HomeMy Public PortalAboutJanurary 2020 - Application for Federal Assistance - 3-16-0023-028-2020 :1
McCALL MUNICIPAL AIRPORT
McCALL, IDAHO
APPLICATION FOR FEDERAL ASSISTANCE - FY 2020
AIRPORT IMPROVEMENT PROGRAM (AIP)
PROJECT NO. 3-16-0023-028-2020
SUBMITTED BY:
CITY OF McCALL, IDAHO
216 EAST PARK STREET
McCALL, IDAHO 83638
SUBMITTED TO:
FEDERAL AVIATION ADMINISTRATION
HELENA AIRPORTS DISTRICT OFFICE
JANUARY 2020
View Burden Statement OMB Number:4040-0004
Expiration Date:10/31/2019
Application for Federal Assistance SF-424
*1.Type of Submission: *2.Type of Application: 'If Revision,select appropriate letter(s):
Q Preapplication (�)New
(�) Application Q Continuation 'Other(Specify):
Q Changed/Corrected Application O Revision
'3.Date Received: 4.Applicant Identifier:
5a.Federal Entity Identifier: 5b.Federal Award Identifier:
State Use Only:
6.Date Received by State: 7.State Application Identifier:
8.APPLICANT INFORMATION:
*a.Legal Name: City of McCall, McCall Municipal Airport
*b.Employer/Taxpayer Identification Number(EIN/TIN): *c.Organizational DUNS:
82-6000022 1889226110000
d.Address:
*Streed: 216 East Park Street
Street2:
*City: McCall
County/Parish: Valley
*State: ID: Idaho
Province:
*Country: USA: UNITED STATES
*Zip/Postal Code: 83 638
e.Organizational Unit:
Department Name: Division Name:
McCall Municipal Airport
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: Mr. *First Name: Richard
Middle Name:
*Last Name: Stein
Suffix:
Title: Airport Manager
Organizational Affiliation:
Telephone Number: (208) 634-1488 Fax Number: (208) 634-3038
*Email: rstein@mccall.id.us
J
Application for Federal Assistance SF-424
*9.Type of Applicant 1:Select Applicant Type:
C: City or Township Government
Type of Applicant 2:Select Applicant Type:
Type of Applicant 3:Select Applicant Type:
*Other(specify):
*10.Name of Federal Agency:
Federal Aviation Administration
11.Catalog of Federal Domestic Assistance Number:
20.106
CFDA Title:
Airport Improvement Program
*12.Funding Opportunity Number:
*Title:
13.Competition Identification Number:
Title:
14.Areas Affected by Project(Cities,Counties,States,etc.):
Add Attachment Delete Attachment View Attachment
*15.Descriptive Title of Applicant's Project:
Airport Master Plan
Attach supporting documents as specified in agency instructions.
View Attachments
'1
Application for Federal Assistance SF-424
16.Congressional Districts Of:
a.Applicant EE-:] *b.Program/Project 1st ID
Attach an additional list of Program/Project Congressional Districts if needed.
=Add Attachment Delete AttachmentView Attachment
17.Proposed Project:
*a.Start Date: 06/01/2020 *b.End Date: 12/31/2021
18.Estimated Funding($):
*a.Federal 239,700.00
*b.Applicant 21,306.00
*c.State 5,327.001
*d.Local
*e.Other
*f. Program Income
*g.TOTAL 266,333.00
*19.Is Application Subject to Review By State Under Executive Order 12372 Process?
O a.This application was made available to the State under the Executive Order 12372 Process for review on
b.Program is subject to E.O. 12372 but has not been selected by the State for review.
O c.Program is not covered by E.O. 12372.
*20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.)
O Yes 0 No
If"Yes",provide explanation and attach
Add Attachment Delete Attachment I View Attachment
21.*By signing this application,I certify(1)to the statements contained in the list of certifications**and(2)that the statements
herein are true,complete and accurate to the best of my knowledge.I also provide the required assurances**and agree to
comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may
subject me to criminal,civil,or administrative penalties,(U.S.Code,Title 218,Section 1001)
F✓ **I AGREE
**The list of certifications and assurances,or an internet site where you may obtain this list,is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix: I Mr. *First Name: Robert
Middle Name: IS.
*Last Name: Giles
Suffix:
*Title: Mayor
.*Telephone Number: (208) 634-1003 Fax Number: (208) 634-3038
*Email: rstein@mccall.id.us
*Signature of Authorized Representative: i *Date Signed: "MAR MW
Cam" -
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100-101, Application for Federal Assistance
(Planning Projects)
Paperwork Reduction Act Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to
a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act
unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this
information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 28
hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2
CFR 200; no assurance of confidentiality is provided. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence Ave. SW,
Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110.
INSTRUCTIONS FOR FORM 5100-101,
Application for Federal Assistance (Planning Projects)
Part I of the Application for Federal Assistance consists of a completed Standard Form (SF)424. The remaining parts of
Form 5100-101 (Parts 11, III, and IV) represent continuation pages that the Sponsor must attach to the SF-424 form. The
signature of the Sponsor's authorized representative on the associated SF-424 form represents acceptance of the
representations and certifications made within the corresponding FAA 5100-101 form.
Part II — Project Approval Information
Section A. Statutory Requirements
This information is necessary for the Federal Aviation Administration to evaluate this request for Federal assistance.
Responses do not require an explanation unless explicitly requested by the question. As necessary, provide any
supplemental information by attaching sheets to this application.
Item 1 — Indicate whether the Sponsor maintains an active registration in the Federal System for Award Management
(SAM). Pursuant to 2 CFR§25.200(b), a Sponsor must maintain an active registration in the Central Contractor
Registration repository(housed within www.SAM.gov)with current information at the time of the application and during the
active period of the Federal award.
Item 2—Indicate whether the Sponsor can commence the project within the same fiscal year the grant is made or within 6
months of when the grant is made, whichever is later. Attach explanation for negative responses. This information is
considered when allocating available discretionary funds. (49 U.S.C. §47115(d)(2))
Item 3— Indicate whether the Sponsor can complete the project without unreasonable delays. If applicable, provide listing
of foreseeable events (e.g. sponsor share issues, controversial issues, coordination delays, etc.)that have potential to
delay completion of the project. (49 USC §47106(a))
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION i
Item 4—Indicate whether the project covered by this request is also covered by another Federal assistance program .If
the project, or portions thereof, is covered by another Federal assistance program, identify the Federal assistance
program by name and the Catalog of Federal Domestic Assistance (CFDA) number.
Item 5—Indicate whether the Sponsor intends to seek reimbursement of indirect costs as defined by 2 CFR§200.414 and
2 CFR Appendix VII to Part 200. This information request does not include the indirect costs claimed by a for-profit entity
(e.g. consultant).
The De Minimis rate may only be used if the Sponsor has not previously received a negotiated Indirect Cost Rate (ICR)
and does not exceed the limitations prescribed in Appendix VII to Part 200.
A Sponsor with an existing approved negotiated ICR must identify the ICR value, the name of the cognizant agency that
approved the ICR and the date of approval.
Limitations of use:Per policy, Sponsor's may only apply an approved ICR to allowable direct salary expenses that are
reasonable and necessary to carry out the project.
Section B. Certification Regarding Lobbying
This section addresses the Sponsor's declaration regarding lobbying activities. The declaration made in the section are
under signature of the authorized representative as identified in box 21 of form SF-424, to which this form is attached
Title 31 U.S.C. § 1352 establishes that no appropriated funds may be expended by a recipient of a Federal grant to pay
any person for influencing or attempting to influence an officer or employee of any agency, Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this covered Federal
assistance action. Pursuant to 40 CFR part 20, this certification attests that the Sponsor has not made, and will not make,
any payment prohibited payment by 31 U.S.C. § 1352.
Part III - Budget Information
This form section is designed so that application can be made for funds from one or more assistance programs. Include
budget estimates for the whole project when completing Sections A, B, C, and D. All applications must contain a
breakdown by the object class categories shown in Lines a-e of Section B.
Section A. Budget Summary
Lines 1-2, Columns (a) and (b)—For applications pertaining to a single grant program, enter on Line 1 under Column (a)
the catalog program title and the Catalog of Federal Domestic Assistance (CFDA) number in Column (b). For applications
pertaining to two funding programs, enter the program title on each line in Column (a)and the respective CFDA number(if
applicable) on each line in Column (b).
Lines 1-2, Columns (c) through (e)—For each line entry in Columns (a)and (b), enter in Columns (c), (d), and (e)the
appropriate amounts of funds needed to support the project. For changes to an existing application, enter new budget
values in Columns (c), (d), and (e).
Line 3—Show the totals for all columns used.
Section B. Budget Categories
The column headings (1) and (2) correspond to the program titles shown for Lines 1-2, Column (a), Section A. For each
program, fill in the total requirements for funds (both Federal and non-Federal) by object class categories. The sub-
columns address the "amount" and "adjusted amount". The sub-column for"adjusted amount" need only be completed
when revising a previously submitted application. The Total column represents the sum across all columns.
Lines 4 a-d—Show the estimated amount for each cost budget (object class)category for each column with program
heading.
Line 4e—Enter the subtotal of lines 4a through 4d.
Line 4f—Enter the estimated amount of program income, if any, the Sponsor expects to generate from this project.
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION ii
Line 4g—Subtract line 4f from line 4e. For all applications, the total amount in Total column, line 4g, must equal the total
amount shown in Section A, Column (e), Line 3.
Section C. Source of Non-Federal Resources
Line 5-6—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.
Column (a)- Enter the program titles identical to Column (a), Section A.
Column (b) - Enter the amount of cash and in-kind contributions to be made by the applicant.
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 contributions to be made from all other sources.
Column (e) - Enter the totals of Columns (b), (c), and (d).
Line 7—Enter the total for each of Columns (b)-(e). The amount in Column (e) should be equal to the amount on Line 3,
Column (d), Section A.
Section D. Forecasted Cash Needs
Line 8—
a. Column "Total for Project' - Enter the amount of cash needed from the grantor agency for the project.
b. Columns 1St Year through 4th Year—Enter the anticipated cash need from grantor agency per fiscal year. The
sum of years 1-4 must equal the value shown under Column "Total for Project."
Lines 814- Enter the amount of cash from all other sources needed by quarter during the first year.
Line 9—
a. Column "Total for Project' - Enter the amount of cash needed from non-Federal sources for the project.
b. Columns 1 st Year through 4th Year—Enter the anticipated cash need from non-Federal sources per fiscal
year. The sum of years 1-4 must equal the value shown under Column "Total for Project."
Line 10—Enter the amount of cash from all other sources needed by fiscal year.
Section E. Budget Estimates of Federal Funds Needed for Balance of the Project
Section E. Other Budget Information
Line 11 —Provide any other explanations required herein or any other comments deemed necessary.
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
Provide a short and concise description of the proposed planning effort. Include a brief narrative on the objective of the
planning effort and why it is needed.
2. Results or Benefits Expected
Identify anticipated results and benefits to be derived from this planning project.
3. Approach
a. Outline a plan of action pertaining to the scope and detail of how the Sponsor proposes to accomplish the work.
b. Identify any factors that might accelerate or impede progress of the planning effort.
c. Provide list of activities in chronological order to show the anticipated schedule of accomplishments and their
target milestone dates.
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION iii
d. Identify project monitoring and oversight mechanisms the Sponsor proposes to implement.
e. List key individuals and entities such as consultant, Sponsor personnel and contractor who will work on the
project. Provide a short description of the nature of their effort or contribution.
4. Geographic Location
Identify the location of the project and surrounding area to be served by the proposed project.
5. If Applicable, Provide the Following Information:
Describe the relationship between this project and other work planned, anticipated, or underway under the Federal
Assistance listed under Part II, Section A. If scope objectives change, explain the circumstances surrounding the need to
revise the application scope of work.
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION iv
U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569
Federal Aviation Administration EXPIRATION DATE: 8/31/2019
Application for Federal Assistance (Planning Projects)
Part II — Project Approval Information
Section A—Statutory Requirements
The term "Sponsor" refers to the applicant name as provided in box 8 of the associated SF-424 form.
Item 1
❑X Yes ❑No
Does Sponsor maintain an active registration in the System for Award Management
(www.SAM.gov)?
Item 2
0 Yes ❑No ❑N/A
Can Sponsor commence the work identified in the application in the fiscal year the grant is
made or within six months after the grant is made,whichever is later?
Item 3
Are there any foreseeable events that would delay completion of the project?If yes, ❑Yes 0 No ❑N/A
provide attachment to this form that lists the events.
Item 4
Is the project covered by another Federal assistance program?If yes, please identify other ❑Yes Q No ❑N/A
funding sources by the Catalog of Federal Domestic Assistance(CFDA)number.
CFDA:
Item 5
Will the requested Federal assistance include Sponsor indirect costs as described in 2 CFR ❑Yes Q No ❑N/A
Appendix VII to Part 200,States and Local Government and Indian Tribe Indirect Cost
Proposals?
If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate
the Sponsor proposes to apply:
❑De Minimis rate of 10% as permitted by 2 CFR §200.414
❑Negotiated Rate equal to % as approved by (the Cognizant Agency)
on (Date) (2 CFR part 200, appendix VII)
Note: Refer to the instructions for limitations of application associated with claiming Sponsor indirect costs.
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION Page 1 of 4
Section B — Certification Regarding Lobbying
The declarations made on this page are under the signature of the authorized representative as identified in box 21 of
form SF-424, to which this form is attached. The term "Sponsor" refers to the applicant name provided in box 8 of the
associated SF-424 form.
The Authorized Representative certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor, to any person
for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract,
grant, loan, or cooperative agreement, the Authorized Representative shall complete and submit Standard
Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions
(3)The Authorized Representative shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans,
and cooperative agreements) and that all subrecipients shall certify and disclose accordingly
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION Page 2 of 4
Part III — Budget Information
Section A—Budget Summary
Federal New or Revised Budget
Grant Program Catalog No
(a) (b) Federal Non-Federal Total
(c) (d) (e)
1.Airport Improvement Program 20-106 $ 239,700 $ 26,633 $ 266,333
2.
3.TOTALS $ 239,700 1 $ 26,633 $ 266,333
Section B—Budget Categories (All Grant Programs)
Airport Improvement Program Other Program
(1) (2)
4. Object Class Categories Amount Adjustment Amount Adjustment Total
+or(-)Amount +or(-)Amount
(Use only for (Use only for
revisions) revisions)
a.Administrative expense $ 5,000 $ $ $ $ 5,000
b.Airport Planning 261,333 261,333
c. Environmental Planning
d. Noise Compatibility Planning
e.Subtotal 266,333 266,333
f. Program Income
g.TOTALS (line a minus line f) $ 266,333 $ $ $ $ 266,333
Section C—Non-Federal Resources
Grant Program Applicant State Other Sources Total
(a) (b) (c) (d) (e)
5. State Grant at 2% $ 21,306 $ 5,327 $ $ 26,633
6.
7.TOTALS $ 21,306 $ 5,327 $ $ 26,633
Section D—Forecasted Cash Needs
Source of funds Total for Project 1St Year 2nd Year 3rd Year 4th Year
8. Federal $ $ $ $ $
9. Non-Federal
10.TOTAL $ $ $ $ $
Section E—Other Budget Information
11. Other Remarks: (attach sheets if necessary)
The following items are hereby incorporated:Sponsor Assurances;Title VI Assurances;Sponsor Certifications; Exhibit"A"
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION Page 3 of 4
Part IV - Program Narrative
(Suggested Format)
PROJECT: Airport Master Plam
AIRPORT: McCall Municipal Airport(KMYL)
1. Objective:
To provide an Airport Master Plan Update with an Airport Layout Plan Update.
2. Benefits Anticipated:
To provide guidance for future development of the McCall Municipal Airport.A Master Plan was last completed in 2007 with some
minimal planning efforts in 2019 for a Pre-Design Study effort.
3. Approach: (See approved Scope of Work in Final Application)
The project will be accomplished as per the standards specified in 150/5070-68.The final Scope of Work to be approved by FAA
4. Geographic Location:
McCall Municipal Airport(KMYL), City of McCall, Idaho,Valley County, Idaho
5. If Applicable, Provide Additional Information:
6. Sponsor's Representative: (include address&telephone number)
Richard Stein-Airport Manager- (208) 634-1488
216 East Park Street
McCall, Idaho 83638
FAA Form 5100-101 (4/16)SUPERSEDES PREVIOUS EDITION Page 4 of 4
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100-130, Drug-Free Workplace — Airport Improvement
Program Sponsor Certification
Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ASP-110.
FAA Form 5100-130
U.S.Department of Transportation OMB CONTROL NUMBER: 2120-0569
r Federal Aviation Administration EXPIRATION DATE:8/31/2019
Drug-Free Workplace
Airport Improvement Program Sponsor Certification
Sponsor: City of McCall Idaho
Airport: McCall Municipal Airport
Project Number: AIP 3-16-0023-028-2020
Description of Work: Airport Master Plan
Application
49 USC §47105(d) authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (AIP). General requirements on the drug-free workplace within federal grant programs are
described in 2 CFR part 182. Sponsors are required to certify they will be, or will continue to provide, a
drug-free workplace in accordance with the regulation. The AIP project grant agreement contains specific
assurances on the Drug-Free Workplace Act of 1988.
Certification Statements
Except for certification statements below marked as not applicable (N/A), this list includes major
requirements of the construction project. Selecting "Yes" represents sponsor acknowledgement and
confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time
based on the certification statement focus area, but no later than the end of the project period of
performance.This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
1. A statement has been or will be published prior to commencement of project notifying employees
that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled
substance is prohibited in the sponsor's workplace, and specifying the actions to be taken against
employees for violation of such prohibition (2 CFR§ 182.205).
0 Yes ❑ No ❑ N/A
2. An ongoing drug-free awareness program (2 CFR§ 182.215) has been or will be established
prior to commencement of project to inform employees about:
a. The dangers of drug abuse in the workplace;
b. The sponsor's policy of maintaining a drug-free workplace;
c. Any available drug counseling, rehabilitation, and employee assistance programs; and
d. The penalties that may be imposed upon employees for drug abuse violations occurring
in the workplace.
®Yes ❑ No ❑ N/A
FAA Form 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3
3. Each employee to be engaged in the performance of the work has been or will be given a copy of
the statement required within item 1 above prior to commencement of project(2 CFR§ 182.210).
❑x Yes ❑ No ❑ N/A
4. Employees have been or will be notified in the statement required by item 1 above that, as a
condition employment under the grant(2 CFR§ 182.205(c)), the employee will:
a. Abide by the terms of the statement; and
b. Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five calendar days after such conviction.
❑x Yes ❑ No ❑ N/A
5. The Federal Aviation Administration (FAA)will be notified in writing within 10 calendar days after
receiving notice under item 4b above from an employee or otherwise receiving actual notice of
such conviction (2 CFR§ 182.225). Employers of convicted employees must provide notice,
including position title of the employee, to the FAA(2 CFR§ 182.300).
❑x Yes ❑No ❑ N/A
6. One of the following actions (2 CFR§ 182.225(b))will be taken within 30 calendar days of
receiving a notice under item 4b above with respect to any employee who is so convicted:
a. Take appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended; and
b. Require such employee to participate satisfactorily in drug abuse assistance or
rehabilitation programs approved for such purposes by a federal, state, or local health,
law enforcement, or other appropriate agency.
❑x Yes ❑No ❑ N/A
7. A good faith effort will be made, on a continuous basis, to maintain a drug-free workplace through
implementation of items 1 through 6 above (2 CFR§ 182.200).
❑x Yes ❑ No ❑ N/A
Site(s) of performance of work (2 CFR§ 182.230):
Location 1
Name of Location: McCall Municipal Airport
Address: 336 Dinehard Lane, McCALL, Idaho 83638
Location 2 (if applicable)
Name of Location:
Address:
Location 3 (if applicable)
Name of Location:
Address:
FAA Form 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 2 of 3
Attach documentation clarifying any above item marked with a "No" response.
Sponsor's Certification
I certify, for the project identified herein, responses to the forgoing items are accurate as marked and
additional documentation for any item marked "no" is correct and complete.
Executed on this 60 day of r mu�j , 2020
Name of Sponsor: City of McCall, Idaho
Name of Sponsor's Authorized Official: Robert S.Giles
Title of Sponsor's Authorized Official: Mayor
Signature of Sponsor's Authorized Official: _
I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and
willfully providing false information to the federal government is a violation of 18 USC § 1001 (False
Statements) and could subject me to fines, imprisonment, or both.
FAA Form 5100-130(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100-134, Selection of Consultants — Airport
Improvement Program Sponsor Certification
Paperwork Reduction Act Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer,ASP-110.
FAA Form 5100-134
1 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569
4W Federal Aviation Administration EXPIRATION DATE:8/31/2019
Selection of Consultants
Airport Improvement Program Sponsor Certification
Sponsor: City of McCall, Idaho
Airport: McCall Municipal Airport
Project Number: AIP 3-16-0023-028-2020
Description of Work: Airport Master Plan
Application
49 USC§47105(d)authorizes the Secretary to require certification from the sponsor that it will comply
with the statutory and administrative requirements in carrying out a project under the Airport Improvement
Program (AIP). General requirements for selection of consultant services within federal grant programs
are described in 2 CFR§§200.317-200.326. Sponsors may use other qualifications-based procedures
provided they are equivalent to standards of Title 40 chapter 11 and FAA Advisory Circular 150/5100-14,
Architectural, Engineering, and Planning Consultant Services for Airport Grant Projects.
Certification Statements
Except for certification statements below marked as not applicable (N/A),this list includes major
requirements of the construction project. Selecting "Yes" represents sponsor acknowledgement and
confirmation of the certification statement. The term"will' means Sponsor action taken at appropriate time
based on the certification statement focus area, but no later than the end of the project period of
performance.This list is not comprehensive and does not relieve the sponsor from fully complying with all
applicable statutory and administrative standards. The source of the requirement is referenced within
parenthesis.
1. Sponsor acknowledges their responsibility for the settlement of all contractual and administrative
issues arising out of their procurement actions (2 CFR§200.318(k)).
❑x Yes []No ❑N/A
2. Sponsor procurement actions ensure or will ensure.full.and open-competition that does not.
unduly limit competition (2 CFR§200.319).
❑x Yes ❑No ❑N/A
3. Sponsor has excluded or will exclude any entity that develops or drafts specifications,
requirements, or statements of work associated with the development of a request-for-
qualifications (RFQ)from competing for the advertised services (2 CFR§ 200.319).
❑x Yes ❑No ❑N/A
FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3
4. The advertisement describes or will describe specific project statements-of-work that provide
clear detail of required services without unduly restricting competition (2 CFR§ 200.319).
p Yes ❑No ❑N/A
5. Sponsor has publicized or will publicize a RFQ that:
a. Solicits an adequate number of qualified sources (2 CFR§200.320(d)); and
b. Identifies all evaluation criteria and relative importance (2 CFR§ 200.320(d)).
p Yes ❑No ❑N/A
6. Sponsor has based or will base selection on qualifications, experience, and disadvantaged
business enterprise participation with price not being a selection factor(2 CFR§ 200.320(d)).
p Yes ❑No ❑N/A
7. Sponsor has verified or will verify that agreements exceeding $25,000 are not awarded to
individuals or firms suspended, debarred or otherwise excluded from participating in federally
assisted projects (2 CFR§180.300).
p Yes ❑No ❑N/A
8. A/E services covering multiple projects: Sponsor has agreed to or will agree to:
a. Refrain from initiating work covered by this procurement beyond five years from the date
of selection (AC 150/5100-14); and
b. Retain the right to conduct new procurement actions for projects identified or not
identified in the RFQ (AC 150/5100-14).
p Yes ❑No ❑N/A
9. Sponsor has negotiated or will negotiate a fair and reasonable fee with the firm they select as
most qualified for the services identified in the RFQ (2 CFR§200.323).
❑x Yes ❑No ❑N/A
10. The Sponsor's contract identifies or will identify costs associated with ineligible work separately
from costs associated with eligible work (2 CFR§ 200.302).
❑x Yes ❑No ❑N/A
11. Sponsor has prepared or will prepare a record of negotiations detailing the history of the
procurement action, rationale for contract type and basis for contract fees (2 CFR§200.318(1)).
M Yes ❑No ❑N/A
12. Sponsor has incorporated or will incorporate mandatory contact provisions in the consultant
contract for AIP-assisted work (49 U.S.C. Chapter 471 and 2 CFR part 200 Appendix II)
p Yes ❑No ❑N/A
FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 2 of 3
13. For contracts that apply a time-and-material payment provision (also known as hourly rates,
specific rates of compensation, and labor rates), the Sponsor has established or will establish:
a. Justification that there is no other suitable contract method for the services (2 CFR
§200.3180));
b. A ceiling price that the consultant exceeds at their risk (2 CFR§200.3180)); and
c. A high degree of oversight that assures consultant is performing work in an efficient
manner with effective cost controls in place 2 CFR§200.3180)).
Ox Yes ❑No ❑N/A
14. Sponsor is not using or will not use the prohibited cost-plus-percentage-of-cost(CPPC) contract
method. (2 CFR§ 200.323(d)).
px Yes ❑No ❑N/A
Attach documentation clarifying any above item marked with "no" response.
Sponsor's Certification
I certify,for the project identified herein, responses to the forgoing items are accurate as marked and
additional documentation for any item marked "no" is correct and complete.
I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and
willfully providing false information to the federal government is a violation of 18 USC § 1001 (False
Statements)and could subject me to fines, imprisonment, or both.
Executed on this day of F:�.bfLt 2020
Name of Sponsor: City of McCall, Idaho
Name of Sponsor's Authorized Official: Robert S.Giles
Title of Sponsor's Authorized Official: Mayor
Signature of Sponsor's Authorized Official:
I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and
willfully providing false information to the federal government is a violation of 18 USC § 1001 (False
Statements) and could subject me to fines, imprisonment, or both.
FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3
J
U.S. Department
of Transportation
Federal Aviation
Administration
FAA Form 5100-135, Certification and Disclosure Regarding
Potential Conflicts of Interest — Airport Improvement Program
Sponsor Certification
Paperwork Reduction Act Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a currently
valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public
reporting for this collection of information is estimated to be approximately 8 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, completing and reviewing the collection of information. All responses to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to the Federal Aviation
Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ASP-110.
FAA Form 5100-135
U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569
�/ Federal Aviation Administration EXPIRATION DATE: 8/31/2019
Certification and Disclosure Regarding Potential Conflicts of Interest
Airport Improvement Program Sponsor Certification
Sponsor: City of McCall, Idaho
Airport: McCall Municipal Airport
Project Number: AIP 3-16-0023-028-2020
Description of Work: Airport Master Plan
Application
Title 2 CFR§ 200.112 and § 1201.112 address Federal Aviation Administration (FAA) requirements for
conflict of interest. As a condition of eligibility under the Airport Improvement Program (AIP), sponsors
must comply with FAA policy on conflict of interest. Such a conflict would arise when any of the following
have a financial or other interest in the firm selected for award:
a) The employee, officer or agent,
b) Any member of his immediate family,
c) His or her partner, or
d) An organization which employs, or is about to employ, any of the above.
Selecting "Yes" represents sponsor or sub-recipient acknowledgement and confirmation of the
certification statement. Selecting "No" represents sponsor or sub-recipient disclosure that it cannot fully
comply with the certification statement. If"No" is selected, provide support information explaining the
negative response as an attachment to this form. This includes whether the sponsor has established
standards for financial interest that are not substantial or unsolicited gifts are of nominal value (2 CFR§
200.318(c)). The term "will" means Sponsor action taken at appropriate time based on the certification
statement focus area, but no later than the end of the project period of performance.
Certification Statements
1. The sponsor or sub-recipient maintains a written standards of conduct governing conflict of
interest and the performance of their employees engaged in the award and administration of
contracts (2 CFR§200.318(c)). To the extent permitted by state or local law or regulations, such
standards of conduct provide for penalties, sanctions, or other disciplinary actions for violations of
such standards by the sponsor's and sub-recipient's officers, employees, or agents, or by
contractors or their agents.
❑x Yes ❑ No
FAA Form 5100-135(2/17)SUPERSEDES PREVIOUS EDITION Page 1 of 2
w
2. The sponsor's or sub-recipient's officers, employees or agents have not and will not solicit or
accept gratuities,favors or anything of monetary value from contractors, potential contractors, or
parties to sub-agreements (2 CFR§200.318(c)).
❑x Yes ❑ No
3. The sponsor or sub-recipient certifies that is has disclosed and will disclose to the FAA any
known potential conflict of interest(2 CFR § 1200.112).
❑x Yes ❑ No
Attach documentation clarifying any above item marked with "no" response.
Sponsor's Certification
I certify, for the project identified herein, responses to the forgoing items are accurate as marked and
have the explanation for any item marked "no" is correct and complete.
Executed on this 13 day of lUACXV`t, 2020
Name of Sponsor: City of McCall, Idaho
Name of Sponsor's Authorized Official: Robert S.Giles
Title of Sponsor's Authorized Official: Mayor
Signature of Sponsor's Authorized Official:
I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and
willfully providing false information to the federal government is a violation of 18 USC § 1001 (False
Statements) and could subject me to fines, imprisonment, or both.
FAA Form 5100-135 (2/17)SUPERSEDES PREVIOUS EDITION Page 2 of 2