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HomeMy Public PortalAbout2019 T-O Engineer - North East Apron Reconstruction -3-16-0023-023-2017 McCALL MUNICIPAL AIRPORT FINAL REPORT AIP 3-16-0023-023-2017 Prepared by: NORTHEAST APRON RECONSTRUCTION Prepared for the City of McCall and the Federal Aviation Administration �� • ENGINEERS Reviewed and approved FINAL CLOSEOUT REPORT by T-O Engineers, Inc. MCCALL MUNICIPAL AIRPORT AIP 3-16-0023-023-2017 • NORTHEAST APRON RECONSTRUCTION The following report was prepared in conformance with FAA Northwest Mountain Region ENGINEERING GUIDANCE 2013-12 ©2019 T-O Engineers,Inc.All rights reserved Owl T-0 ENGINEERS Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3-16-00023-023-2017 Table of Contents A. Project History..................................................................................... 1 1. Project Location.................................................................................. 2. Work Items Constructed and Deleted......................................................... 3. Contract Dates................................................................................... 4. Construction Sequencing....................................................................... 5. Contractors and Subcontractors............................................................... 2 6. Liquidated Damages ............................................................................ B. Administrative Costs ............................................................................. 2 C. Engineering Costs and Construction Management........................................ 3 1. Consultant Services Summary................................................................. 2. Sponsor Force Account Services Summary.................................................. D. Construction ....................................................................................... 3 1. Summary of Change Orders ................................................................... 2. Summary of Final Quantities................................................................... 3. Final Inspection Report ......................................................................... 4. Record Drawings ................................................................................ 5. Summary of Test Results....................................................................... 6. Revised Construction Management Plan..................................................... 7. Items Acquired by Sponsor..................................................................... 4 8. DBE Utilization................................................................................... E. Airport Layout Plan (ALP) ....................................................................... 5 F. Airport Master Record............................................................................ 5 G. Pavement Strength Survey...................................................................... 5 H. Sponsor/Consultant Certifications ............................................................ 5 i T-O ENGINEERS 0 2019 T-O Engineers,Inc.All rights reserved Final Closeout Report McCall Municipal Airport Northeast Aiaron Reconstruction AIP 3-16-00023-023-2017 Appendix A — Project Financial Information Appendix B — Construction Quantities Appendix C — Construction Testing Appendix D — DBE Participation Summary Appendix E — Pavement Strength Survey Appendix F — Sponsor Certifications Appendix G — Sponsor/Consultant Certifications for Project Testing Appendix H —Project Photographs II T-O ENGINEERS ©2019 T-0 Engineers,Inc.All rights reserved Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3-16-0023-023-2017 A. Project History 1. Project Location McCall Municipal Airport (MYL) is located Valley County, Idaho one mile south of the City of McCall off of State Highway 55. This project involved the reconstruction of the Northeast Apron at the McCall Municipal Airport. 2. Work Items Constructed and Deleted The work items for this project were all constructed under Schedule A: Northeast Apron Reconstruction. This major items under this schedule included milling and removal of the existing pavement section, excavation, subbase course, base course, HMA pavement, concrete paving, and pavement marking. No change orders were processed for this project and no work items were deleted. 3. Contract Dates Contract Award 27 June 2017 Notice to Proceed 16 July 2018 Scheduled Substantial Completion 02 September 2018 Actual Substantial Completion 27 August 2018 Final Inspection 14 September 2018 Final Acceptance 14 September 2018 4. Construction Sequencing Phase 1 — Phase 1 consisted of all major work to reconstruct the northwest portion of the Northeast Apron. Main construction items were milling, excavation, removal of existing drainage structures, removal of existing tie downs, subbase course, base course, HMA paving, concrete paving, and placement of temporary pavement markings. During this phase the northwest portion of the Northeast Apron was closed. Phase 2 — Phase 2 consisted of all major work to reconstruct the southeast portion of the Northeast Apron. Main construction items were milling, excavation, removal of existing tie downs, subbase course, base course, HMA paving, and placement of temporary pavement markings. During this phase the southeast portion of the Northeast Apron was closed. Phase 3— Phase 3 consisted of placement of permanent pavement markings. 1 a T-O ENGINEERS ©2019 T-O Engineers,Inc.All rights reserved Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3 16 0023 023 2017 5. Contractors and Subcontractors Prime Contractor Granite Excavation, Inc 23 Warm Lake Highway Cascade, ID 83611 Subcontractors • Pavement Marking And Obliteration Curtis Clean Sweep Boise, ID • Concrete Pusher Construction Boise, ID • Rotomilling Western Construction Boise, ID • SWPPP Syman Nampa, ID • HMA Idaho Materials & Construction Nampa, ID 6. Liquidated Damages There were no liquidated damages assessed on this project. B. Administrative Costs Administrative costs are summarized below. A Final Payment Summary Worksheet, SF- 271, and SF-425 are included in Appendix A. DescriptionAmount Expended Independent Fee Estimate (Rood &Associates) $3,000.00 Advertisement $302.45 Total Administrative Cost $3,302.45 2 T•O ENGINEERS ©2019 T-O Engineers,Inc.All rights reserved Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3-16-0023-023-2017 C. Engineering Costs and Construction Management 1. Consultant Services Summary T-O Engineers provided professional services for construction administration under this grant. The professional services contract is dated December 8, 2016 and was approved by the FAA on May 25, 2017. The actual fees incurred by the City of McCall for Consultant Services are summarized below. A Final Payment Summary Worksheet, SF-271, and SF-425 are included in Appendix A. Description Budget Actual Professional Services Contract Consultant Design Phase Services $97,168.00 $95,761.51 Consultant Construction Services $144,997.50 $139,012.48 Final Contract Total $242,165.50 $234,773.99 -O En ineers Total $234,773.9 2. Sponsor Force Account Services Summary No force account work was performed on this project. D. Construction 1. Summary of Change Orders No change orders were processed for this project. 2. Summary of Final Quantities Bid Item 6B—Stabilized Construction Entrance was not constructed and was 100% below the original estimate. Bid Item 7 —Sawcut Asphalt Pavement totaled 30% over the original estimate due to the removal of 16 additional tie down anchors and saw cutting new pavement between phases to create a lap joint. Bid Item 10 — Remove and Dispose of Existing Tie Down Anchors ended up being 76% over the original estimate due to discovery of 16 additional tie down anchors that were not found during the original survey. Bid Item 13C— Unsuitable Overdepth Excavation — Remove and Replace ended up being 99% under the original estimate. Only one small soft spot was encountered during construction. 3 ma T-O ENGINEERS ©2019 T-O Engineers,Inc.All rights reserved Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3 16 0023 023 2017 Bid Item 19— Unpaved Shoulder Surfacing (Rotomillings) ended up being 100% under the original estimate, as the owner choose not to have the millings installed. All other quantities were within +/- 10% of the original estimate. The actual costs incurred by the City of McCall during construction are summarized below. Final quantities for all bid items can be viewed on the final contractors pay request included in Appendix B. Description Budget Actual Construction Contract Schedule A— Northeast Apron Reconstruction $1,143,609.00 $1,104,857.25 ranite Excavation Total $1,104,857.2 3. Final Inspection Report The final inspection for the project was held on 14 September 2018. Those present for the inspection were Charlie Smith of T-O Engineers and Jay Scherer of McCall Municipal Airport. No deficiencies were found and no punch list was created. 4. Record Drawings Record Drawings will be submitted to the FAA under separate cover. 5. Summary of Test Results All Quality Control and Quality Acceptance testing was completed in accordance with the project specifications. All tests met or exceeded the requirements of the specifications. Summaries of test results for bid items covered under this grant are included in Appendix C. 6. Revised Construction Management Plan The Construction Management Plan has been updated to show actual number of tests taken for bid items covered under this grant and is included in Appendix C. 7. Items Acquired by Sponsor No items were acquired by the Sponsor as part of this project. 8. DBE Utilization This project had no DBE Contract Goals. A summary of DBE Participation is included in Appendix D. 4 T-O ENGINEERS ©2019 T-O Engineers,Inc.All rights reserved Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3-16-0023-023-2017 E. Airport Layout Plan (ALP) This project reconstructed existing pavements. No changes to the ALP are necessary from this project. F. Airport Master Record No updates to the Airport Master Record are necessary from this project. G. Pavement Strength Survey Pavement Strength Survey (Form 5320-1) has been updated and is included in Appendix E. H. Sponsor/Consultant Certifications The following updated Sponsor Certifications are included in Appendix F. The original Sponsor Certifications were included with the grant application package submitted to the FAA for this project: Sponsor Certification for Construction Project Final Acceptance Sponsor Certification for Drug-Free Workplace Sponsor Certification for Equipment/Construction Contracts Sponsor Certification for Project Plans and Specifications Sponsor Certification for Real Property Acquisition Sponsor Certification for Selection of Consultants Sponsor Certification for Potential Conflicts of Interest Appendix G includes the following sponsor/consultant certifications for project testing: Sponsor Certification of Testing Laboratories Consultant Certification for Project Testing Appendix H includes before and after photographs of the Northeast Apron reconstruction. 5 Val T-O ENGINEERS ©2019T-0 Engineers,Inc.All rights reserved Appendix A- Project Financial Information FINAL PAYMENT SUMMARY WORKSHEET NOTE: List all contracts(e.g.,engineering,construction)separately. (Include only eligible PROJECT: 3-16.0023.023-2017 LOCATION: McCall Municipal Airport,McCall,Idaho SPONSOR ACTION FAA ACTION To be filled out by FAA FEDERAL TOTAL INELIGIBLE COSTS ALLOWABLE COSTS COSTS FOR FEDERAL PARTICIPATION WORK ITEMS: (Total costs-Ineligible costs) ADMINISTRATION: $ 1. Advertisement $ 302.45 $ 2. Independent Estimate $ 3,000.00 $ $ 3. Other.(define costs) $ $ $ ENGINEERING: Firm Name: T-0 Engineers,Inc. $ 1. Project Formulation/Predesign $ $ 2. Design $ 95,761.51 $ $ 3. Inspection $ 139,012.48 $ $ 4. Amendment $ $ $ 5. Other(define costs) $ $ $ 6. Planning(ALP Update,etc.) $ $ $ ENGINEERING: Firm Name. $ 1. Project Formulation/Predesign $ $ 2. Design $ $ $ 3. Inspection $ $ $ 4. Amendments $ $ $ 5. Other(define costs) $ $ $ 6. Planning(ALP Update,etc.) $ $ $ FORCE ACCOUNT: $ 1. Design $ $ 2. Inspection $ $ $ 3. Construction $ $ $ 4. Planning $ $ $ CONSTRUCTION: Contractor Name Granite Excavation,Inc. $ BID: $ 1,104,857.25 $ C.O.(Summary) $ $ $ OTHER(define costs) $ $ $ Contractor Name $ BID $ C.O.(Summary) $ $ $ OTHER(define costs) $ $ $ LAND(total from land acq.cost sheet) $ $ $ EQUIPMENT: (Each Piece) Name Manufacturer/Equipment 1. $ $ $ 2. $ $ $ Credit:(List any interest earned on Federal Funds) GRAND TOTAL $ 1,342,933.69 $ $ FEDERAL SHARE REQUESTED FOR REIMBURSEMENT(100%X Grand Total) =$1,208,640.00 $ (Note:The percent Federal share must be rounded down to the nearest cent). Certified current 5/22/07 OUTLAY REPORT AND REQUEST FOR REIMBURSEMENT FOR CONSTRUCTION PROGRAMS OMB APPROVAL NO.0348-0002 PAGE of 1 PAGES (See instructions on back) 1.TYPE OF REQUEST Z. BASIS OF REQUEST 3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO ®FINAL ❑ PARTIAL ®CASH ❑ACCRUAL WHICH THIS REPORT IS SUBMITTED 4.FEDERAL GRANTOR OTHER 5. PARTIAL PAYMENT REQUEST NO. IDENTIFYING NUMBER ASSIGNED BY FAA- NMR FEDERALAGENCY Final Report 6. EMPLOYER IDENTIFICATION NUMBER 7. RECIPIENT'S ACCOUNT NUMBER A`IP 3-16-0023-023-2017 OR IDENTIFYING NUMBER 6 PERIOD COVERED BY THIS REQUEST FROM(Month,day,year) TO(Month,day,year) 82-s00002z August 1, 2018 May 31, 2019 DOT-FAI7NM-2059 9. RECIPIENT ORGANIZATION 10.PAYEE(Where check is to be sent if different from item 9) Name: City of McCall Name. No.and Street: 216 East Park Street No.and Street City,state and Z/P Co McCall, ID 83638 de: ciry state and 11 ZIP Code: STATUS OF FUNDS PROGRAMS-- (b) FUNCTIONS-- ACTIVITIES CLASSIFICATION (a) (c) This Period Previous Period TOTAL a. Administrative Expense b. Prelimina Ex ense $ 3 302.45 C. Land,structures,right-of-way 0.00 d. Architectural engineering basic fees 0.00 e. Other architectural en ineerin fees 95 761.51 f. Project inspection fees 0.00 Land develo ment 139 012.48 h. Relocation ex ense 0.00 i. Relocation payments to individuals 0.00 and businesses 0.00 Demolition and removal k. Construction and 2roject improvement cost 0.00 I. E uipment 1 104 857.25 m. Miscellaneous cost 0.00 n. Total cumulative to date Sum of lines a through m 0.00 o. Deductions for ro ram income 1,342,933.69 Net cumulative to date Line n minus Line o 0.00 Federal share to date 1,342,933.69 r. Rehabilitation rants 100%reimbursement 1 342 933.69 s. Total Federal share Sum of Lines 9 and r 0.00 t. Federal pa ments previously requested 1 208 640.00 $ 0.00 u. Amount re uested for reimbursement $ $ $ 1 208 640.00 v. Percent of ro ect com leted 12.CERTIFICATION u SIGNATURE OF AUTHORIZED OCERTIFYING OFFICIAL % 1 00% a. RECIPIENT DATE REPORT SUBMITTED I certify that to the best of my knowledge and belief the billed costs of disbursements are in accordance with TYPED OR PRINTED NAME OR TITLE the terms of the project and that the reimbursement represents the Federal share due which has not been Jackie A mon, Ma or previously requested and that an inspection has been SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL performed and all work is in accordance with the terms b. REPRESENTATIVE of the grant. CERTIFYING TO LINE 11 V TYPED OR PRINTED NAME OR TITLE AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION USABLE STANDARD FORM 271(Rev.7-97) 271.103 Prescribed by OMB Circular A-102 and A-110 FEDERAL FINANCIAL REPORT (Follow form instructions) 1.Federal Agency and Organizational Element to Which 2.Federal Grant or Other Identifying Number Assigned by Federal Agency(To Page of Report is Submitted report multiple grants,use FFR Attachment) 3-16-0023-023 1 1 Federal Aviation Administration -2017 Airports Division pages 3.Recipient Organization(Name and complete address including Zip code) City of McCall, 216 East Park Street, McCall, ID 83638 4a.DUNS Number 4b.EIN 5.Recipient Account Number or Identifying 6.Report Type 7.Basis of Accounting Number(To report multiple grants,use FFR ❑ Quarterly ❑x Cash 18-892-2611 82-6000022 Attachment) ❑ semi-Annual ❑ Accrual ❑ Annual DOT-FA17NM-2059 Final 8.Project/Grant Period(Month,Day,Year) E9. ReporLitn( Period End Date(Month,Day,Year) From: August 1, 2018 To: May 31, 2019 319 Cumulative 10.Transactions Use lines a-c for sin ale or combined multi le rant reporting) Federal Cash To re ort multiple SEants se arately,also use FFR Attachment): $1,208,640.00 a.Cash Recei is $1,208,640.00 b.Cash Disbursements $0.00 c.Cash on Hand line a minus b-)_ Use lines d-o for sin le rant re ortin Federal Expenditures and Unobli ated Balance: $1 250 797.00 ®ReciDient .Total Federal funds authorized $1,208,640.00 .Federal share of ex enditures $0.00 f.Federal share of unli uidated obli ations $1,208,640.00 Total Federal share sum of lines e and f $42,157.00 .Unobli ated balance of Federal funds line d minus Share: #$134 293.69 i.Total rei ient share re uired 134,293.69j.Reci ient share of ex enditures 0.00 k.Remainingrecipient share to be provided line i minus Pro ram Income: I.Total Federal share of program income earned m.Program income expended in accordance with the deduction alternative n.Program income expended in accordance with the addition alternative o.Unex ended ro ram income line I minus line m or line n 11. a.Type b.Rate c.Period Period To d. Base e.Amount Charged f.Federal Share Indirect From I Expense .Totals: 12. Remarks:Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation: 13.Certification: By signing this report,I certify to the best of my knowledge and belief that the report is true,complete,and accurate,and the expenditures,disbursements and cash receipts are for the purposes and intent set forth in the award documents. I am aware that any false, fictitious,or fraudulent information may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 18,Section 1001) a.Typed or Printed Name and Title of Authorized Certifying Official c.Telephone(Area code,number,and extension) Jackie Aymon (208)634-7142 Mayor, City of McCall d.Email Address jaymon@mccall.id.us b.Signature of Authorized Certifying Official e. Date Report Submitted(Month,Day,Year) 14.Agency use only: Standard Form 425-Revised 10/11/2011 OMB Approval Number:0348-0061 Expiration Date:2/28/2015 Paperwork Burden Statement According to the Paperwork Reduction Act,as amended,no persons are required to respond to a collection of information unless it displays a valid OMB Control Number.The valid OMB control number for this information collection is 0348-0061.Public reporting burden for this collection of information is estimated to average 1.5 hours per response,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.Send comments regarding the burden estimate or any other aspect of this collection of information,including suggestions for reducing this burden,to the Office of Management and Budget,Paperwork Reduction Project(0348-0061),Washington,DC 20503. Appendix B- Construction Quantities O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C, O V Q ON N m W 0 0 Q W N W fA N��00 t�l N N y A F E a w 0 0 0 0 0 0 0 O A C O A r J a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O N �o O O O O O O O O O O O O N O 0 0 0 0 0 0 0 0 0 0 0 N W 9 t9 to M di fA eA fA fA N3 M kf1 fA W fA fA V3 to to to to fA fA f9 N� �� � O F» W y>m J d 0 0_ E H a t r r m ro m T O C'L A a J N 000 aL r O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O N p cp t0 r Qi O O r N Qi W W W W O O 0 0�Cl(")0 I J C O N W 1�Q W W O O rON fA fA O� O O W fA m `� o as � O O O cl, N O O O A ` J a d 00000 00000000000 0 a�00000000 000 o�cor of 0orri c`�omo��r�ioa orn�m000 00 c o c Q coW O W Q N V3 ,O N M N O O W N N 7 co r N� fA to fA fA N fA Vi fA � Vi M O W W WW to fA� � E w vi ua u>e> 'A `A in in ui of w U 0 0 0 0 0 0 0 0 0 0 o m 0 0 0 0 0 0 0 or o v o 0 o rn v' ococ�roi oor�ririN�coaoo c6Nmorrooa o� [FITco N W N O to V3 � r wwu>e» 0 0 o a m m N w o m n N co p c N Q f N Q t7 N M A J d d '' J LL LL Y LL Q Q Q Y Y Y Y Y Y Y Y LL LL 'C N V N N W Q Q Q (n W W l(n W r (n N N W R A J J J J W W W J J(n U U U U U U d } Ca CL L cn cn r d d O d U o s o m Z c ° m m O 0 a N c U c 0 u m A e6 y W C0 O c A U y Q d _ K an w 0 vv ° d E rn m m R OQ W N y 0 C 30 m N C C m m N p a O Q d o ct m o W c A a c t c _ � N 7 U D C C m A E c a y m H H O E u LL Q a rn a a 0. i7L 0 w 9 w rn K 'R a c° w" d c c W y o o c o o c c c w w Y d t d�r Nfl' NC ZO aadE Z .aw n A�O c 0 No o W am w ❑ U o. m y c y— S cn U Q N C A E N W CQ m m o U iat � � a �ry 7 R N a d m r N '—^ 9 O W tE E a O m n a N A C 0 V m 7 O E O w a W} !V6 t ,y Ry =f'mUUONEwaafNL UU= a' o aCd0 020 A0 Ao wu 'O Z. t� % o my.oN daVa1«arn ao= Uymo oc aC raE6 omE VT 0 c Eu o ci OaR o Ua2zQa mO r E y O rivui .c Sao ..Z PAY APP SUMMARY/BREAKOUT Throu h Se tember 30 2018 PROJECT TITLE McCall Municipal Airport PROJECT NUMBER: AIP 3-16-0023-023 OWNER: City of McCall ENGINEER. _ T-0 Engineers Pay Request No. 3 -Final Pay Request Work Completed Work Total Work Preceding Completed This Completed Bid Schedule A $1,096,394.20 - Period To Date $8,463.05 $1,104,857.25 subtotal $8,463.05 $1,104,857.25 Gross Amount Due Less 5%Retainage f1 104 857,25 Less Other Retainage $0.00 Payment Amount Due to Date $0.00 Less Previous Payments $1 104$57.25 s1 o4�,s7a.as Pa ment Amount Due Contractor $63 282.76 FAA Share AIP Eligible FAA Match Percentage Federal Share 90.00% $56,954.48 Engineer-T-O Engineers (f Z c Date ractor Granite Excavation Date Owner-City of McCall Date Appendix C- Construction Testing 00 O coo � m -0o 2 -� J _f -(/) N n to _O O "p N O C O O O O p p 0 cn U (0 _I 0 (t U U V NL .0 E J Q co @ p C Q y C C C C O m W U U O O O O U C p_ U U U U U to To N Q N p Q Q p w IY O d N . 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U U U U W « U U U U U UUU p Q Q U a�i Ir U ~ N (n (n (n (n Q Q Q Q Q (n (n (n (nQ Q a Z a d Q Q Q Q Q Q Q O I— c F- U c ) c Q c) o O J N z U ~ U Q O w 7 O 7 a_ M o w 'Q O .T Y C rn 'O U > Z Q d 'U � C L n. c6 a 'O c c ch Q � m J J N E Q O N f (6 @ OU Z O (_n rO`C o U d G O�j C Q) O C U N C .c C .0 W U (D F- � C)) OX NO >w Q CD Q oa) a� (If O a uco co Q) @ c6 a> u n E m U E w a o p Q O ff ¢ C� a Q in U Q F- U O ¢ in � a w !n U QQ ~ ACCEPTANCE TESTS AIRPORT: McCall Municipal Aiport, McCall, ID AIP PROJECT NUMBER: 3-16-0023-023 P-152 DENSITY TESTS SUMMARY OPTIMUM MINIMUM MOISTURE MOISTURE DENSITY ACTUAL DATE 7-20-2018 LOT/SAMPLE# CONTENT(%) CONTENT(%) SPECIFIED(%) DENSITY(%) REMARKS 1 19.3 15.6 95 101 PASS 7-20-2018 2 16.5 7-20-2018 15.6 95 101 PASS 3 18.3 15.6 95 7-20-2018 4 98 PASS 14.2 15.6 95 7-20-2018 5 100 PASS 19.2 15.6 7-24-2018 6 20 95 100 PASS 7-24-2018 15.6 95 98 PASS 7 15 15.6 95 7-24-2018 g 97 PASS 17.5 15.6 95 99 PASS 7-24-2018 9 19.1 15.6 95 97 PASS 7-24-2018 10 16.2 15.6 95 97 PASS 8-9-2018 11 9.1 8'7 95 96 PASS 8-9-2018 12 10.6 8.7 95 8-9-2018 13 97 PASS 18.1 15.6 95 8-13-2018 14 13.4 97 PASS 8-13-2018 15.6 95 101 PASS 15 16.8 15.6 95 8-14-2018 16 17.8 98 PASS 15.6 95 98 PASS 8-14-2018 17 18 15.6 95 99 PASS ACCEPTANCE TESTS AIRPORT: McCall Municipal Aiport, McCall, ID AIP PROJECT NUMBER: 3-16-0023-023 P-154 DENSITY TESTS SUMMARY OPTIMUM MINIMUM MOISTURE MOISTURE DENSITY ACTUAL DATE LOT/SAMPLE# CONTENT(%) CONTENT(%) SPECIFIED (%) DENSITY(%)101 REREMARKS SS 7-24-2018 1 7.9 8.7 100 2 8 8 8.7 100 100 PASS 7-24-2018 102 PASS 7-24-2018 3 6.9 8.7 100 9.1 8.7 100 100 7-24-2018 4 PASS 5 8 8.7 100 100 PASS 7-24-2018 100 101 PASS -2018 6 6.8 8.7 7-24 7 7 1 8.7 100 101 PASS 7-24-2018 100 101 PASS 7-24-2018 8 8.8 8.7 g 7 2 8.7 100 101 PASS 7-25-2018 100 103 PASS 7-25-2018 10 6.3 8.7 8.7 100 101 PASS 7-25-2018 11 6'4 12 5.8 8.7 100 101 PASS 7-25-2018 100 101 PASS 7-25-2018 13 6.4 8.7 14 64 8.7 100 101 PASS . 7-25-2018 100 102 PASS 7-25-2018 15 7.7 8.7 16 65 8.7 100 101 PASS . 7-25-2018 102 PASS 7-25-2018 17 6.1 8.7 100 18 6.6 8.7 100 104 PASS 7-25-2018 100 104 PASS 7-25-2018 19 6.8 8.7 20 5.7 8.7 100 101 PASS 7-25-2018 7-25-2018 21 7.7 8.7 100 103 PASS 22 5.3 8.7 100 101 PASS 8-10-2018 100 102 PASS 8-10-2018 23 3.6 8.7 24 7 8.7 100 100 PASS 8-10-2018 100 100 PASS 8-14-2018 25 5.8 8.7 26 7 8.7 100 101 PASS 8-14-2018 100 100 PASS 8-15-2018 27 6.4 8.7 28 7 3 8.7 100 103 PASS 8-15-2018 8-15-2018 29 6.7 8.7 100 102 PASS 8-15-2018 30 6.8 8.7 100 104 PASS ACCEPTANCE TESTS AIRPORT: McCall Municipal Aiport, McCall, ID AIP PROJECT NUMBER: 3-16-0023-023 P-208 DENSITY TESTS SUMMARY OPTIMUM MINIMUM MOISTURE MOISTURE DENSITY ACTUAL DATE LOT/SAMPLE# CONTENT(%) CONTENT(%) SPECIFIED (%) DENSITY N REMARKS 7-27-2018 1 7 7-27-2018 9.2 2 7.5 9.2 100 102 PASS 7-27-2018 3 100 100 PASS 7.2 9.2 100 7-27-2018 4 101 PASS 6.2 9.2 100 7-30-2018 5 100 PASS 7.2 9.2 100 7-30-2018 6 6.8 9.2 100 100 PASS 7-30-2018 7 100 PASS 6.6 9.2 100 7-31-2018 g 102 PASS 2 100 7-31-2018 g 7.3 9. 102 PASS 2 100 8-20-2018 10 7.6 9.11.8 9.2 100 101 PASS 8-21-2018 11 101 PASS 2 100 8-21-2018 12 5.5 9. 100 PASS 2 9.1 9. 100 100 P 8-21-2018 13 ASS 8.8 9.2 100 8-21-2018 14 101 PASS 5.1 9.2 100 8-21-2018 15 5.2 9.2 100 100 PASS 8-21-2018 16 101 PASS 5.5 9.2 100 101 PASS Ln Y Q w cc to O I-O J Z r N Ln Q w cV lD N 2 00 O m p >- O a) cr1 Q r-1 to m d -Ln i--1 N w z O O O H Z U_ O O O = r 4 r-4 ri D_ w v-} yn -Ln a rn Un 00 N 00 m I— Z 0 00 zt Z 01 O It Q Q rn D y lD l0 �D Q O O O .--1 NO CL N �Q Q o 00 Ql 00 C w Ql Ol 0l C (D W = < N w w W H Q L V N Z lD O W Z �n V W U p Ln Q � o ° o � � f6 r m u 00 O) 00 o^ y0 Ol Ql Ol i Q f to Q N r ui r Z m 00 a) r !Z Q 0 Ql Ol Ql .0 N - O Ln 7 m 1n 0o r N O N 00 00 00 O a) m m U �.D U ri m Ln a' w 00 m 0 op o am m 5 ° Q z ri N m U w LLI f\ JJ G a O Q a `" Q 00 00 00 ri r-i --I O O O N N N r-1 m m LU 00 00 N Q 00 0 Appendix D- DBE Participation Summary DBE PARTICIPATION SUMMARY NOTE: This information must be provided to the FAA project manager prior to contract award and at contract completion. For material supplier contracts (assuming the supplier performs a commercially useful function), multiply the contract amount by 60 percent). LOCATION: McCall Municipal Airport, McCall, Idaho ❑ Award PROJECT NO: AIP 3-16-0023-023-2017 ® Completion APPROVAL DBE DATE OVERALL CONTRACT GOALS: No Goals N/A PRIME CONTRACT: 1 NO. 1 NAME: Granite Excavation, Inc WORK ITEMS: Northeast Apron Reconstruction TOTAL CONTRACT AMOUNT: $ 1,143,609.00 DBE SUBCONTRACTS: 2 NO. 2 NAME: Curtis Clean Sweep WORK ITEMS: Pavement marking removal and striping SUBCONTRACT AMOUNT: $ 3,178.00 0.28 % NO. 3 NAME: WORK ITEMS: SUBCONTRACT AMOUNT: $ % NO. 4 NAME: WORK ITEMS: SUBCONTRACT AMOUNT: $ % Appendix E- Pavement Strength Survey 0 � O r 0 W , $ M Q W w 'ot 1D Z a A r 0.O � W� 0 Z W �Q s 10 z� N ¢� F a� o N�14 I I G I r i r 0 O c � a � N Q r O QOf I a J I I Q a a ao C� m Z I � a � O M w > I r a N J K N � J r Cf) Q U z o 0 0 mw �� LiJ W o N � J T =wwias� (n Q 0000io (� E r 110— n Z 2 O ONO PO+ W (f) W l o d l l l V _ Wne p m I l l a l d w u 0 u n n Q a E .0 0 O O O 0 0 0 0 0 0 0 N 0 0 0 0 0 0 0 0 2 O Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q J Q Q Q Q Q Q Q Q Q Q ------------- T-- -------- ------------ Z? U z Zo a'O W? 1 0 0 N d f m m v� ------------ ' O >i cif o o O N 0 Y m N vl p a0 < n < d N < N Oni [V N v01 d N r01 M O d� n LL Q Y f f O g a a s ov a a � a I a I � a a O 7 e n * o IZ p 0 x 0 0 - O o 0 o O - - Q O Wj a a a 0 a a a a a d o oa a 0 a l a a I l0 I l0 I I tQi� 1 I a a l g a l d l u l a al a a a a s z.N mh o n a ]r JUm 3 ¢ az4m 0 o o rnw�� N mo mo 0 0 0 0 0 0 0 0 0 a 7 al 1 al N R la al ri a al a al a u d d 2 < 2 al a s al al d u a l w o o z mo _ in a a �7n < m b < m b ip b U W 4\ o N m m m �aZr I 7 1 I p_ I ` 1 I I I 1 al FN Zg a � a � � a a `r n a a a a a azr ¢ r m0 - aio oOV ap> }\ m KQ�1U/1 I\. K mtn I LL yl m QM= Y m O g InU I r J U mazri a N n n N W N N W N N N N OZQ Ind J g I N N M N N N N N N n N N N N r W O� WO m O N n a rn o ¢ ar�Q> 0 I OV j SQi V�j Mom A1LxS Si SH wto 0-1 JD NDGWW NEW OHMS 3fIDIWO SDB=SB SD 1N3fdMgl SIH1 JD NDW711"BD EM'"LJfg Ha ANY M33NDN3 o-1 JD AO1 M 111 SI LN3NIO N SN0 4Li#M 0-1 BIOlQ) ,� c�-dad of ava'vws.11�wa'wv zz:z�:ol e�ovelm�nw a�oz wowas w..�.d m�md�aw«�sww nu�rou:l Appendix F- Sponsor Certifications �4W U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-129, Construction Project Final Acceptance — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-129 U.S.Department of Transportation OMB CONTROL NUMBER: 2120-0569 Federal Aviation Administration EXPIRATION DATE:8/31/2019 Construction Project Final Acceptance Airport Improvement Program Sponsor Certification Sponsor: City of McCall, Idaho Airport: McCall Municipal Airport Project Number: AIP 3-16-0023-023-2017 Description of Work: Northeast Apron Reconstruction Application 49 USC §47105(d), authorizes the Secretary to require me certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program. General standards for final acceptance and close out of federally funded construction projects are in 2 CFR § 200.343—Closeout and supplemented by FAA Order 5100.38. The sponsor must determine that project costs are accurate and proper in accordance with specific requirements of the grant agreement and contract documents. Certification Statements Except for certification statements below marked not applicable (N/A), this list includes major requirements of the construction project. Selecting "Yes" represents sponsor acknowledgment and confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. The personnel engaged in project administration, engineering supervision, project inspection, and acceptance testing were or will be determined to be qualified and competent to perform the work (Grant Assurance). Yes ❑ No ❑N/A ❑X 2. Construction records, including daily logs, were or will be kept by the resident engineer/construction inspector that fully document contractor's performance in complying with: a. Technical standards (Advisory Circular(AC) 150/5370-12); b. Contract requirements (2 CFR part 200 and FAA Order 5100.38); and c. Construction safety and phasing plan measures (AC 150/5370-2). 0 Yes ❑ No ❑N/A 3. All acceptance tests specified in the project specifications were or will be performed and documented. (AC 150/5370-12). X❑Yes ❑ No ❑N/A FAA Form 5100-129(1/17)SUPERSEDES PREVIOUS EDITION page 1 of 3 4. Sponsor has taken or will take appropriate corrective action for any test result outside of allowable tolerances (AC 150/5370-12). ❑X Yes ❑ No ❑ N/A 5. Pay reduction factors required by the specifications were applied or will be applied in computing final payments with a summary made available to the FAA(AC 150/5370-10). Q Yes ❑ No ❑ N/A 6. Sponsor has notified, or will promptly notify the Federal Aviation Administration (FAA)of the following occurrences: a. Violations of any federal requirements set forth or included by reference in the contract documents(2 CFR part 200); b. Disputes or complaints concerning federal labor standards (29 CFR part 5); and c. Violations of or complaints addressing conformance with Equal Employment Opportunity or Disadvantaged Business Enterprise requirements (41 CFR Chapter 60 and 49 CFR part 26). Q Yes ❑ No ❑ N/A 7. Weekly payroll records and statements of compliance were or will be submitted by the prime contractor and reviewed by the sponsor for conformance with federal labor and civil rights requirements as required by FAA and U.S. Department of Labor(29 CFR Part 5). 0 Yes ❑ No ❑ N/A 8. Payments to the contractor were or will be made in conformance with federal requirements and contract provisions using sponsor internal controls that include: a. Retaining source documentation of payments and verifying contractor billing statements against actual performance(2 CFR§200.302 and FAA Order 5100.38); b. Prompt payment of subcontractors for satisfactory performance of work(49 CFR§26.29); c. Release of applicable retainage upon satisfactory performance of work(49 CFR§26.29); and d. Verification that payments to DBEs represent work the DBE performed by carrying out a commercially useful function (49 CFR§26.55). Q Yes ❑ No ❑ N/A 9. A final project inspection was or will be conducted with representatives of the sponsor and the contractor present that ensure: a. Physical completion of project work in conformance with approved plans and specifications (Order 5100.38); b. Necessary actions to correct punch list items identified during final inspection are complete (Order 5100.38); and c. Preparation of a record of final inspection and distribution to parties to the contract (Order 5100.38); 0 Yes ❑ No ❑ N/A 10. The project was or will be accomplished without material deviations, changes, or modifications from approved plans and specifications, except as approved by the FAA(Order 5100.38). 0 Yes ❑ No ❑ N/A FAA Form 5100-129(1/17)SUPERSEDES PREVIOUS EDITION page 2 of 3 11. The construction of all buildings have complied or will comply with the seismic construction requirements of 49 CFR §41.120. Q Yes No N/A 12. For development projects, sponsor has taken or will take the following close-out actions: a. Submit to the FAA a final test and quality assurance report summarizing acceptance test results, as applicable (Grant Condition); b. Complete all environmental requirements as established within the project environmental determination (Oder 5100,38); and c. Prepare and retain as-built plans (Order 5100.38). ❑X Yes No N/A 13. Sponsor has revised or will revise their airport layout plan (ALP) that reflects improvements made and has submitted or will submit an updated ALP to the FAA no later than 90 days from the period of performance end date. (49 USC §47107 and Order 5100.38). 0 Yes No N/A Attach docurentation clarifying any above item marked with "No" response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. Executed on this aILl- day of ,� t l 1, 2019 Name of Sponsor: City of McCall, Idaho Name of Sponsor's Authorized Official: Jackie J.Aymon Title of Sponsor's Authorized Official: Mayor, City of McCall, Idaho 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 5100-129(1/17)SUPERSEDES PREVIOUS EDITION page 3 of 3 ko� 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 r OMB CONTROL NUMBER:2120-0569 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 3-16-0023-023-2017 Description of Work: Northeast Apron Reconstruction 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). Z 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 Deinhard Lane, McCall, ID 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 iI 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 Executed on this 'aU day of 2019 f Name of Sponsor: City of McCall. Idaho Name of Sponsor's Authorized Official: Jackie J. Aymon Title of Sponsor's Authorized Official: Mayor, City of McCall, Idaho 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(1117) SUPERSEDES PREVIOUS EDITION Page 3 of 3 �r U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-131, Equipment and Construction Contracts — Airport Improvement Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-131 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 Federal Aviation Administration EXPIRATION DATE:8/31/2019 Equipment and Construction Contracts Airport Improvement Sponsor Certification Sponsor: City of McCall, Idaho Airport: McCall Municipal Airport Project Number: AIP 3-16-0023-023-2017 Description of Work: Northeast Apron Reconstruction Application 49 USC §47105(d)authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program (AIP). General procurement standards for equipment and construction contracts within Federal grant programs are described in 2 CFR §§200.317-200.326. Labor and Civil Rights Standards applicable to the AIP are established by the Department of Labor(www.dol.gov)AIP Grant Assurance C.1—General Federal Requirements identifies all applicable Federal Laws, regulations, executive orders, policies, guidelines and requirements for assistance under the AIP. Sponsors may use state and local procedures provided the procurement conforms to these federal standards. This certification applies to all equipment and construction projects. Equipment projects may or may not employ laborers and mechanics that qualify the project as a "covered contract" under requirements established by the Department of Labor requirements. Sponsor shall provide appropriate responses to the certification statements that reflect the character of the project regardless of whether the contract is for a construction project or an equipment project. Certification Statements Except for certification statements below marked as not applicable (N/A), this list includes major requirements of the construction project. Selecting "Yes" represents sponsor acknowledgement and confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. A written code or standard of conduct is or will be in effect prior to commencement of the project that governs the performance of the sponsor's officers, employees, or agents in soliciting, awarding and administering procurement contracts (2 CFR §200.318). ❑x Yes ❑ No ❑ N/A FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 4 2. For all contracts, qualified and competent personnel are or will be engaged to perform contract administration, engineering supervision, construction inspection, and testing (Grant Assurance C.17). 0 Yes ❑ No ❑ N/A 3. Sponsors that are required to have a Disadvantage Business Enterprise (DBE)program on file with the FAA have included or will include clauses required by Title VI of the Civil Rights Act and 49 CFR Part 26 for Disadvantaged Business Enterprises in all contracts and subcontracts. 0 Yes ❑ No ❑ N/A 4. Sponsors required to have a DBE program on file with the FAA have implemented or will implement monitoring and enforcement measures that: a. Ensure work committed to Disadvantaged Business Enterprises at contract award is actually performed by the named DBEs(49 CFR§26.37(b)); b. Include written certification that the sponsor has reviewed contract records and has monitored work sites for performance by DBE firms (49 CFR§26.37(b)); and c. Provides for a running tally of payments made to DBE firms and a means for comparing actual attainments (i.e. payments)to original commitments (49 CFR§26.37(c)). 0 Yes ❑ No ❑ N/A 5. Sponsor procurement actions using the competitive sealed bid method (2 CFR§200.320(c)).was or will be: a. Publicly advertised, allowing a sufficient response time to solicit an adequate number of interested contractors or vendors; b. Prepared to include a complete, adequate and realistic specification that defines the items or services in sufficient detail to allow prospective bidders to respond; c. Publicly opened at a time and place prescribed in the invitation for bids; and d. Prepared in a manner that result in a firm fixed price contract award to the lowest responsive and responsible bidder. 0 Yes ❑ No ❑ N/A 6. For projects the Sponsor proposes to use the competitive proposal procurement method (2 CFR§ 200.320(d)), Sponsor has requested or will request FAA approval prior to proceeding with a competitive proposal procurement by submitting to the FAA the following: a. Written justification that supports use of competitive proposal method in lieu of the preferred sealed bid procurement method; b. Plan for publicizing and soliciting an adequate number of qualified sources; and c. Listing of evaluation factors along with relative importance of the factors. ❑Yes ❑ No 0 N/A 7. For construction and equipment installation projects,the bid solicitation includes or will include the current federal wage rate schedule(s)for the appropriate type of work classifications(2 CFR Part 200,Appendix II). 0 Yes ❑ No ❑ N/A FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 2 of 4 8. Concurrence was or will be obtained from the Federal Aviation Administration (FAA) prior to contract award under any of the following circumstances (Order 5100.38D): a. Only one qualified person/firm submits a responsive bid; b. Award is to be made to other than the lowest responsible bidder; and c. Life cycle costing is a factor in selecting the lowest responsive bidder. Yes ❑ No ❑ N/A 9. All construction and equipment installation contracts contain or will contain provisions for: a. Access to Records (§200.336) b. Buy American Preferences (Title 49 U.S.C. §50101) c. Civil Rights- General Provisions and Title VI Assurances(41 CFR part 60) d. Federal Fair Labor Standards (29 U.S.C. § 201, et seq) e. Occupational Safety and Health Act requirements (20 CFR part 1920) f. Seismic Safety—building construction (49 CFR part 41) g. State Energy Conservation Requirements-as applicable(2 CFR part 200, Appendix II) h. U.S. Trade Restriction (49 CFR part 30) i. Veterans Preference (49 USC §47112(c)) Z Yes ❑ No ❑ N/A 10. All construction and equipment installation contracts exceeding $2,000 contain or will contain the provisions established by: a. Davis-Bacon and Related Acts (29 CFR part 5) b. Copeland "Anti-Kickback"Act (29 CFR parts 3 and 5) Yes ❑ No ❑ N/A 11. All construction and equipment installation contracts exceeding $3,000 contain or will contain a contract provision that discourages distracted driving (E.O. 13513). Z Yes ❑ No ❑ N/A 12. All contracts exceeding $10,000 contain or will contain the following provisions as applicable: a. Construction and equipment installation projects-Applicable clauses from 41 CFR Part 60 for compliance with Executive Orders 11246 and 11375 on Equal Employment Opportunity; b. Construction and equipment installation -Contract Clause prohibiting segregated facilities in accordance with 41 CFR part 60-1.8; C. Requirement to maximize use of products containing recovered materials in accordance with 2 CFR § 200.322 and 40 CFR part 247; and d. Provisions that address termination for cause and termination for convenience (2 CFR Part 200, Appendix II). 0 Yes ❑ No ❑ N/A FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 4 13. All contracts and subcontracts exceeding $25,000: Measures are in place or will be in place(e.g. checking the System for Award Management)that ensure contracts and subcontracts are not awarded to individuals or firms suspended, debarred, or excluded from participating in federally assisted projects(2 CFR parts 180 and 1200). ❑x Yes ❑ No ❑ N/A 14. Contracts exceeding the simplified acquisition threshold (currently$150,000)include or will include provisions, as applicable, that address the following: a. Construction and equipment installation contracts-a bid guarantee of 5%, a performance bond of 100%, and a payment bond of 100% (2 CFR§200.325); b. Construction and equipment installation contracts-requirements of the Contract Work Hours and Safety Standards Act(40 USC 3701-3708, Sections 103 and 107); c. Restrictions on Lobbying and Influencing (2 CFR part 200, Appendix II); d. Conditions specifying administrative, contractual and legal remedies for instances where contractor of vendor violate or breach the terms and conditions of the contract (2 CFR §200,Appendix II); and e. All Contracts-Applicable standards and requirements issued under Section 306 of the Clean Air Act(42 USC 7401-7671q), Section 508 of the Clean Water Act(33 USC 1251- 1387, and Executive Order 11738. ❑x Yes ❑ No ❑ N/A Attach documentation clarifying any above item marked with "No" response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. Executed on this 1,0 day of AJ �" 2019 t Name of Sponsor: City of McCall, Idaho Name of Sponsor's Authorized Official: Jackie J.Aymon Title of Sponsor's Authorized Official: Mayor,City of McCall, Idaho Signature of Sponsor's Authorized Offi6ia1: I declare under penalty of perjury that the oregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-131 (1/17)SUPERSEDES PREVIOUS EDITION Page 4 of 4 �4W U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-132, Project Plans and Specifications — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-132 r01 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 Federal Aviation Administration EXPIRATION DATE:8/31/2019 Project Plans and Specifications Airport Improvement Program Sponsor Certification Sponsor: City of McCall, Idaho Airport: McCall Municipal Airport Project Number: AIP 3-16-0023-023-2017 Description of Work: Northeast Apron Reconstruction Application 49 USC§47105(d)authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program (AIP). Labor and civil rights standards applicable to AIP are established by the Department of Labor(www.dol.gov/). AIP Grant Assurance CA—General Federal Requirements identifies applicable federal laws, regulations, executive orders, policies, guidelines and requirements for assistance under AIP. A list of current advisory circulars with specific standards for procurement, design or construction of airports, and installation of equipment and facilities is referenced in standard airport sponsor Grant Assurance 34 contained in the grant agreement. Certification Statements Except for certification statements below marked as not applicable(N/A),this list includes major requirements of the construction project. Selecting"Yes" represents sponsor acknowledgement and confirmation of the certification statement. The term"will' means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. The plans and specifications were or will be prepared in accordance with applicable federal standards and requirements, so that no deviation or modification to standards set forth in the advisory circulars, or FAA-accepted state standard, is necessary other than those explicitly approved by the Federal Aviation Administration (FAA) (14 USC§47105). ❑x Yes ❑ No ❑N/A 2. Specifications incorporate or will incorporate a clear and accurate description of the technical requirement for the material or product that does not contain limiting or proprietary features that unduly restrict competition (2 CFR§200.319). ❑x Yes ❑ No ❑N/A FAA Form 5100-132(1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3 3. The development that is included or will be included in the plans is depicted on the current airport layout plan as approved by the FAA(14 USC §47107). 0 Yes ❑ No ❑ N/A 4. Development and features that are ineligible or unallowable for AIP funding have been or will be omitted from the plans and specifications (FAA Order 5100.38, par. 3-43). 9 Yes ❑ No ❑ N/A 5. The specification does not use or will not use "brand name" or equal to convey requirements unless sponsor requests and receives approval from the FAA to use brand name (FAA Order 5100.38, Table U-5). 0 Yes ❑ No ❑ N/A 6. The specification does not impose or will not impose geographical preference in their procurement requirements (2 CFR §200.319(b) and FAA Order 5100.38, Table U-5). 0 Yes ❑ No ❑ N/A 7. The use of prequalified lists of individuals, firms or products include or will include sufficient qualified sources that ensure open and free competition and that does not preclude potential entities from qualifying during the solicitation period (2 CFR §319(d)). ❑x Yes ❑ No ❑ N/A 8. Solicitations with bid alternates include or will include explicit information that establish a basis for award of contract that is free of arbitrary decisions by the sponsor(2 CFR § 200.319(a)(7)). El Yes ❑ No ❑ N/A 9. Concurrence was or will be obtained from the FAA if Sponsor incorporates a value engineering clause into the contract(FAA Order 5100.38, par. 3-57). El Yes ❑ No ❑ N/A 10. The plans and specifications incorporate or will incorporate applicable requirements and recommendations set forth in the federally approved environmental finding (49 USC §47106(c)). 0 Yes ❑ No ❑ N/A 11. The design of all buildings comply or will comply with the seismic design requirements of 49 CFR §41.120. (FAA Order 5100.38d, par. 3-92) [:] Yes ❑ No 0 N/A 12. The project specification include or will include process control and acceptance tests required for the project by as per the applicable standard: a. Construction and installation as contained in Advisory Circular(AC) 150/5370-10. ❑x Yes ❑ No ❑ N/A FAA Form 5100-132(1/17)SUPERSEDES PREVIOUS EDITION Page 2 of 3 b. Snow Removal Equipment as contained in AC 150/5220-20. ❑Yes ❑ No x N/A c. Aircraft Rescue and Fire Fighting (ARFF)vehicles as contained in AC 150/5220-10. ❑Yes ❑ No p N/A 13. For construction activities within or near aircraft operational areas(AOA): a. The Sponsor has or will prepare a construction safety and phasing plan (CSPP)conforming to Advisory Circular 150/5370-2. b. Compliance with CSPP safety provisions has been or will be incorporated into the plans and specifications as a contractor requirement. c. Sponsor will not initiate work until receiving FAA's concurrence with the CSPP(FAA Order 5100.38, Par. 5-29). p Yes [] No ❑ N/A 14. The project was or will be physically completed without federal participation in costs due to errors and omissions in the plans and specifications that were foreseeable at the time of project design (49 USC §47110(b)(1)and FAA Order 5100.38d, par. 3-100). p Yes ❑ No ❑ N/A Attach documentation clarifying any above item marked with "No"response. Sponsor's Certification I certify,for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked"no"is correct and complete. Executed on this I�GG day of �� 2019 Name of Sponsor: City of McCall, Idaho Name of Sponsor's Authorized Official: Jackie J.Aymon Title of Sponsor's Authorized Official: Mayor,City of McCall, Idaho Signature of Sponsor's Authorized Officia �- 1 declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-132(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-133, Real Property Acquisition — 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 5100-133 4101 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 w Federal Aviation Administration EXPIRATION DATE:8/31/2019 Real Property Acquisition Airport Improvement Program Sponsor Certification Sponsor: City of McCall, Idaho Airport: McCall Municipal Airport Project Number: AIP 3-16-0023-023-2017 Description of Work: Northeast Apron Reconstruction 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 real property acquisition and relocation assistance are in 49 CFR Part 24. The AIP project grant agreement contains specific requirements and assurances on the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (Uniform Act), as amended. Certification Statements Except for certification statements below marked not applicable(N/A), this list includes major requirements of the real property acquisition 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. 1. The sponsor's attorney or other official has or will have good and sufficient title as well as title evidence on property in the project. ❑Yes ❑No ❑x N/A 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 or will be extinguished, modified, or subordinated. ❑Yes ❑No ❑x N/A 3. If property for airport development is or 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. ❑Yes ❑No 0 N/A FAA Form 5100-133(1/17)SUPERSEDES PREVIOUS EDITION Page 1 of 3 4. Property in the project is or 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. ❑Yes ❑No p N/A 5. For any acquisition of property interest in noise sensitive approach zones and related areas, property interest was or will be obtained to ensure land is used for purposes compatible with noise levels associated with operation of the airport. ❑Yes ❑No F1 N/A 6. For any acquisition of property interest in runway protection zones and areas related to 14 CFR 77 surfaces or to clear other airport surfaces, property interest was or 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. ❑Yes ❑No ❑x N/A 7. Appraisals prepared by qualified real estate appraisers hired by the sponsor include or 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 to the property owner or representative to accompany appraisers during inspections. ❑Yes ❑No Z N/A 8. Each appraisal has been or 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 Federal Aviation Administration (FAA)for review. ❑Yes ❑No ❑x N/A 9. A written offer to acquire each parcel was or will be presented to the property owner for not less than the approved amount of just compensation. ❑Yes ❑No p N/A 10. Effort was or 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. ❑Yes ❑No ❑x N/A FAA Form 5100-133(1/17) SUPERSEDES PREVIOUS EDITION Page 2 of 3 11. If a negotiated settlement is not reached, the following procedures were or 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. ❑Yes ❑No ED N/A 12. If displacement of persons, businesses,farm operations, or non-profit organizations is involved, a relocation assistance program was or will be established,with displaced parties receiving general information on the program in writing, including relocation eligibility, and a 90-day notice to vacate. ❑Yes ❑No px NIA 13. Relocation assistance services, comparable replacement housing, and payment of necessary relocation expenses were or will be provided within a reasonable time period for each displaced occupant in accordance with the Uniform Act. ❑Yes O No OO N/A Attach documentation clarifying any above item marked with "No"response. Sponsor's Certification I certify,for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. Executed on this day of &14 2019 Name of Sponsor: City of McCall, Idaho Name of Sponsor's Authorized Official: Jackie J.Aymon Title of Sponsor's Authorized Official: Mayor, City of McCall, Idaho Signature of Sponsor's Designated Official Representat " I declare under penalty of perjury that the foregoing is tru 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 5100-133(1/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 ,p 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 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 NOW 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 3-16-0023-023-2017 Description of Work: Northeast Apron Reconstruction 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). x❑Yes ❑No ❑N/A 5. Sponsor has publicized or will publicize a RFQ that: a. Solicits an adequate number of qualified sources (2 CFR § 200.320(d)); and b. Identifies all evaluation criteria and relative importance (2 CFR § 200.320(d)). ❑x Yes ❑No ❑N/A 6. Sponsor has based or will base selection on qualifications, experience, and disadvantaged business enterprise participation with price not being a selection factor(2 CFR §200.320(d)). 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). 21 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). 0 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). 0 Yes ❑No ❑N/A 11. Sponsor has prepared or will prepare a record of negotiations detailing the history of the procurement action, rationale for contract type and basis for contract fees (2 CFR §200.318(i)). Z 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) 0 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)). ©Yes ❑No ❑N/A 14. Sponsor is not using or will not use the prohibited cost-plus-percentage-of-cost(CPPC)contract method. (2 CFR § 200.323(d)). ❑x Yes ❑No ❑N/A Attach documentation clarifying any above item marked with "no" response. Sponsor's Certification I certify,for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. Executed on this 24 day of u�` 2019 Name of Sponsor: City of McCall, Idaho", Name of Sponsor's Authorized Official: Jackie J.Aymon Title of Sponsor's Authorized Official: Mayor, City of McCall, Idaho Signature of Sponsor's Authorized Officia. 1 declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC§ 1001 (False Statements)and could subject me to fines, imprisonment, or both. FAA Form 5100-134(2/17)SUPERSEDES PREVIOUS EDITION Page 3 of 3 �4W 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 ?1 U.S.Department of Transportation OMB CONTROL NUMBER:2120-0569 fir/ 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 3-16-0023-023-2017 Description of Work: Northeast Apron Reconstruction Application Title 2 CFR§200.112 and § 1201.112 address Federal Aviation Administration (FAA)requirements for conflict of interest. As a condition of eligibility under the Airport Improvement Program (AIP), sponsors must comply with FAA policy on conflict of interest. Such a conflict would arise when any of the following have a financial or other interest in the firm selected for award: a) The employee, officer or agent, b) Any member of his immediate family, c) His or her partner, or d) An organization which employs, or is about to employ, any of the above. Selecting"Yes" represents sponsor or sub-recipient acknowledgement and confirmation of the certification statement. Selecting "No"represents sponsor or sub-recipient disclosure that it cannot fully comply with the certification statement. If"No"is selected, provide support information explaining the negative response as an attachment to this form. This includes whether the sponsor has established standards for financial interest that are not substantial or unsolicited gifts are of nominal value (2 CFR§ 200.318(c)). The term "will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. Certification Statements 1. The sponsor or sub-recipient maintains a written standards of conduct governing conflict of interest and the performance of their employees engaged in the award and administration of contracts (2 CFR§200.318(c)).To the extent permitted by state or local law or regulations, such standards of conduct provide for penalties, sanctions,or other disciplinary actions for violations of such standards by the sponsor's and sub-recipient's officers, employees, or agents, or by contractors or their agents. ❑x Yes ❑ No FAA Form 5100-135(2/17)SUPERSEDES PREVIOUS EDITION Page 1 of 2 2. The sponsor's or sub-recipient's officers, employees or agents have not and will not solicit or accept gratuities, favors or anything of monetary value from contractors, potential contractors, or parties to sub-agreements (2 CFR § 200.318(c)). O 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). 0 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 I have the explanation for any it marked "no" is correct and complete. Executed on this day of Cf ! 2019 Name of Sponsor: City of McCall, Idaho Name of Sponsor's Authorized Official: Jackie J.Aymon Title of Sponsor's Authorized Official: Mayor, City of McCall, Idaho Signature of Sponsor's Authorized Official: �- I declare under penalty of perjury that the-fbregoing 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 Appendix G—Sponsor/Consultant Certifications for Project Testing SPONSOR CERTIFICATION OF TESTING LABORATORIES City of McCall, ID McCall Municipal Airport, McCall, ID AIP 3-16-0023-023- _. 2017 Sponsor's Name Airport Project Number Northeast Apron Reconstruction Project Description — Sections P-401-3.5 and P-501-3.4 of Advisory Circular 150/5370-10, "Standards for Specifying Construction of Airports," require that testing laboratories meet certification requirements prior to the start of construction. These laboratories were used to develop job mix formulas and perform quality assurance tests for construction of bituminous and Portland cement concrete pavements. We hereby certify that the testing laboratory listed below has met the requirements of ASTM D 3666 for bituminous pavement and C 1077 for Portland cement concrete pavement, and has shown evidence of participation in an accredited program. ALLWEST Testing and Engineering, 255 N. Linder Road, Meridian, ID 83642 Name and Address of Testing Agency - AASHTO Name of Accreditation Program -- - 2 k9 S nsor's Au oriz d Representative Date Richard Stein, Airport Manager, McCall Municipal Airport Typed Name and Title of Sponsor's Representative L_ 19 Sponsor's ngineering Representative ate Kevin Bissell, Project Mang er, T-O Engineers Typed Name and Title of Sponsor's Engineering Representative CONSULTANT CERTIFICATION FOR PROJECT TESTING (Paving projects over $250,000) Airport: McCall Municipal Airport, McCall, ID Project No.: AIP 3-16-0023-023-2017 Project Description: Northeast Apron Reconstruction All final tests and quality control requirements were performed, per the project specifications. Tests that failed or did not meet the applicable standard were highlighted. Pay reductions were applied as required by the specifications, or corrective measures required for control tests were completed. A summary of all final tests and quality control requirements has been provided to the sponsor. Signed: 4, ? ►ry i Consultant (Kevin Bissell, roject Manager, T-O Engineers) Signed: _� _ S/�onsor( ' •har tein, Airport Manager, M all Municipal Airport) Appendix H— Project Photographs Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3-16-0023-023-2017 Project Photographs WCA Figure 1: Northeast Apron Prior to Reconstruction Figure 2: Northeast Apron Prior to Reconstruction Final Closeout Report McCall Municipal Airport Northeast Apron Reconstruction AIP 3-16-0023-023-2017 Figure 3: Fueling Apron Prior to Reconstruction