGRAM

Part II is the second of three-part application forms to be used for the State block grant program under 

the Airport Improvement Program. Part II is the principal information on a State’s qualifications to 

administer non-primary airport projects under the AIP. 

States receiving block grants will be expected to carry out the program in accordance with the 

information presented in these application forms. States may use any written format they choose to 

provide the information below. Each item should be addressed. 

1. Describe your State’s general approach to the block grant program. 

2. Describe your agency or organization to show that it is capable of administering effectively a block 

grant. 

3. Describe your airport system planning process. Specify how safety and security projects are 

justified in your airport system planning process. 

4. Describe your environmental study and protection requirements as they apply to airport 

development. 

5. Define your project programming process as well as the project priority ranking system and compare 

it with the FAA system. This item must include how your programming process provides for meeting 

critical safety and security projects. It must also describe how the programming process ensures 

that the needs of the national airport system are addressed. 

6. Describe your procedure for compliance with Federal procedural and other standard requirements. 

7. Describe any channeling act that requires the State to be an agent, sponsor, or otherwise participate 

in financial oversight of a Federal airport project. 

State Block Grant Information (8/01) 

Page 1 of 1 
Order 5100.38C Appendix 26. Block Grant Application June 28, 2005

Page 330 

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June 28, 2005 Appendix 27. Block Grant Agreement Order 5100.38C

Page 331

U.S. Department 

of Transportation 

Federal Aviation 

Administration

AVIATION BLOCK GRANT PROGRAM 

GRANT AGREEMENT 

PART I – OFFER

 

Date of Offer 

 

Block Grant No 

 

Contract No 

 

DUNS No 

TO: 

(herein called the “State”) 

FROM: The United States of America (acting through the Federal Aviation Administration, herein called the “FAA”)

WHEREAS, the State has submitted to the FAA a Block Grant Application dated , for a grant of 

Federal funds for a block grant as authorized under Title 49, United States Code (USC), section 47128 

(herein called the “Act”), which Block Grant Application, as approved by the FAA, is hereby incorporated 

herein and made a part hereof; and 

WHEREAS, the FAA has approved a block grant for the State as more particularly described in the 

Block Grant Application to carry out airport planning, development and noise program implementation 

projects (herein called the "projects") at airports in the State that are not primary airports as defined in 

the Act. 

NOW THEREFORE, in consideration of the State’s ratification of said Block Grant Application and 

Acceptance of this Offer as hereinafter provided, THE FEDERAL AVIATION ADMINISTRATION 

OFFERS AND AGREES to pay the United States share of allowable costs in accomplishing projects. 

The maximum obligation of the United States payable under this Offer shall be $ . Of this amount 

a minimum of $ must be expended for projects at airports as prescribed in Condition 9. 

State Block Grant Agreement (9-01) Page 1 

Page 1 of 4 
Order 5100.38C Appendix 27. Block Grant Agreement June 28, 2005

Page 332 

This Offer is made on and SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS:

Conditions

1. Future grant amendments may increase the foregoing maximum obligation of the United States 

under the provisions of Section 47108(b) of the Act. 

2. The allowable costs of the projects shall not include any costs determined by the FAA to be ineligible 

for consideration as to allowability under the Act. 

3. Payment of the United States' share of the allowable costs will be made pursuant to and in 

accordance with the provisions of such regulations, and procedures, as the United States Secretary 

of Transportation (herein call the “Secretary”) shall prescribe. Final determination of the United 

States' share will be based upon the final audit of the total amount of allowable costs and settlement 

will be made for any upward or downward adjustments to the Federal share of costs. 

4. The State shall assure that projects are carried out and completed without undue delays and in 

accordance with the terms hereof, and such regulations and procedures as the Secretary shall 

prescribe, and agrees to comply with the Assurances that were made part of the Block Grant 

Application. 

5. The FAA reserves the right to amend or withdraw this Offer at any time prior to its Acceptance by the 

State. 

6. This Offer shall expire and the United States shall not be obligated to pay any part of the costs of the 

projects unless this Offer has been accepted by the State on or before *, or such subsequent date as 

may be prescribed in writing by the FAA. 

7. The State shall take all steps, including litigation if necessary, to recover Federal funds spent 

fraudulently, wastefully, or in violation of Federal antitrust statutes, or misused in any other manner 

in any projects upon which Federal funds have been expended. For the purposes of this Grant 

Agreement, the term "Federal funds" means funds however used or disbursed by the State that were 

originally paid pursuant to this or any other Federal grant agreement. It shall obtain the approval of 

the Secretary as to any determination of the amount of the Federal share of such funds. It shall 

return the recovered Federal share, including funds recovered by settlement, order, or judgment, to 

the Secretary. It shall furnish to the Secretary, upon request, all documents and records pertaining 

to the determination of the amount of the Federal share or to any settlement, litigation, negotiation, 

or other efforts taken to recover such funds. All settlements or other final positions of the State, in 

court or otherwise, involving the recovery of such Federal share shall be approved in advance by the 

Secretary. 

8. The United States shall not be responsible or liable for damage to property or injury to persons that 

may arise from, or be incident to, compliance with this Grant Agreement. 

9. Entitlements for non-primary airports must be utilized as follows: 

 

State Block Grant Agreement (9-01) Page 2 

Page 2 of 4 
June 28, 2005 Appendix 27. Block Grant Agreement Order 5100.38C

Page 333

The State's acceptance of this Offer and ratification and adoption of the Block Grant Application 

incorporated herein shall be evidenced by execution of this instrument by the State, as hereinafter 

provided, and this Offer and Acceptance shall comprise a Grant Agreement, as provided by the Act, 

constituting the contractual obligations and rights of the United States and the State with respect to the 

accomplishment of the projects and compliance with the Assurances and Conditions as provided herein. 

Such Grant Agreement shall become effective upon the State's Acceptance of this Offer. 

UNITED STATES OF AMERICA 

FEDERAL AVIATION ADMINISTRATION

(Signature)

 

(Typed Name) 

 

(Title) 

State Block Grant Agreement (9-01) Page 3 

Page 3 of 4 
Order 5100.38C Appendix 27. Block Grant Agreement June 28, 2005

Page 334 

PART II - ACCEPTANCE

The State does hereby ratify and adopt all Assurances, statements, representations, warranties, 

covenants, and agreements contained in the Block Grant Application and incorporated materials referred 

to in the foregoing Offer and does hereby accept this Offer and by such Acceptance agrees to comply 

with all of the terms and Conditions in this Offer and in the Block Grant Application. 

Executed this day of , . 

 

(Name of State) 

(SEAL) (Signature of State’s Designated Official Representative)

By: 

(Typed Name of State’s Designated Official Representative) 

Title: 

Attest: (Typed Title of State’s Designated Official Representative)

Title: 

CERTIFICATE OF STATE'S ATTORNEY 

I, , acting as Attorney for the State do hereby certify: 

That in my opinion the State is empowered to enter into the foregoing Grant Agreement under the laws 

of the State of . Further, I have examined the foregoing Grant Agreement and the actions taken 

by said State and State's official representative has been duly authorized and that the execution thereof 

is in all respects due and proper and in accordance with the laws of the said State and the Act. Further, 

it is my opinion that the said Grant Agreement constitutes a legal and binding obligation of the State in 

accordance with the terms thereof. 

Dated at this day of , . 

By

(Signature of Sponsor’s Attorney) 

Title:

(Title of Sponsor’s Attorney) 

State Block Grant Agreement (9-01) Page 4 

Page 4 of 4 
June 28, 2005 Appendix 28. AIP Grant Status Report 

(FAA Form 5100-107 - Electronic Version) Order 5100.38C

Page 335

Note: This is a screen print of the interface for entry of appropriate grant data related to specific AIP 

grants. The form is generated by the AIP-ACAIS automation system and the format expands to conform 

to the data supplied by the system user. This form, an explanation of its purpose, and instructions for 

use can be found in FAA Order 5100-20, Programming Control and Reporting Procedures Grant-in-Aid 

Program. 
Order 5100.38C Appendix 28. AIP Grant Status Report 

(FAA Form 5100-107 - Electronic Version) June 28, 2005

Page 336 

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June 28, 2005 Appendix 29. Finance Template for LOI Applicants Order 5100.38C

Page 337

FINANCE TEMPLATE FOR LOI APPLICANTS

The Federal Aviation Administration has established a finance template for the purpose of standardizing the 

submission of airport’s financial plans under the Letter of Intent (LOI) application. The FAA will utilize this 

information so that a comprehensive financial analysis of selected applicants’ funding requests can be made 

to ensure the most effective utilization of available federal funds. Airport sponsors are required to submit 

their financial plans in a format comparable to this template. If a sponsor is interested in utilizing a preformatted template, please contact Dennis Walsh, FAA Airports Financial Assistance Division, at 

202-493-4890 (APP-510). 
Order 5100.38C Appendix 29. Finance Template for LOI Applicants June 28, 2005

Page 338 

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June 28, 2005 Appendix 30. Obligations in Block Grant Suspension or Termination 

OBLIGATIONS IN BLOCK GRANT SUSPENSION OR TERMINATION

Associated 

City 

Name of 

Obligated 

Airport 

Date of 

Regional 

Agreement* 

Date of 

Block 

Grant 

Agreement* 

Date of 

Airport 

Project 

Agreement* 

Scope of Work 

(Type of Elements and Activities in 

Planning, Land, Construction, 

or Equipment Projects) 

Closeout Status of 

Airport 

Project 

Amount 

of 

Federal 

Funds 

C

R

*For preparing a summary of airport project obligations in block grant suspension or termination, see the definitions of terms 
Order 5100.38C Appendix 30. Obligations in Block Grant Suspension or Termination 

Page 340 

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