Item C18Meeting Date: October 17, 2012 Division: Countv Administrator
Bulk Item: Yes Department: Airports
F.1"0401 my 040 al"MI till lc[�Kfomfmqi 0 1=0 RAWMMOTMATOW11WIMM
LIM" ��Mwwlffilmiww M.01.
1)" at the Key West International Airport.
iiiiiii ill I I IFFIR 11 FIR
TOTAL COST: $2,526,964 INDIRECT COST: NA BUDGETED: Yes
DIFFERENTIAL OF LOCAL PREFERENCE: NA
COST TO COUNTY: None SOURCE OF FUNDS: FAA, Operating
I k"I DLIVA No I0
wompre
A
SEP 2 8 2012
.1J -
AMOUNT PER YEAR: NA
AfB//PurIcasing Risk Managemen�M
Not Required
AGENDA ITEM #
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Federal Aviation Administration
(FAA)
Effective Date: Execution
Expiration Date: Open
Contract Purpose/Description: Grant funding to "Construct New Terminal Building (Reimbursement,
Phase 4 of 6); Improve Airport Access Road (Phase 1); Improve Apron (Phase 1) and Improve
j Airfield Drainage (Phase 1)" at the Key West International Airport.
Contract Manager: Peter Horton # 5200 Airports - Stop # 5
(name) (Ext.) (Department/ Stop)
for BOCC meeting on: October 17, 2012 Agenda Deadline: October 2, 2012
CONTRACT COSTS
Total Dollar Value of Contract: $2,526,964.00 Current Year Portion: 0
Budgeted? Yes Account Codes: pending set-up for Grant #037-46
Grant: Yes - FAA
County Match: Operating
ADDITIONAL COSTS
Estimated Ongoing Costs: n/a For:
(not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes
Date In
Needed
Reviewer
Date Out
Yes No
r 11VV
Airports Director
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for Ris anagement
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WOMB
Pedro Mercado
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County Attorney
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Department
of Transportation
.1194"re I F-1011111@1[ 4
Mr. Peter Horton
Director of Airports
Key W st'FL'33040
ffl
LRDFINININ121MA-mi F-ag 111r, 0 —1
mffi
Ecopy
Dear Mr. Horton: Eui
RE: Key West International Airport apr4 I
AIP Number 3-12-0037-046-2012 L) 111 A I —
Grant Offer
We are enclosing the original and one copy of a Grant Offer for AIP Project No. 3-12-0037-046-2012 for
Key West International Airport, in response to your Application for Federal Assistance dated July 12,
2012. Your acceptance of this Offer will constitute a Grant Agreement by which the government will
participate in the allowable costs of the project amounting to $2,274,267 (Federal share).
Once the authorized official has executed the Agreement and the official's signature has been notarized
and sealed/stamped, the attorney for the Monroe County Board of County Commissioners must certify
that the Sponsor's acceptance complies with local and state law and constitutes a legal and binding
obligation on the part of the Sponsor. Please note that the Agreement is not legal unless the attorney
signs it AFTER the Sponsor.
If the terms of this Offer are satisfactory, please execute the document as soon as possible, but not later
than September 19, 2012. To assist us in administrative reporting requirements, you are requested to
notify this office by emailing a PDF of signature page of the grant immediately upon executing the grant.
Only the original executed grant needs to be returned to this office. The remaining copy is for your
file.
•FIVAFJIUIXI�o a - a Ila 0
IF 01jr4*11R. MR. I bi-, I He 11000
Sincerely,
Aoele-7
Bart Vernace P. E.
Manager
cc: w/enclosure (grars
FDOT16 0
U S. Department
of Transportation
Federal Aviation
Administration
Date of Offer:
September 13, 2012
Project Number:
3-12-0037-046-2012
Recipient:
Monroe County Board of County Commissioners (Herein called Sponsor)
Airport:
Key West International Airport
OFFER
THE FEDERAL AVIATION ADMINISTRATION, FOR AND ON BEHALF OF THE UNITED STATES, HEREBY OFFERS AND AGREES
to pay, as the United States' share, ninety percent (90%) of the allowable costs incurred in accomplishing the project consisting of the
following:
"Construct New Terminal Building (Reimbursement, Phase 4 of 6); Improve Airport Access Road (Phase 1); Improve
Apron (Phase 1) and Improve Airfield Drainage (Phase 1)"
as more particularly described in the Project Application dated July 12,2012.
The maximum obligation of the United States payable under this Offer shall be $2,274,267 for airport development.
W�dwflwll-wi ii ?Mdn wwift- , "M ww" Wial
UNITED STATES OF AMERICA
FEDERAL AVIATION ADMINISTRATION Manager, Airports District Office
The Sponsor agrees to accomplish the project in compliance with the terms and conditions contained herein and in the document "Terms
and Conditions of Accepting Airport Improvement Program Grants' dated April 13, 2012. The Sponsor specifically acknowledges that
knowingly@riid �ilffully providing false information to the Federal Government is a violation of 18 U.S.C. Section 1001 (False Statements)
and could subject the Sponsor's Designated Official Representative to fines, imprisionment or both if the U.S. Department of Justice
determines the ofircial acted outside the scope of his/her duties.
Executed thisl7§ay of,4L-�, 20
(Seal Name Name of Sponsor
Attest Signature of Spanoe, Designated Official Representative
0&§JJV --m—AND —IR.
Title Title
acting as Attorney for the Sponsor do hereby certify:
SIR
I -ft. 1011
by the Sponsor, there are no legal impediments that will prevent full performance by the Sponsor Further, it is my opinion that the said
nd binding ob' ation of ■th
Gran it constitutes a legal a =!�7 Sponsor in accordance with the terms thereof.
I F-j-,
Signature of 7ftM, Date
- My—
X_n
ROW-M "M
Mi I i
MINEW
Terms and Condons
of Accepting Airport Improvement Program Grants
ment source documents.
This document contains the terms and conditions of accepting Airport Improvement Program (AIP) grants from
the Federal Aviation Administration (FAA) for the purpose of carrying out the provisions of Title 49, United States
Code. These terms and conditions become applicable when the Sponsor accepts a Grant Offer from the FAA
that references this document. The FAA may unilaterally amend the terms and conditions by notification in
writing, and such amendment will only apply to grants accepted after notification.
L DEFINITIONS
A, Sponsor —An agency that is legally, financially, and otherwise able to assume and carry out thit;
certifications, representations, warranties, assurances, covenants and other obligations required in this
document and in the accepted Grant Agreement.
B. Project —Work as identified in this grant Agreement.
C. Primary Airport —A commercial service airport the Secretary of Transportation determines to have more
than 10,000 passengers boarding each year.
D. "this grant" — In this document the term "this grant" refers to the applicable grant agreement or grant
agreements that incorporate(s) these Terms and Conditions as part of the grant agreement.
11. CERTIFICATIONS
Title 49, United states Code, section 47105(d), authorizes the Secretary to require certification from the
Sponsor that it will comply with statutory and administrative requirements in carrying out a project under the
AIP. The following list of certified items includes major requirements for this aspect of project implementation
However, the list is not comprehensive, nor does it relieve sponsors from fully complying with all applicable
statutory and administrative standards. In accepting this grant, the Sponsor certifies that each of the following
items was or will be complied with in the performance of grant agreements. If a certification cannot be met for
a specific project, the Sponsor must fully explain in an attachment to the project application.
A. Sponsor Certification for Selection of Consultants. General standards for selection of consultant
services within Federal grant programs are described in Title 49, Code of Federal Regulations (CFR), and
Part 18.36. Sponsors may use other qualifications -based procedures provided they are equivalent to
specific standards in 49 CFR 18 and Advisory Circular 150/5100-14, Architectural, Engineering, and
Planning Consultant Services for Airport Grant Projects.
1 . Solicitations were (will be) made to ensure fair and open competition from a wide area of interest.
2. Consultants were (will be) selected using competitive procedures based on qualifications, experience,
and disadvantaged enterprise requirements with the fees determined through negotiations.
3, A record of negotiations has been (will be) prepared reflecting considerations involved in the
establishment of fees, which are not significantly above the Sponsor's independent cost estimate.
4. If engineering or other services are to be performed by Sponsor force account personnel, prior
approval was (will be) obtained from the FAA.
5. The consultant services contracts clearly establish (will establish) the scope of work and delineate the
division of responsibilities between all parties engaged in carrying out elements of the project.
6. Costs associated with work ineligible for AIP funding are (will be) clearly identified and separated from
eligible items in solicitations, contracts, and related project documents.
7. Mandatory contact provisions for grant -assisted contracts have been (will be) included in consultant
services contracts.
8. The cost -plus -percentage -of -cost methods of contracting prohibited under Federal standards were
not (will not be) used.
9. If the services being procured cover more than the single grant project referenced in this certification,
the scope of work was (will be) specifically described in the advertisement; and future work will not be
initiated beyond five years.
B. Sponsor Certification for Project Plans and Specifications. AIP standards are generally described in
Advisory Circulars 150/5100-6, Labor Requirements for the Airport Improvement Program; 150/5100-15,
Civil Rights Requirements for the Airport Improvement Program-, and 150/5100-16, Airport Grant
Assurance One —General Federal Requirements. A list of current advisory circulars with specific
standards for design or construction of airports, as well as procurement/installation of equipment and
facilities, is referenced in standard airport sponsor Grant Assurance 34 in this document.
1. The plans and specifications were (will be) prepared in accordance with applicable Federal standards
and requirements; so no deviation or modification to standards set forth in the advisory circulars, or
State standard, is necessary other than those previously approved by the FAA.
Page I of 18
2. Specifications for the procurement of equipment are not (will not be) proprietary or written so as to
restrict competition. At least two manufacturers can meet the specifications.
3. The development included (to be included) in the plans is depicted on the airport layout plan
approved by the FAA.
4. Development that is ineligible for AIP funding has been (will be) omitted from the plans and
specifications or otherwise identified to assure that no reimbursement will be made for the cost of the
ineligible item(s).
5. The process control and acceptance tests required for the project by standards contained in Advisory
Circular 150/5370-10 are (will be) included in the project specifications.
6. If a value engineering clause is incorporated into the contract, concurrence was (will be) obtained
from the FAA.
7. The plans and specifications incorporate (will incorporate) applicable requirements and
recommendations set forth in the Federally approved environmental finding.
8. For construction activities within or near aircraft operational areas, the requirements contained in
Advisory Circular 150/5370-2 have been (will be) discussed with the FAA, as well as incorporated into
the specifications; and a safety/phasing plan has FAA's concurrence, if required.
9. The project was (will be) physically completed without Federal participation in costs due to errors and
omissions in the plans and specifications that were foreseeable at the time of project design.
C. Sponsor Certification for Equipment/Construction Contracts. General standards for equipment and
construction contracts within Federal grant programs are described in Title 49, CFR, Part 18.36. AIP
standards are generally described in FAA Advisory Circular (AC) 150/5100-6, Labor Requirements for the
Airport Improvement Program; 150/5100-15, Civil Rights Requirements for the Airport Improvement
Program; and 150/5100-16, Airport Grant Assurance One —General Federal Requirements. Sponsors
may use State and local procedures provided procurements conform to these Federal standards.
1 A code or standard of conduct is (will be) in effect governing the performance of the Sponsor's
officers, employees, or agents in soliciting and awarding procurement contracts.
2. Qualified personnel are (will be) engaged to perform contract administration, engineering supervision,
construction inspection, and testing.
3. Unless the FAA approved (has approved) otherwise, the procurement was (will be) publicly
advertised using the competitive sealed bid method of procurement.
4. The bid solicitation clearly and accurately describes (will describe):
a. The current Federal wage rate determination for all construction projects; and
b. All other requirements of the equipment and/or services to be provided.
5. Concurrence was (will be) obtained from FAA prior to contract award under any of the following
circumstances:
a. only one qualified person/firm submits a responsive bid;
b. The contract is to be awarded to other than the lowest responsible bidder;
c. Life cycle costing is a factor in selecting the lowest responsive bidder; or
a. Proposed contract prices are more than 10 percent over the Sponsor's cost estimate.
'i. All contracts exceeding $100,000 require (will require) the following provisions:
A bid guarantee of 5 percent, a performance bond of 100 percent, and a payment bond of 100
percent;
b. Conditions specifying administrative, contractual, and legal remedies, including contract
termination, for those instances in which contractors violate or breach contact terms; and
c. Compliance with applicable standards and requirements issued under Section 306 of the Clean
Air Act (42 USC 1857(h)), Section 508 of the Clean Water Act (33 USC 1368), and Executive
Order 11738.
All construction contracts contain (will contain) provisions for:
a, Compliance with the Copeland "Anti -Kick Back" Act; and
b. Preference given in the employment of labor (except in executive, administrative, and supervisory
positions) to honorably discharged Vietnam -era veterans and disabled veterans.
All construction contracts exceeding $2,000 contain (will contain) the following provisions:
a. Compliance with the Davis -Bacon Act based on the current Federal wage rate determination; and
b. Compliance with the Contract Work Hours and Safety Standards Act (40 USC 327-330), Sections
103 and 107.
9. All construction contracts exceeding $10,000 contain (will contain) appropriate clauses from 41 CFR
Part 60 for compliance with Executive Orders 11246 and 11375 on Equal Employment Opportunity.
14-. 1will containT clauses revuired from Title VI of the Civil Rights
Act and 49 CFR 23 and 49 CFR 26 for Disadvantaged Business Enterprises.
11. Appropriate checks have been (will be) made to assure that contracts or subcontracts are not
awarded to those individuals or firms suspended, debarred, or voluntarily excluded from doing
business with any U.S, Department of Transportation (DOT) element and appearing on the DOT
Unified List.
D. Sponsor Certification for Real Property Acquisition. General requirements on real property
acquisition and relocation assistance are in Title 49, CFR, Part 24 and the Uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (Uniform Act).
1 . The Sponsor's attorney or other official has (will have) good and sufficient title and title evidence on
property in the project.
2. If defects and/or encumbrances exist in the title that adversely impact the Sponsor's intended use of
property in the project, they have been (will be) extinguished, modified, or subordinated.
3. If property for airport development is (will be) leased, the following conditions have been (will be) 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 this grant agreement.
4. Property in the project is (will be) in conformance with the current Exhibit "A" property map, which is
based on deeds, title opinions, land surveys, the approved airport layout plan, and project
documentation.
5. For any acquisition of property interest in noise sensitive approach zones and related areas, property
interest was (will be) obtained to ensure land is used for purposes compatible with noise levels
associated with operation of the airport.
6. For any acquisition of property interest in runway protection zones and areas related to 14 CFR 77
surfaces, property interest was (will be) obtained for the following:
a. The right of flight;
b. The right of ingress and egress to remove obstructions; and
c. The right to restrict the establishment of future obstructions.
7. Appraisals prepared by qualified real estate appraisers hired by the Sponsor include (will include) the
following:
a. Valuation data to estimate the current market value for the property interest acquired on each
parcel; and
b. Verification that an opportunity has been provided the property owner or representative to
accompany appraisers during inspections.
8, Each appraisal has been (will be) reviewed by a qualified review appraiser to recommend an amount
for the offer of just compensation, and the written appraisals and review appraisal are (will be)
available to FAA for review.
9. A written offer to acquire each parcel was (will be) presented to the property owner for not less thar
the approved amount of just compensation.
10. Effort was (will be) made to acquire each property through the following negotiation procedures:
a. No coercive action was (will be) taken to induce agreement; and
b. Supporting documents for settlements are (will be) included in the project files.
11. If a negotiated settlement is not reached, the following procedures were (will be) used:
a, Condemnation was (will be) initiated and a court deposit not less than the just compensation was
(will be) made prior to possession of the property; and
b. Supporting documents for awards were (will be) included in the project files.
12. If displacement of persons, businesses, farm operations, or non-profit organizations is involved, a
relocation assistance program was (will be) established, with displaced parties receiving general
information on the program in writing, including relocation eligibility, and a 90-day notice to vacate.
13. Relocation assistance services, comparable replacement housing, and payment of necessary
relocation expenses were (will be) provided within a reasonable time period for each displaced
occupant in accordance with the Uniform Act.
E. Sponsor Certification for Construction Project Final Acceptance. General requirements for final
acceptance and closeout of Federally funded construction projects are in Title 49, CFR, Part 18.50. The
Sponsor shall determine that project costs are accurate and proper in accordance with specific
requirements of this grant Agreement and contract documents.
1. The personnel engaged in project administration, engineering supervision, construction inspection,
and testing were (will be) determined to be qualified as well as competent to perform the work.
2. Daily construction records were (will be) kept by the resident engineer/construction inspector as
follows:
a. Work in progress
b. Quality and quantity of materials delivered
c. Test locations and results
d. instructions provided the contractor
e. Weather conditions
f. Equipment use
g. Labor requirements
lz-��
x, Safety problems
i Changes required.
u. Weekly payroll records and statements ofcompliance submitted by the prime contractor
and reviewed by the Sponsor for Federal |euo, and civil rights requirements (Advisory Circulars
1mVm1o0-Qand 1n0/n1oo-15).
4. Complaints regardingthe mandated Federal provisions set forth mthe contract documents have been
(will be) submitted to the FAA.
m. All tests specified in the plans and specifications were (will be) performed and the test o,svne
documented eawell esmade available tothe FAA.
s. For any teat results outside of onowou|e to|enances, appropriate corrective actions were (will be)
taken.
7. Payments to the contractor were (will be) made in compliance with contract provisions as follows:
a. Payments are verified by the Sponsor's internal audit of contract records kept by the resident
engineer; and
b. If appropriate, pay reduction factors required by the specifications are applied in computing final
payments; and a summary of pay reductions are made available to the FAA.
a, The dangers ofdrug abuse inthe workplace;
u The Gponsor'spolicy of maintaining adrug-free workplace;
c, Any available drug counseling, rehabilitation, and employee assistance programs; and
d. The penalties that may he imposed upon employees for drug abuse violations occurring in the
workplace.
u, Each employee to be engaged in the performance of the work has been (will be) given a copy of the
statement required within item Iabove.
4. Employees have U be) notified in the statement required uyitem I above that, esecondition
ofemployment under this grant, the employee will:
o. Abide bythe terms ofthe statement; and
Page 4of18
b, Notify the employer in writing of his or her conviction for a violation of a criminal drug statute
occurring in the workplace no later than five calendar days after such conviction.
5. The FAA will be noted in writing within ten calendar days after receiving notice under item 4b above
from an employee or otherwise receiving actual notice of such conviction. Employers of convicted
employees must provide notice, including position title of the employee, to the FAA. Notices shall
include the project number of each affected grant.
6. One of the following actions will be taken within 30 calendar days of receiving a notice under item 4b
above with respect to any employee who is so convicted:
a. Take appropriate personnel action against such an employee, up to and including termination,
consistent with the requirements of the Rehabilitation Act of 1973, as amended; or
b. Require such employee to participate satisfactorily in a drug abuse assistance or rehabilitation
program approved for such purposes by a Federal, State, or local health, law enforcement, or
• appropriate agency.
7. A good faith effort will be made to continue to maintain a drug -free workplace through implementation
► items 1 through 6 ••
GENERAL CONDITIONS
A. The allowable costs of the project shall not include any costs determined by the FAA to be ineligible for
consideration under Title 49 U.S.C.
IMM TWUMSTM -
requested revision to the project work description and grant amount shall constitute an amendment to this
Grant Agreement.
if requested by the Sponsor and authorized by the FAA, the letter of credit method of payment may be
used. It is understood and agreed that the Sponsor agrees to request cash withdrawals on the letter of
credit only when actually needed for its disbursements and to timely reporting of such disbursements as
required. It is understood that failure to adhere to this provision may cause the letter of credit to be
M. Unless otherwise approved by the FAA, it will not acquire or permit any contractor or subcontractor to
acquire any steel or manufactured products produced outside the United States to be used for any project
for airport development or noise compatibility for which funds are provided under this grant. The Sponsor
will include in every contract a provision implementing this condition.
N, Central Contractor Registration and Universal Identifier Requirements
t Requirement for Central Contractor pegisbratiow(CCR)
Unless you are exempted from this requirement under 2 CFR 25.10, you as the recipient must
maintain the currency of your information in the CCR until you submit the final financial report
required under this award o, receive the final payment, whichever is later. This requires that you
review and update the information at least annually after the initial registration, and more frequently if
required uychanges inyour information oranother award term.
2. Requirement for Data Universal Numbering System (QuNS)Numbers
|fyou are authorized tomake subaworusunder this award, you:
a. Must notify potential subrecipients that no entity (see definition in paragraph C of this award term)
may receive a subaward from you unless the entity has provided its DUNS number to you.
u. May not make osubaward toanentity unless the entity has provided its DUNS number toyou.
3. Definitions
For purposes ofthis award term:
a. Central Contractor Registration (CCp) means the Federal repository into which on entity must
provide information required for the conduct of business as a recipient, Additional information
about registration procedures may be found at the CoR Internet site (currently at
http://Wvw.cocgov).
u. Data Universal Numbering System (DUNS) number means the nine -digit number established and
assigned by Dun and Bradstreet, Inc. (o&B) to uniquely identify business entities. A DUNS
number may be obtained from D&B by telephone (currently 666-705-5711) o, the Internet
(currently ato/tp://`feugoxdnb.conowabmm)
c. Entity, as it is used mthis award term, means all ofthe following, as defined at2CFR partom.
oubparto:
1) A Governmental organization, which is a State, local government, or Indian Tribe,
2) A foreignpublicemity;
o; Adomestic orforeign nonprofit mgsmizoUom
4) Adomestic orforeign for -profit organization; and
a) A Federal agenoy, but only as m suunacipient under an award orsuuawo,d»oo non -Federal
entity.
u. Smuamaot
1) This term means alegal instrument toprovide support for the performanceufany portion o,
the substantive project or program for which you received this award and that you as the
recipient award tomneligible aubrecipienL
2) The term does not include your procurement ofproperty and services needed mcaout the
project or program (for further explanation, uau Sec. u1oofthe attachment to OMB u,uma,
A-138. "Audits ofStates, Local Governments, and Non -Profit Organizations").. Asubaward
may be provided through any |egel ogreemant, including on agreement that you consider
contract.
e. 3uurecipienrmeans anentity that:
1Receives asubawe,ufrom you under this award; and
2� Is accountable to you for the use of the Federal funds provided by the subaward.
a. A subaward maybe provided through any legal agreement, including an agreement that you
consider acontract.
O. If this grant agreement includes pavement work that equals o, exceeds $250.000. the Sponsor will
perform the following:
1 Furnish aconstruction management program toFAA prior to the start ofconstruction which shall
detail the measures and procedurestoueused tocomply with the quality control provisions v,the
construction contract, including, but not limited to, all quality control provisions and tests required
bythe Federal specifications. The program shall include eaominimum:
%M.ML--J3��
a. The name of the person representing the Sponsor who has overall responsibility for contract
administration for the project and the authority to take necessary actions to comply with the
contract.
b. Names of testing laboratories and consulting engineer firms with quality control responsibilities on
the project, together with a description of the services to be provided.
c. Procedures for determining that testing laboratories meet the requirements of the American
Society of Testing Materials standards on laboratory evaluation, referenced in the contract
specifications (D3666, C1077),
d. Qualifications of engineering supervision and construction inspection personnel.
e. A listing of all tests required by the contract specifications, including the type and frequency of
tests to be taken, the method of sampling, the applicable test standard, and the acceptance
criteria or tolerances permitted for each type of test.
f. Procedures for ensuring that the tests are taken in accordance with the program, that they are
documented daily, that the proper corrective actions, where necessary, are undertaken.
2. Submit at completion of the project, a final test and quality control report documenting the results of
all tests performed, highlighting those tests that failed or did not meet the applicable test standard
The report shall include the pay reductions applied and reasons for accepting any out -of -tolerance
material. An interim test and quality control report shall be submitted, if requested by the FAA.
3� Failure to provide a complete report as described in paragraph 2, or failure to perform such tests,
shall, absent any compelling justification, result in a reduction in Federal participation for costs
incurred in connection with construction of the applicable pavement. Such reduction shall be at the
discretion of the FAA and will be based on the type or types of required tests not performed or not
documented and will be commensurate with the proportion of applicable pavement with respect to the
total pavement constructed under this grant agreement.
4� The FAA, at its discretion, reserves the right to conduct independent tests and to reduce grant
payments accordingly if such independent tests determine that Sponsor tests results are inaccurate.
-Fcre 2 ptr)ze*�i ?c-�,129z s, an effective
airport pavement maintenance management program as is required by Airport Sponsor Assurance
Number 11. The Sponsor shall use such program for the useful life of any pavement constructed,
reconstructed, or repaired with Federal financial assistance at the airport. As a minimum, the program
must conform with the following provisions:
Pavement Maintenance Management Program
An effective pavement maintenance management program is one that details the procedures to be
followed to assure that proper pavement maintenance, both preventive and repair, is performed. An
airport sponsor may use any form of inspection program it deems appropriate. The program must, as a
minimum, include the following:
1 , Pavement Inventory. The following must be depicted in an appropriate form and level of detail:
a. Location of @11 runways, taxiways, and aprons;
b. Dimensions;
c. Type of pavement, and;
d. Year of construction or most recent major rehabilitation.
For compliance with the Airport Improvement Program (AIP) assurances, pavements that have been
constructed, reconstructed, or repaired with federal financial assistance shall be so depicted.
2. Inspection Schedule.
a. Detailed Inspection. A detailed inspection must be performed at least once a year. If a history of
recorded pavement deterioration is available; i,e., Pavement Condition Index (PCI) survey as set
forth in Advisory Circular 150/5380-6, "Guidelines and Procedures for Maintenance of Airport
Pavements," the frequency of inspections may be extended to three years.
b. Drive -By Inspection. A drive -by inspection must be performed a minimum of once per month to
detect unexpected changes in the pavement condition.
3. Record Keeping. Complete information on the findings of all detailed inspections and on the
maintenance performed must be recorded and kept on file for a minimum of five years. The types of
distress, their locations, and remedial action, scheduled or performed, must be documented. The
minimum information to be recorded is listed below:
a. Inspection date;
b. Location;
c, Distress types; ami
d. Maintenance scheduled or performed.
For drive -by inspections, the date of inspection and any maintenance performed must be recorded
4. Information Retrieval. An airport Sponsor may use any form of record keeping it deems
appropriate7 so long as the information and records produced by the pavement survey can be
retrieved to provide a report to the FAA as may be required.
5. Reference. Refer to Advisory Circular 150/5380-6, "Guidelines and Procedures for Maintenance of
Airport Pavements," for specific guidelines and procedures for maintaining airport pavements and
N�U
ade under the terms of this
�M
MASSURANCES
The following FAA document titled ASSURANCES Airport Sponsors, dated April 2012, is incorporated as part
of these Terms and Conditions:
A. General.
1These assurances shall be compiled with in the performance of grant agreements for airport
development, airport planning, and noise compatibility program grants for airport sponsors.
2. These assurances are required to be submitted as part of the project application by sponsors requesting
funds under the provisions of Title 49, U.S.C., subtitle VII, as amended. As used herein, the term "public
agency sponsor" means a public agency with control of a public -use airport; the term "private sponsor"
means a private owner of a public -use airport; and the term "Sponsor' includes both public agency
sponsors and private sponsors.
3. Upon acceptance of this grant offer by the Sponsor, these assurances are incorporated in and become
part of this grant agreement.
B. Duration and Applicability.
1. Airport development or Noise Compatibility Program Projects Undertaken by a Public Agency
Sponsor. The terms, conditions and assurances of this grant agreement shall remain in full force and
effect throughout the useful life of the facilities developed or equipment acquired for an airport
development or noise compatibility program project, or throughout the useful life of the project items
installed within a facility under a noise compatibility program project, but in any event not to exceed
twenty (20) years from the date of acceptance of a grant offer of Federal funds for the project. However,
there shall be no limit on the duration of the assurances regarding Exclusive Rights and Airport Revenue
so long as the airport is used as an airport. There shall be no limit on the duration of the terms,
conditions, and assurances with respect to real property acquired with federal funds. Furthermore, the
duration of the Civil Rights assurance shall •' specified in the assurances.
2. Airport Development or Noise Compatibility Projects Undertaken by a Private Sponsor. The
preceding paragraph 1 also applies to a private sponsor except that the useful life of project items
installed within a facility or the useful life of the facilities developed or equipment acquired under an
airport development or noise compatibility program project shall be no less than ten (10) years from the
date of acceptance of Federal aid for the project.
3. Airport Planning Undertaken ■ a Sponsor. Unless otherwise specified in this grant agreement, only
Assurances 1, 2, 3, 5, 6. 13, 18, 30, 32, 33, and 34 in section C apply to planning projects. The terms,
conditions, and assurances of this grant agreement shall remain in full force and effect during the life of
the project.
C Sponsor Certification. The Sponsor hereby assures and certifies, with respect to this grant that:
1. General Federal Requirements. It will comply with all applicable Federal laws, regulations, executive
orders, policies, guidelines, and requirements as they relate to the application, acceptance and use of
Federal funds for this project including but not limited to the following:
Federal Legislation
a. Title 49, U.S.C., subtitle VII, as amended.
b. Davis -Bacon Act - 40 U.S.C. 276(a), et se
c. Federal Fair Labor Standards Act - 29 U.S.C. 201, et se
d. Hatch Act — 5 U.S.C. 1501, et se
e. Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Title 42 U.S.C.
4601, gLaeq."
f. National Historic Preservation Act of 1966 - Section 106 - 16 U.S.C. 470(f).
g, Archeological and Historic Preservation Act of 1974 - 16 U.S.C. 469 through 469c.,
h. Native Americans Grave Repatriation Act - 25 U.S.C. Section 3001, gt se
i. Clean Air Act, P.L. 90-148, as amended.
j. Coastal Zone Management Act, P.L. 93-205, as amended.
k. Flood Disaster Protection Act of 1973 - Section 102(a) - 42 U.S.C. 4012a.1
1. Title 49, U.S.C., Section 303, (formerly known as Section 4(f))
m. Rehabilitation Act of 1973 - 29 U.S.C. 794.
n. Civil Rights Act of 1964 - Title V1 - 42 U.S.C. 2000d through d-4.
o. Age Discrimination Act of 1975 - 42 U.S.C. 6101, et se
p. American Indian Religious Freedom Act, P.L. 95-341, as amended.
q. Architectural Barriers Act of 1968 -42 U.S.C. 4151, et seg.'
r. Power plant and Industrial Fuel Use Act of 1978 - Section 403- 2 U.S.C. 8373.1
s. Contract Work Hours and Safety Standards Act - 40 U.S.C. 327, et seg.'
t. Copeland Anti kickback Act - 18 U.S.C. 874.1
u. National Environmental Policy Act of 1969 - 42 U.S.C, 4321, et seg.,
v. Wild and Scenic Rivers Act, P.L. 90-542, as amended.
w. Single Audit Act of 1984 - 31 U.S.C. 7501, gL§ec � L
x. Drug -Free Workplace Act of 1988 - 41 U.S.C. 702 through 706.
Executive Orders
Executive Order 11246 - Equal Employment Opportunity'
Executive Order 11990 - Protection of Wetlands
Executive Order 11998 — Flood Plain Management
Executive Order 12372 - Intergovernmental Review of Federal Programs
Executive Order 12699'Seismic Safety of Federal and Federally Assisted New Building Construction`
Executive Order 12ana'Environmental Justice
Federal Regulations
a. 14CFRPart 13-Investigative and Enforcement Procedures.
u. 14 CFR Part 16 - Rules of Practice For Federally Assisted Airport Enforcement Proceedings.
o. 14CFRPart 15n-Airport noise compatibility planning.
u. 28cFRPart 1-Procedures for predetermination ofwage ranas.`
e. 28CFRPart 3-Contractors and subcontractors unpublic building orpublic work financed inwhole or
part byloans orgrants from the United States.`
,. 28 cFR Pert 5 - Labor standards provisions applicable tocontracts covering federally financed and
assisted construction (also labor standards provisions applicable to non -construction contracts
subject to the Contract Work Hours and Safety Standards Act).'
g. 41 CFR Part 6o-Office ofFederal Contract Compliance Programa, Equal Employment Opportunity,
Department ofLabor (Federal and feuerancontracting
o. 4eCFRPart 18 -Vnikz�na uminist�dve�qvi�monts�rgrants and unope^edveagreements toate�
and �oa|g�emme^�. i. 4eCFRPart on - New restrictions onlobuying.
]. 4e CFR Pau 21 - Nondiscrimination in federal isteu programs or the Department of
rransportation-effectuaUonofTitleNofthaCkd/Rights Act m1em4.
x. 49 CFR Part 23 - Participation by Disadvantage Business Enterprise in Airport Concessions.
|. 4eCFR Part 24 - Uniform relocation assistance and real property acquisition for Federal and federally
assisted programs. `z
m. 48 CFR Pan 26 — Participation By Disadvantaged Business Enterprises in Department of
Transportation Programs.
n. 49 CFR Part 27 - Nondiscrimination on the basis of handicap in programs and activities receiving or
benefiting from Federal financial assietance.'
o. 48 CFR Part 28—Government wide debarment and suspension (nonpmovremenV and government
wide requirements for drug -free workplace (g,anta).
p. 49 CFR Part 30 - Denial of public works contracts to suppliers of goods and services of countries that
deny procurement market access toUS.contractors.
q, 4e CFR Pan 41 Seismic safety of Federal and federally assisted o, regulated new building
Office of Management and Budget Circulars
a. A-87 - Cost Principles Applicable to Grants and Contracts with State and Local Governments.
b. A-1 33 - Audits of States, Local Governments, and Non -Profit Organizations
These laws do not apply to airport planning sponsors.
These laws do not apply to private sponsors.
3 49 CFR Part 18 and OMB Circular A-87 contain requirements for State and Local Governments receiving
Federal assistance. Any requirement levied upon State and Local Governments by this regulation and circular
shall also be applicable to private sponsors receiving Federal assistance under Title 49, United States Code.
Specific assurances required to be included in grant agreements by any of the above laws, regulations or
circulars are incorporated by reference in this grant agreement.
2. Responsibility and Authority of the Sponsor.
a. Public Agency Sponsor: It has legal authority to apply for this grant, and to finance and carry out
the proposed project; that a resolution, motion or similar action has been duly adopted or passed as
an official act of the applicant's governing body authorizing the filing of the application, including all
understandings and assurances contained therein, and directing and authorizing the person identified
as the official representative of the applicant to act in connection with the application and to provide
such additional information as may be required.
b. Private Sponsor: It has legal authority to apply for this grant and to finance and carry out the
proposed project and comply with all terms, conditions, and assurances of this grant agreement. It
shall designate an official representative and shall in writing direct and authorize that person to file
this application, including all understandings and assurances contained therein; to act in connection
with this application; and to provide such additional information as may be required.
3. Sponsor Fund Availability. It has sufficient funds available for that portion of the project costs which are
not to be paid by the United States. It has sufficient funds available to assure operation and maintenance
of items funded under this grant agreement which it will own or control.
a. It, a public agency or the Federal government, holds good title, satisfactory to t
Secretary, to the landing area of the airport or site thereof, or will give assuran
satisfactory to the Secretary that good title will be acquired.
b. For noise compatibility program projects to be carried out on the property of the Spons
it holds good title satisfactory to the Secretary to that portion of the property upon wh lil
Federal funds will be expended or will give assurance to the Secretary that good title
be obtained.
MOM a 0011101"JEWErimtHAL �T-
Ono
g. It will grant the Secretary the right to disapprove the use of the Sponsor's employees to do all or any
part of the project.
h. It understands and agrees that the Secretary's approval of this project grant or the Secretary's
approval of any planning material developed as part of this grant does not constitute or imply any
assurance or commitment on the part of the Secretary to approve any pending or future application
for a Federal airport grant.
2) charge reasonable, and not unjustly discriminatory, prices for each unit or service, provided that
the contractor may be allowed to make reasonable and nondiscriminatory discounts, rebates, or
other similar types of price reductions to volume purchasers.
c. Each fixed -based operator at the airport shall be subject to the same rates, fees, rentals, and other
charges as are uniformly applicable to all other fixed -based operators making the same or similar
uses of such airport and utilizing the same or similar facilities.
d. Each air carrier using such airport shall have the right to service itself or to use any fixed -based
operator that is authorized or permitted by the airport to serve any air carrier at such airport.
e. Each air carrier using such airport (whether as a tenant, non tenant, or subtenant of another air
carrier tenant) shall be subject to such nondiscriminatory and substantially comparable rules,
regulations, conditions, rates, fees, rentals, and other charges with respect to facilities directly and
substantially related to providing air transportation as are applicable to all such air carriers which
make similar use of such airport and utilize similar facilities, subject to reasonable classifications such
as tenants or non tenants and signatory carriers and non signatory carriers. Classification or status as
tenant or signatory shall not be unreasonably withheld by any airport provided an air carrier assumes
obligations substantially similar to those already imposed on air carriers in such classification or
status.
f. It will not exercise or grant any right or privilege which operates to prevent any person, firm, or
corporation operating aircraft on the airport from performing any services on its own aircraft with its
Page 14 of 18
own employees [including, but not limited to maintenance, repair, and fueling] that it may choose to
perform.
g. In the event the Sponsor itself exercises any of the rights and privileges referred to in this assurance,
the services involved will be provided on the same conditions as would apply to the furnishing of such
services by commercial aeronautical service providers authorized by the Sponsor under these
provisions.
h. The Sponsor may establish such reasonable, and not unjustly discriminatory, conditions to be met by
all users of the airport as may be necessary for the safe and efficient operation of the airport.
i. The Sponsor may prohibit or limit any given type, kind or class of aeronautical use of the airport if
such action is necessary for the safe operation of the airport or necessary to serve the civil aviation
needs of the public.
23. Exclusive Rights. It will permit no exclusive right for the use of the airport by any person providing, or
intending to provide, aeronautical services to the public. For purposes of this paragraph, the providing of
the services at an airport by a single fixed -based operator shall not be construed as an exclusive right if
both of the following apply:
a, It would be unreasonably costly, burdensome, or impractical for more than one fixed -based operator
to provide such services, and
b. If allowing more than one fixed -based operator to provide such services would require the reduction
of space leased pursuant to an existing agreement between such single fixed -based operator and
such airport. It further agrees that it will not, either directly or indirectly, grant or permit any person,
firm, or corporation, the exclusive right at the airport to conduct any aeronautical activities, including,
but not limited to charter flights, pilot training, aircraft rental and sightseeing, aerial photography, crop
dusting, aerial advertising and surveying, air carrier operations, aircraft sales and services, sale of
aviation petroleum products whether or not conducted in conjunction with other aeronautical activity,
repair and maintenance of aircraft, sale of aircraft parts, and any other activities which because of
their direct relationship to the operation of aircraft can be regarded as an aeronautical activity, and
that it will terminate any exclusive right to conduct an aeronautical activity now existing at such an
airport before the grant of any assistance under Title 49, United States Code.
and Rental Structure. It will maintain a fee and rental structure for the facilities and services at the
25. Airport Revenues.
a. All revenues generated by the airport and any local taxes on aviation fuel established after December
30, 1987, will be expended by it for the capital or operating costs of the airport; the local airport
system; or other local facilities which are owned or operated by the owner or operator of the airport
and which are directly and substantially related to the actual air transportation of passengers or
property; or for noise mitigation purposes on or off the airport. The following exceptions apply to this
paragraph:
1 , If covenants or assurances in debt obligations issued before September 3, 1982, by the owner or
operator of the airport, or provisions enacted before September 3, 1982, in governing statutes
controlling the owner or operator's financing, provide for the use of the revenues from any of the
airport owner or operator's facilities, including the airport, to support not only the airport but also
the airport owner or operator's general debt obligations or other facilities, then this limitation on
the use of all revenues generated by the airport (and, in the case of a public airport, local taxes
on aviation fuel) shall not apply.
2. If the Secretary approves the sale of a privately owned airport to a public sponsor and provides
funding for any portion of the public sponsor's acquisition of land, this limitation on the use of all
revenues generated by the sale shall not apply to certain proceeds from the sale. This is
conditioned on repayment to the Secretary by the private owner of an amount equal to the
remaining unamortized portion (amortized over a 20-year period) of any airport improvement
grant made to the private owner for any purpose other than land acquisition on or after October 1,
1996, plus an amount equal to the federal share of the current fair market value of any land
acquired with an airport improvement grant made to that airport on or after October 1, 1996.
3, Certain revenue derived from or generated by mineral extraction, production, lease, or other
means at a general aviation airport (as defined at Section 47102 of title 49 United States Code), if
the FAA determines the airport sponsor meets the requirements set forth in Sec. 813 of Public
Law 112-95.
b. As part of the annual audit required under the Single Audit Act of 1984, the Sponsor will direct that
the audit will review, and the resulting audit report will provide an opinion concerning, the use of
airport revenue and taxes in paragraph (a), and indicating whether funds paid or transferred to the
owner or operator are paid or transferred in a manner consistent with Title 49, United States Code
and any other applicable provision of law, including any regulation promulgated by the Secretary or
Administrator.
c. Any civil penalties or other sanctions will be imposed for violation of this assurance in accordance
with the provisions of Section 47107 of Title 49, United States Code.
Page 15 of 18
t6. Reports and Inspections. It will:
a. submit to the Secretary such annual or special financial and operations reports as the Secretary ma
reasonably request and make such reports available to the public; make available to the public a
reasonable times and places a report of the airport budget in a format prescribed by the Secretary;
b. for airport development projects, make the airport and all airport records and documents affecting th
airport, including deeds, leases, operation and use agreements, regulations and other instruments
available for inspection by any duly authorized agent of the Secretary upon reasonable request;
c. for noise compatibility program projects, make records and documents relating to the project an
continued compliance with the terms, conditions, and assurances of this grant agreement includin
deeds, leases, agreements, regulations, and other instruments, available for inspection by any dul
authorized agent of the Secretary upon reasonable request; and
d. in a format and time prescribed by the Secretary, provide to the Secretary and make available to th
public following each of its fiscal years, an annual report listing in detail: I
1) all amounts paid by the airport to any other unit of government and the purposes for which each
such payment was made; and
2) all services and property provided by the airport to other units of government and the amount of
compensation received for provision of each such service and property.
27, Use by Government Aircraft. It will make available all of the facilities of the airport developed with
Federal financial assistance and all those usable for landing and takeoff of aircraft to the United States for
use by Government aircraft in common with other aircraft at all times without charge, except, if the use by
Government aircraft is substantial, charge may be made for a reasonable share, proportional to such use,
for the cost of operating and maintaining the facilities used, Unless otherwise determined by the
Secretary, or otherwise agreed to by the Sponsor and the using agency, substantial use of an airport by
Government aircraft will be considered to exist when operations of such aircraft are in excess of those
which, in the opinion of the Secretary, would unduly interfere with use of the landing areas by other
authorized aircraft, or during any calendar month that —
r3rilquGrarzTE
DOT -assisted contracts. The recipient's DBE program, as required by 49 CFR Part 26, and as approved
by DOT, is incorporated by reference in this agreement. Implementation of this program is a legal
obligation and failure to carry out its terms shall be treated as a violation of this agreement. Upon
notification to the recipient of its failure to carry out its approved program, the Department may impose
sanctions as provided for under Part 26 and may, in appropriate cases, refer the matter for enforcement
under 18 U.S.C. 1001 and/or the Program Fraud Civil Remedies Act of 1986 (31 U3.C. 3801).
C8. Hangar Construction. If the airport owner or operator and a person who owns an aircraft agree that a
hangar is to be constructed at the airport for the aircraft at the aircraft owner's expense, the airport owner
or operator will grant to the aircraft owner for the hangar a long term lease that is subject to such terms
and conditions on the hangar as the airport owner or operator may impose.
39. Competitive Access.
a. If the airport owner or operator of a medium or large hub airport (as defined in section 47102 of title
49, U.S.C.) has been unable to accommodate one or more requests by an air carrier for access to
gates or other facilities at that airport in order to allow the air carrier to provide service to the airport or
to expand service at the airport, the airport owner or operator shall transmit a report to the Secretary
that-
1. Describes the requests;
2. Provides an explanation as to why the requests could not be accommodated; and
3, Provides a time frame within which, if any, the airport will be able to accommodate the requests.
b, Such report shall be due on either February I or August I of each year if the airport has been unable
to accommodate the request(s) in the six month period prior to the applicable due date.
Airport Improvement Program
Orlando Airports District Office
Federal Assistance Request Checklist
APPLICATION CHECKLIST
Airport:
KEY WEST INTERNATIONAL AIRPORT
Sponsor:
MONROE COUNTY, FLORIDA
City, State
KEY WEST, FLORIDA
Date of Application:
JUNE 29, 2012
Cover Letter:
X Letter of Credit method of payment requested.
X Project(s) identified. (Any changes from previous meetings/discussions should be discussed
prior to submission.)
If pre -application, proposed application date identified.
If application, any changes to requested amount are identified and reasons provided..
If application, identify if any changes have taken place on Exhibit "A" Property Map since last
grant..
If application, identify if any changes have taken place on Exhibit "C" Title Opinion since last
grant
Application (Revise Pre -Application Documentation):
X Standard Form 424—Application for Federal Assistance.
X Detailed Project Information Sheet.
X Individual Project Cost Breakdowns and Total Cost Summary.
Bid Tabulations and Recommendation for Award.
X Project Sketch — One for each or one drawing will all projects.
X Environmental Determination Documentation for each project.
X Individual Project Schedules.
Appraisals (Land Acquisition Projects).
Independent Cost Estimates (Design Only or Construction Phase Services >$100K).
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED
6/29/2012
Applicant Identifer
1. TYPE OF SUBMISSION
Application
® Construction
® Non -Construction
Pre -application
❑ Construction
❑ Non -Construction
3. DATE RECEIVED BY STATE
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY
Federal Identifier
5. APPLICANT INFORMATION
Legal Name:
Monroe County, Florida
Organizational Unit. -
Department: Board of County Commissioners
Organizational DUNS: 15-563-9339
Division:
Address:
Name and telephone number of the person to be contacted on matters
involving this application (give area code):
Street: 3491 South Roosevelt Boulevard
Prefix: Mr. First Name: Peter
City: Key West
Middle Name: J.
County: Monroe
Last Namo: Horton
State: Florida zip code: 33040-
Suffix:
country: USA
Email: horton- eter monraecounE -fl. ov
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
5 1 9 1 -- 16 1 0 10 10 7 4 9
Phone Number (give area code):
305-809-5200
Fax Number (give area code):
305-292-3578
8. TYPE OF APPLICATION:
❑New ❑Continuation ®Revision
If Revision, enter appropriate letter(s) in box(es)
(See instructions for description of letters.) El
Other (specify)
7. TYPE OF APPLICANT: (See instructions for Application Types)
B
Other (specify)
9. NAME OF FEDERAL AGENCY: Federal Aviation Administration
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
2 10 1 . I 1 1 0_1_61
TITLE Name of Program : Airport Im provement Prog ram
11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
See Attachment "A" for descriptive titles
12. AREAS AFFECTED BY PROJECT (Cities, Counties, State, etc.):
Key West, Monroe Coun# , Florida
13. PROPOSED PROJECT
14, CONGRESSINAL DISTRICTS OF:
Start Date: 07/01/2012 Ending Date: 6/30/2013
a. Applicant 18th I b. Project 18th
16. ESTIMATED FUNDING:
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. Federal
a. Yes.❑ THIS PREAPPLICATION WAS MADE AVAILABLE TO THE
STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW
ON DATE:
b. No. ❑ PROGRAM IS NOT COVERED BY E.O. 12372
® OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW
b. Applicant $ 2,250,000'
c. State
d. Local
Other $ 250,000
_et]
f. Program Income
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
❑ Yes If "Yes", attach an explanation. ❑ No
g. TOTAL $ 2,500,000
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIONIPREAPPLICATION ARE TRUE AND CORRECT.
THE GOVERNING BODY OF THE APPLICANT HAS DULY AUTHORIZED THE DOCUMENT, AND THE APPLICANT WILL COMPLY WITH
THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Authorized Representative
Prefix: Mr. I First Name: Peter
Middle Name: J.
Last Name: Horton
Suffix:
b. Title: Airport Director
c. Telephone Number(give area code): 305-809-5200
d. Signature of Authorized Representative
e. Date Signed:
Previous Editions Usable Standard For424 (REV 8.2003)
Authorized for Local Reproduction Prescribed by OMB Circular A-1 02
JUNE 29, 2012
KEY WEST INTERNATIONAL AIRPORT
ATTACHMENT "A"
PROJECT APPLICATION (3-12-0037-046-2012)
GRANT DESCRIPTION AND COST BREAKDOWN SHEET
I. Grant Description
A) Terminal Construction (PFL0007630)
Construct a new Terminal Building, rehabilitation and remodeling the existing Terminal Building in
compliance with the County Building Department and the Americans with Disabilities Act. These funds
will pay for bond funds use for eligible project costs. Also included are baggage elevator construction
and arrival area improvements
B) Pave Airport Entrance Road Plans and Specifications (PFL0009146)
The airport access road from A1A, Faraldo Circle is in need of a new surface course of Asphalt Concrete.
This project would provide the design services required to produce Plans and Specifications for a milling
and overlay project. No construction services are included.
C) Commercial Ramp Rehabilitation Conceptual Plan (PFL0007737)
The existing asphalt apron has required significant maintenance due to the introduction of new flights of
the B-737-700W. Additional flights by the B-737 are anticipated due to the merger of Southwest Airlines
and Air Tran Airlines. Temporary PCC pads have been built and more may be needed as B-737 flights
increase. The existing pavement strength for the commercial apron is 95,000 Ibs Dual Gear (DG) while
the B-737 is approximately 135,000 Ibs DG. Passenger numbers have also been on the rise with new
record annual enplanements for 2011.
D) Emergency Drainage Improvements (TBD)
The south portion of the Runway 9-27 Runway Safety Area between Runway 9-27 and Taxiway A has
been flooding with large rain storms. This was noted as a deficiency during the most recent FAA Part 139
Inspection and the airport was directed to develop a Corrective Action Plan for this issue. This project
will accomplish 1) Drainage system inspection and cleaning; 2) Determination of existing problems; 3)
Development of a phased Corrective Action Plan; 4) Permitting of Corrective Action Plan; 5) Construction
of first phase of Corrective Action Plan.
II. Cost Breakdown
A) Bond Repayment for Terminal Construction (PFL0007630)
Bond Repayment
$1,723,552
DBE Implementation
$90,800
Project Application
$1,500
Subtotal
$1,815,852
B) Pave Airport Entrance Road, Plans and Specifications (PFL0009146)
Administration
$700
Engineering (Design)
$37,606
Survey
$4,000
Testi ng
$5,000
Project Application
$250
DBE
$8,000
Subtotal
$55,556
C) Commercial Ramp Rehabilitation Conceptual Design (PFL0007737)
Administration
$800
Engineering (Design)
$74,700
Survey
$8,000
Testi ng
$7,000
Project Application
$500
DBE
$9,000
Subtotal
$100,000
D) Emergency Drainage Improvements (TBD)
Administration
$700
Engineering (Design)
$70,750
Survey
$4,000
Testi ng
$5,000
Project Application
$250
Construction Management
$12,000
Construction
$150,000
Project Application
$300
Quarterly Report and As -built Information
$2,000
DBE
$10,000
Subtotal
$255,000
Total $ 2,500,000
Entitlement Grant Request $ 2,250,000
Discretionary Grant Request
Total Grant Request (90%) $ 2,250,000
Others (10%) $ 250,000
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Detailed Project Information Sheet
Airport Improvement Program
Grant Application
Airport: Key West International Airport
City, State: Key West, Florida
Project Title: Bond Repayment for Terminal Construction (PFL0007630)
Project Description: Construct a new Terminal Building, rehabilitation and remodeling the
existing Terminal Building in compliance with the County Building
Department and the Americans with Disabilities Act. These funds will
pay for bond funds use for eligible project costs. Also included in this
project are a baggage elevator and arrival building improvements.
Project Justification: The new terminal facility will provide the terminal area needed for the
present and near future for adequate operation as stated in the
Terminal Study and approved Master Plan
Special Circumstances: N/A
Project Cost Information:
Total Cost (100%)
FAA Share (90%)
State (Insert %)
Local (10%)
$1,815,852
1 $1,634,267
$Amnt
$181,585
Type of Funding Proposed (FAA Share Only)
Fund Type
Funds Available
Funds to be Used
Funds Remaining
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
Total
$ Amnt
$ Amnt
$ Amnt
Alternate Funding Plan: Entitlement Funds requested, if not available this project will be
delayed.
Airport:
City, State:
Project Title:
Project Description
Project Justification
Special Circumstances:
Project Cost Information:
Detailed Project Information Sheet
Airport Improvement Program
Grant Application
Key West International Airport
Key West, Florida
Pave Airport Entrance Road, Plans and Specifications (PFL0009146)
The airport access road from AIA N, Faraldo Circle is in need of a new
surface course of Asphalt Concrete. This project would provide the
design services required to produce Plans and Specifications for a
milling and overlay project. No bidding services or services during
construction are included.
The entrance road to the airport needs improvement. The last time this
area was paved was 24 years ago, in 1988. It had been scheduled for
repavement during the New Terminal Complex Project, however that
portion of the project had to be postponed due to a lack of funding.
During that project, all construction vehicles had to use the road, since
it is the entrance to the airport. As a result, the condition of the road
surface had deteriorated greatly in the last several years. FDOT
Pavement condition Survey ranked the road as "Poor" with a PCI of 53.
Total Cost (100%)
FAA Share (90%)
State (Insert %)
Local (10%)
$55,556
1 $50,000
$Amnt
$5,556 �]
Tvr)e of Funding Proposed (FAA Share Only)
Fund Type
Funds Available
Funds to be Used
Funds Remaining
P, NP, C, SA, D & FY
(e.g., NP2012)
$ Amnt
$ Amnt
$ Amnt
P, NP, C, SA, D & FY
(e.g., NP2012)
$ Amnt
$ Amnt
$ Amnt
P, NP, C, SA, D & FY
(e.g., NP2012)
$ Amnt
$ Amnt
$ Amnt
Total
$ Amnt
$ Amnt
$ Amnt
Alternate Funding Plan: Entitlement Funds requested, if not available this project will be delayed.
Airport:
City, State:
Project Title:
Project Description
Project Justification
Special Circumstances:
Project Cost Information:
Detailed Project Information Sheet
Airport Improvement Program
Grant Application
Key West International Airport
Key West, Florida
Commercial Ramp Rehabilitation Conceptual Plan (PFL0007737)
The existing asphalt apron has required significant maintenance due to
the introduction of new flights of the B-737-700W. Additional flights by
the B-737 are anticipated due to the merger of Southwest Airlines and
Air Tran Airlines. Temporary PCC pads have been built and more may be
needed as B-737 flights increase. The existing pavement strength for the
commercial apron is 95,000 Ibs Dual Gear (DG) while the B-737 is
approximately 135,000 Ibs DG. Passenger numbers have also been on
the rise with new record annual enplanements for 2011.
To avoid deterioration of the pavement due to the increase in B-737
operations and improve the existing drainage system to avoid flooding.
None
Total Cost (100%)
FAA Share (90%)
State (Insert %)
Local (10%)
$100,000
$90,000
$Amnt
$10,000
Type of Funding Proposed (FAA Share Only)
Fund Type
Funds Available
Funds to be Used
Funds Remaining
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
Total
$ Amnt
$ Amnt
$ Amnt
Alternate Funding Plan: Entitlement Funds requested, if not available this project will be delayed.
Detailed Project Information Sheet
Airport Improvement Program
Grant Application
Airport: Key West International Airport
City, State: Key West, Florida
Project Title: Emergency Drainage Improvements (TBD)
Project Description: During large rain storms the Runway 9-27 RSA can be flooded as a result
of a drainage system that does not have the capacity to drain the area in
a reasonable time. The airport Runway Safety Area will flood after rain
storms and leave standing water up to 6 inches deep in the infield area
between Taxiway A and Runway 9-27. This project will accomplish the
following; 1) Determine the current condition of the existing storm
drainage system and will clean the system; 2) Determine the cause of
the flooding and develop a phased Corrective Action Plan; 3) Permit the
project with the South Florida Water Management District; 4) Advertise
and open Bids for Phase 1 Construction; 5) Provide Services During
Construction.
Project Justification: Standing water within a RSA is not in conformance with FAA Standards.
Special Circumstances: This deficiency was noted in EYW's most recent certification inspection.
Project Cost Information:
Total Cost (100%)
FAA Share (90%)
State (Insert %)
Local (10%)
$100,000
1 $90,000
$Amnt
$10,000
Type of Funding Proposed (FAA Share Only)
Fund Type
Funds Available
Funds to be Used
Funds Remaining
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
P, NP, C, SA, D & FY
$ Amnt
$ Amnt
$ Amnt
(e.g., NP2012)
Total
$ Amnt
$ Amnt
$ Amnt
Alternate Funding Plan: Entitlement Funds requested, if not available this project will be delayed.
Key West International Airport
Bond Repayment for Terminal Construction
PROPOSED PROJECT SCHEDULE
Proposed Proiect Elements Dates
Completion of Plans Specifications & Engr. Report N/A
Submit Plans and Specs to FAA N/A
Advertisement of Project for Bids N/A
Receipt of Bids N/A
Submittal of Project Application to FAA 07/01/12
Execution of FAA Grant 08/01/12
Notice to Proceed to Contractor N/A
Completion of Construction 12/31/12
Final Inspection N/A
Project Close Out N/A
Key West International Airport
Pave Airport Entrance Road, Plans and Specifications
PROPOSED PROJECT SCHEDULE
Proposed Proiect Elements Dates
Completion of Plans Specifications & Engr. Report 10/15/12
Submit Plans and Specs to FAA 11/01/12
Advertisement of Project for Bids 12/01/12
Receipt of Bids 01/15/13
Submittal of Project Application to FAA 01/30/13
Execution of FAA Grant 03/30/13
Notice to Proceed to Contractor 05/30/13
Completion of Construction 06/15/13
Final Inspection 06/30/13
Project Close Out 09/15/13
Key West International Airport
Commercial Ramp Rehabilitation Conceptual Plan
PROPOSED PROJECT SCHEDULE
Proposed Proiect Elements Dates
Completion of Plans Specifications & Engr. Report 10/15/12
Submit Plans and Specs to FAA 11/01/12
Advertisement of Project for Bids 12/01/12
Receipt of Bids 01/15/13
Submittal of Project Application to FAA 01/30/13
Execution of FAA Grant 03/30/13
Notice to Proceed to Contractor 05/30/13
Completion of Construction 06/15/13
Final Inspection 06/30/13
Project Close Out 09/15/13
Key West International Airport
Emergency Drainage Improvements
PROPOSED PROJECT SCHEDULE
Proposed Proiect Elements Dates
Completion of Plans Specifications & Engr. Report 11/15/12
Submit Plans and Specs to FAA 12/01/12
Advertisement of Project for Bids 01/01/13
Receipt of Bids 02/15/13
Submittal of Project Application to FAA 02/30/13
Execution of FAA Grant 04/30/13
Notice to Proceed to Contractor 06/30/13
Completion of Construction 07/15/13
Final Inspection 07/30/13
Project Close Out 10/15/13
DETERMINATION OF ENVIRONMENTAL IMPACTS
Airport: Key West International Airport, Key West, Florida
Detailed Project Description (attach project drawing and additional pages as necessaiy):
Bond Repayment for Terminal Construction.
Is the proposed project(s) listed
1050.1 E?
Please identify which paragraph(s):
as categorically excluded in one or more of paragraphs 307-312of FAA Order
In order for the FAA to determine the appropriate course of action, as a Categorical Exclusion, the sponsor must certifi-
that the proposed action does NOT (1) involve any of the following circumstances, and does NOT (2) have a significant
effect. A determination as to whether the proposed project (s) may have a significant environmental effect is made by
considering any requirements applicable to the specific resource (see FAA Order 1050.1 F Appendix A).
a. Have an adverse effect on cultural resources protected under the National Historic Preservation Act of 1966, as
amended.
b. Have an impact on properties protected under section 4(� of the Department of Transportation Act.
c. Have an impact on natural, ecological (e.g. invasive species), or scenic resources of Federal, Tribal, State, or local
significance (for example: Federally listed or proposed endangered, threatened, or candidate species or designated or
proposed critical habitat under the Endangered Species Act), resources protected by the Fish and Wildlife
Coordination Act; wetlands; floodplains prime, unique, State or locally important farmlands; energy supply and
natural resources; and wild and scenic rivers, including study or eligible river segments and solid waste management.
d. Cause a division or disruption of an established community, or a disruption of orderly, planned development or an
inconsistency with plans or goals that have been adopted by the community- in which the project is located.
e. Cause an increase in congestion from surface transportation (by causing a decrease in Level of Service below
acceptable level determined by appropriate transportation agency, such as a highway agency).
f. Have an impact on noise levels of noise -sensitive areas.
g. Have an impact on air quality or violate local, State, or Federal air quality- standards under the Clean Air Act
Amendments of 1990.
h. Have an impact on seater quality, sole source aquifers, a public seater supply system, or State or Tribal seater quality-
standards established under the Clean Water Act and the Safe Drinking Water Act.
i. Have effect(s) on the quality- of the human environment that are likely to be highly controversial on environmental
grounds. The term "controversial" means a substantial dispute exists as to the size, nature, or effect of a proposed
Federal action. The effects of an action are considered highly controversial when reasonable disagreement exists over
the project's risks of causing environmental harm. Opposition on environmental grounds by a Federal, state, or local
government agency or by a Tribe or by a substantial number of the persons affected by the action should be
considered in determining whether or not reasonable disagreement regarding the effects of a proposed action exists.
j. Likelihood to be inconsistent with any Federal, State, Tribal, or local lase relating to the environmental aspects of the
proposed action.
k. Likely to directly, indirectly, or cumulatively create a significant impact on the human environmental, including, but
not limited to, actions likely to cause a significant lighting impact on residential areas or commercial use of business
properties, likely to cause a significant impact on the visual nature of surrounding land uses likely to be contaminated
with hazardous materials based on Phase I or Phase II Environmental Due Diligence Audit (EDDA's), or likely to
cause such contamination
I certify that the project(s) described above meet(s) the test for a Categorical Exclusion in accordance with FAA Order
1050.1E and paragraphs a thru k above.
Signature of Authorized Airport Representative Date
FAA Determination (by program manager signature):
Categorically Excluded: Date:
Requires further environmental analysis: Date:
ENVIRONMENTAL DETERMINATION CHECKLIST (FY 22)
Airport: Key West International Airport, Key West, Florida
Proposed Project(s): Bond Repayment for Terminal Construction
Prepared and certified by: Eric S. Nielsen, P.E. Date: June 28, 2012
YES
NO
COMMENTS
IS THIS PROPOSED PROJECT LISTED AS
CATEGORICALLY EXCLUDED IN FAA ORDER
1050.1E, paragraphs 307-312
X
THIS PROPOSED PROJECT WILL AFFECT:
Coastal Resources
X
Section 4(f) Land
X
Farmland
X
Endangered or Threatened Species (Federal or State
listed)
X
Floodplains
X
Hazardous Materials or Solid Waste Management
X
Historic/Architectural, Archaeological/Cultural
Resources
X
Light Emissions or Cause Visual Impacts
X
Natural Resources or Energy Supply
X
Low Income or Minority- Populations or Children
X
Wetlands
X
Wild and Scenic Rivers (study or eligible)
X
THIS PROPOSED PROJECT IS LIKELY TO:
Be highly controversial on environmental grounds
including opposition by Federal, state, local, or Tribal
or a substantial number of persons affected by the
action.
X
Be inconsistent with any Federal, State, or local law
relating to the environmental aspects of the proposed
action.
X
Cause community- disruption or inconsistency with
plans or goals that have been adopted by the
communitv
X
Cause an increase of 1.5 DNL over noise sensitive
areas
X
Displace persons or businesses
X
Disrupt local traffic patterns and substantially reduce
levels of service (LOS) of roads serving the airport and
surrounding communities
X
Result in a substantial loss in community tax base
X
Impact water quality, sole source aquifers, public water
supply system, or state or tribal water quality standards
X
Impact or violate local, state, Tribal, or Federal air
ualit�- standards
X
Attach detailed comments for all "yes" answers on a separate sheet, and explain
your justification for a request for a determination of Categorical Exclusion.
DETERMINATION OF ENVIRONMENTAL IMPACTS
Airport: Key West International Airport, Key West, Florida
Detailed Project Description (attach project drawing and additional pages as necessaiy):
Pave Airport Entrance Road, plans and specifications.
Is the proposed project(s) listed
1050.1 E?
Please identify which paragraph(s):
as categorically excluded in one or more of paragraphs 307-312of FAA Order
In order for the FAA to determine the appropriate course of action, as a Categorical Exclusion, the sponsor must certifi-
that the proposed action does NOT (1) involve any of the following circumstances, and does NOT (2) have a significant
effect. A determination as to whether the proposed project (s) may have a significant environmental effect is made by
considering any requirements applicable to the specific resource (see FAA Order 1050.1 F Appendix A).
a. Have an adverse effect on cultural resources protected under the National Historic Preservation Act of 1966, as
amended.
b. Have an impact on properties protected under section 4(� of the Department of Transportation Act.
c. Have an impact on natural, ecological (e.g. invasive species), or scenic resources of Federal, Tribal, State, or local
significance (for example: Federally listed or proposed endangered, threatened, or candidate species or designated or
proposed critical habitat under the Endangered Species Act), resources protected by the Fish and Wildlife
Coordination Act; wetlands; floodplains prime, unique, State or locally important farmlands; energy supply and
natural resources; and wild and scenic rivers, including study or eligible river segments and solid waste management.
d. Cause a division or disruption of an established community, or a disruption of orderly, planned development or an
inconsistency with plans or goals that have been adopted by the community- in which the project is located.
e. Cause an increase in congestion from surface transportation (by causing a decrease in Level of Service below
acceptable level determined by appropriate transportation agency, such as a highway agency).
f. Have an impact on noise levels of noise -sensitive areas.
g. Have an impact on air quality or violate local, State, or Federal air quality- standards under the Clean Air Act
Amendments of 1990.
h. Have an impact on seater quality, sole source aquifers, a public seater supply system, or State or Tribal seater quality-
standards established under the Clean Water Act and the Safe Drinking Water Act.
i. Have effect(s) on the quality- of the human environment that are likely to be highly controversial on environmental
grounds. The term "controversial" means a substantial dispute exists as to the size, nature, or effect of a proposed
Federal action. The effects of an action are considered highly controversial when reasonable disagreement exists over
the project's risks of causing environmental harm. Opposition on environmental grounds by a Federal, state, or local
government agency or by a Tribe or by a substantial number of the persons affected by the action should be
considered in determining whether or not reasonable disagreement regarding the effects of a proposed action exists.
j. Likelihood to be inconsistent with any Federal, State, Tribal, or local lase relating to the environmental aspects of the
proposed action.
k. Likely to directly, indirectly, or cumulatively create a significant impact on the human environmental, including, but
not limited to, actions likely to cause a significant lighting impact on residential areas or commercial use of business
properties, likely to cause a significant impact on the visual nature of surrounding land uses likely to be contaminated
with hazardous materials based on Phase I or Phase II Environmental Due Diligence Audit (EDDA's), or likely to
cause such contamination
I certify that the project(s) described above meet(s) the test for a Categorical Exclusion in accordance with FAA Order
1050.1E and paragraphs a thru k above.
Signature of Authorized Airport Representative Date
FAA Determination (by program manager signature):
Categorically Excluded: Date:
Requires further environmental analysis: Date:
ENVIRONMENTAL DETERMINATION CHECKLIST (FY 22)
Airport: Key West International Airport, Key West, Florida
Proposed Project(s): Pave Airport Entrance Road, plans and specifications
Prepared and certified by: Eric S. Nielsen, P.E. Date: June 28, 2012
YES
NO
COMMENTS
IS THIS PROPOSED PROJECT LISTED AS
CATEGORICALLY EXCLUDED IN FAA ORDER
1050.1E, paragraphs 307-312
X
THIS PROPOSED PROJECT WILL AFFECT:
Coastal Resources
X
Section 4(f) Land
X
Farmland
X
Endangered or Threatened Species (Federal or State
listed)
X
Floodplains
X
Hazardous Materials or Solid Waste Management
X
Historic/Architectural, Archaeological/Cultural
Resources
X
Light Emissions or Cause Visual Impacts
X
Natural Resources or Energy Supply
X
Low Income or Minority- Populations or Children
X
Wetlands
X
Wild and Scenic Rivers (study or eligible)
X
THIS PROPOSED PROJECT IS LIKELY TO:
Be highly controversial on environmental grounds
including opposition by Federal, state, local, or Tribal
or a substantial number of persons affected by the
action.
X
Be inconsistent with any Federal, State, or local law
relating to the environmental aspects of the proposed
action.
X
Cause community- disruption or inconsistency with
plans or goals that have been adopted by the
communitv
X
Cause an increase of 1.5 DNL over noise sensitive
areas
X
Displace persons or businesses
X
Disrupt local traffic patterns and substantially reduce
levels of service (LOS) of roads serving the airport and
surrounding communities
X
Result in a substantial loss in community tax base
X
Impact water quality, sole source aquifers, public water
supply system, or state or tribal water quality standards
X
Impact or violate local, state, Tribal, or Federal air
ualit�- standards
X
Attach detailed comments for all "yes" answers on a separate sheet, and explain
your justification for a request for a determination of Categorical Exclusion.
DETERMINATION OF ENVIRONMENTAL IMPACTS
Airport: Key West International Airport, Key West, Florida
Detailed Project Description (attach project drawing and additional pages as necessaiy):
Commercial Ramp Rehabilitation Conceptual Plan to evaluate layout, pavement materials and drainage.
Is the proposed project(s) listed
1050.1 E?
Please identify which paragraph(s):
as categorically excluded in one or more of paragraphs 307-312of FAA Order
In order for the FAA to determine the appropriate course of action, as a Categorical Exclusion, the sponsor must certifi-
that the proposed action does NOT (1) involve any of the following circumstances, and does NOT (2) have a significant
effect. A determination as to whether the proposed project (s) may have a significant environmental effect is made by
considering any requirements applicable to the specific resource (see FAA Order 1050.1 F Appendix A).
a. Have an adverse effect on cultural resources protected under the National Historic Preservation Act of 1966, as
amended.
b. Have an impact on properties protected under section 4(� of the Department of Transportation Act.
c. Have an impact on natural, ecological (e.g. invasive species), or scenic resources of Federal, Tribal, State, or local
significance (for example: Federally listed or proposed endangered, threatened, or candidate species or designated or
proposed critical habitat under the Endangered Species Act), resources protected by the Fish and Wildlife
Coordination Act; wetlands; floodplains prime, unique, State or locally important farmlands; energy supply and
natural resources; and wild and scenic rivers, including study or eligible river segments and solid waste management.
d. Cause a division or disruption of an established community, or a disruption of orderly, planned development or an
inconsistency with plans or goals that have been adopted by the community- in which the project is located.
e. Cause an increase in congestion from surface transportation (by causing a decrease in Level of Service below
acceptable level determined by appropriate transportation agency, such as a highway agency).
f. Have an impact on noise levels of noise -sensitive areas.
g. Have an impact on air quality or violate local, State, or Federal air quality- standards under the Clean Air Act
Amendments of 1990.
h. Have an impact on seater quality, sole source aquifers, a public seater supply system, or State or Tribal seater quality-
standards established under the Clean Water Act and the Safe Drinking Water Act.
i. Have effect(s) on the quality- of the human environment that are likely to be highly controversial on environmental
grounds. The term "controversial" means a substantial dispute exists as to the size, nature, or effect of a proposed
Federal action. The effects of an action are considered highly controversial when reasonable disagreement exists over
the project's risks of causing environmental harm. Opposition on environmental grounds by a Federal, state, or local
government agency or by a Tribe or by a substantial number of the persons affected by the action should be
considered in determining whether or not reasonable disagreement regarding the effects of a proposed action exists.
j. Likelihood to be inconsistent with any Federal, State, Tribal, or local lase relating to the environmental aspects of the
proposed action.
k. Likely to directly, indirectly, or cumulatively create a significant impact on the human environmental, including, but
not limited to, actions likely to cause a significant lighting impact on residential areas or commercial use of business
properties, likely to cause a significant impact on the visual nature of surrounding land uses likely to be contaminated
with hazardous materials based on Phase I or Phase II Environmental Due Diligence Audit (EDDA's), or likely to
cause such contamination
I certify that the project(s) described above meet(s) the test for a Categorical Exclusion in accordance with FAA Order
1050.1E and paragraphs a thru k above.
Signature of Authorized Airport Representative Date
FAA Determination (by program manager signature):
Categorically Excluded: Date:
Requires further environmental analysis: Date:
ENVIRONMENTAL DETERMINATION CHECKLIST (FY 22)
Airport: Key West International Airport, Key West, Florida
Proposed Project(s): Commercial Ramp Rehabilitation Conceptual Plan to evaluate layout, pavement materials
and drainage.
Prepared and certified by: Eric S. Nielsen, P.E. Date: June 28, 2012
YES
NO
COMMENTS
IS THIS PROPOSED PROJECT LISTED AS
CATEGORICALLY EXCLUDED IN FAA ORDER
1050.1E, paragraphs 307-312
X
THIS PROPOSED PROJECT WILL AFFECT:
Coastal Resources
X
Section 4(f) Land
X
Farmland
X
Endangered or Threatened Species (Federal or State
listed)
X
Floodplains
X
Hazardous Materials or Solid Waste Management
X
Historic/Architectural, Archaeological/Cultural
Resources
X
Light Emissions or Cause Visual Impacts
X
Natural Resources or Energy Supply
X
Low Income or Minority- Populations or Children
X
Wetlands
X
Wild and Scenic Rivers (study or eligible)
X
THIS PROPOSED PROJECT IS LIKELY TO:
Be highly controversial on environmental grounds
including opposition by Federal, state, local, or Tribal
or a substantial number of persons affected by the
action.
X
Be inconsistent with any Federal, State, or local law
relating to the environmental aspects of the proposed
action.
X
Cause community- disruption or inconsistency with
plans or goals that have been adopted by the
communitv
X
Cause an increase of 1.5 DNL over noise sensitive
areas
X
Displace persons or businesses
X
Disrupt local traffic patterns and substantially reduce
levels of service (LOS) of roads serving the airport and
surrounding communities
X
Result in a substantial loss in community tax base
X
Impact water quality, sole source aquifers, public water
supply system, or state or tribal water quality standards
X
Impact or violate local, state, Tribal, or Federal air
ualit�- standards
X
Attach detailed comments for all "yes" answers on a separate sheet, and explain
your justification for a request for a determination of Categorical Exclusion.
DETERMINATION OF ENVIRONMENTAL IMPACTS
Airport: Key West International Airport, Key West, Florida
Detailed Project Description (attach project drawing and additional pages as necessaiy):
Emergency Drainage Lnprovements.
Is the proposed project(s) listed
1050.1 E?
Please identify which paragraph(s):
as categorically excluded in one or more of paragraphs 307-312of FAA Order
In order for the FAA to determine the appropriate course of action, as a Categorical Exclusion, the sponsor must certifi-
that the proposed action does NOT (1) involve any of the following circumstances, and does NOT (2) have a significant
effect. A determination as to whether the proposed project (s) may have a significant environmental effect is made by
considering any requirements applicable to the specific resource (see FAA Order 1050.1 F Appendix A).
a. Have an adverse effect on cultural resources protected under the National Historic Preservation Act of 1966, as
amended.
b. Have an impact on properties protected under section 4(� of the Department of Transportation Act.
c. Have an impact on natural, ecological (e.g. invasive species), or scenic resources of Federal, Tribal, State, or local
significance (for example: Federally listed or proposed endangered, threatened, or candidate species or designated or
proposed critical habitat under the Endangered Species Act), resources protected by the Fish and Wildlife
Coordination Act; wetlands; floodplains prime, unique, State or locally important farmlands; energy supply and
natural resources; and wild and scenic rivers, including study or eligible river segments and solid waste management.
d. Cause a division or disruption of an established community, or a disruption of orderly, planned development or an
inconsistency with plans or goals that have been adopted by the community- in which the project is located.
e. Cause an increase in congestion from surface transportation (by causing a decrease in Level of Service below
acceptable level determined by appropriate transportation agency, such as a highway agency).
f. Have an impact on noise levels of noise -sensitive areas.
g. Have an impact on air quality or violate local, State, or Federal air quality- standards under the Clean Air Act
Amendments of 1990.
h. Have an impact on seater quality, sole source aquifers, a public seater supply system, or State or Tribal seater quality-
standards established under the Clean Water Act and the Safe Drinking Water Act.
i. Have effect(s) on the quality- of the human environment that are likely to be highly controversial on environmental
grounds. The term "controversial" means a substantial dispute exists as to the size, nature, or effect of a proposed
Federal action. The effects of an action are considered highly controversial when reasonable disagreement exists over
the project's risks of causing environmental harm. Opposition on environmental grounds by a Federal, state, or local
government agency or by a Tribe or by a substantial number of the persons affected by the action should be
considered in determining whether or not reasonable disagreement regarding the effects of a proposed action exists.
j. Likelihood to be inconsistent with any Federal, State, Tribal, or local lase relating to the environmental aspects of the
proposed action.
k. Likely to directly, indirectly, or cumulatively create a significant impact on the human environmental, including, but
not limited to, actions likely to cause a significant lighting impact on residential areas or commercial use of business
properties, likely to cause a significant impact on the visual nature of surrounding land uses likely to be contaminated
with hazardous materials based on Phase I or Phase II Environmental Due Diligence Audit (EDDA's), or likely to
cause such contamination
I certify that the project(s) described above meet(s) the test for a Categorical Exclusion in accordance with FAA Order
1050.1E and paragraphs a thru k above.
Signature of Authorized Airport Representative Date
FAA Determination (by program manager signature):
Categorically Excluded: Date:
Requires further environmental analysis: Date:
ENVIRONMENTAL DETERMINATION CHECKLIST (FY 22)
Airport: Key West International Airport, Key West, Florida
Proposed Project(s): Emergency Drainage Lnprovements.
Prepared and certified by: Eric S. Nielsen, P.E. Date: June 28, 2012
YES
NO
COMMENTS
IS THIS PROPOSED PROJECT LISTED AS
CATEGORICALLY EXCLUDED IN FAA ORDER
1050.1E, paragraphs 307-312
X
THIS PROPOSED PROJECT WILL AFFECT:
Coastal Resources
X
Section 4(f) Land
X
Farmland
X
Endangered or Threatened Species (Federal or State
listed)
X
Floodplains
X
Hazardous Materials or Solid Waste Management
X
Historic/Architectural, Archaeological/Cultural
Resources
X
Light Emissions or Cause Visual Impacts
X
Natural Resources or Energy Supply
X
Low Income or Minority- Populations or Children
X
Wetlands
X
Wild and Scenic Rivers (study or eligible)
X
THIS PROPOSED PROJECT IS LIKELY TO:
Be highly controversial on environmental grounds
including opposition by Federal, state, local, or Tribal
or a substantial number of persons affected by the
action.
X
Be inconsistent with any Federal, State, or local law
relating to the environmental aspects of the proposed
action.
X
Cause community- disruption or inconsistency with
plans or goals that have been adopted by the
communitv
X
Cause an increase of 1.5 DNL over noise sensitive
areas
X
Displace persons or businesses
X
Disrupt local traffic patterns and substantially reduce
levels of service (LOS) of roads serving the airport and
surrounding communities
X
Result in a substantial loss in community tax base
X
Impact water quality, sole source aquifers, public water
supply system, or state or tribal water quality standards
X
Impact or violate local, state, Tribal, or Federal air
ualit�- standards
X
Attach detailed comments for all "yes" answers on a separate sheet, and explain
your justification for a request for a determination of Categorical Exclusion.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
11/30/2007
PART II
PROJECT APPROVAL INFORMATION
SECTION A
Item 1.
Does this assistance request require State, local, regional,
Name of Governing Body:
or other priority rating?
Priority:
❑ Yes 0 No
Item 2.
Does this assistance request require State, or local
Name of Agency or Board:
(Attach Documentation)
advisory, educational or health clearances?
❑ Yes 0 No
Item 3.
Does this assistance request require clearinghouse review
(Attach Comments)
in accordance with OMB Circular A-95?
❑ Yes 0 No
Item 4.
Does this assistance request require State, local,
Name of Approving Agency:
regional or other planning approval?
Date:
❑ Yes 0 No
Item 5.
Check one: State
Is the proposal project covered by an approved
Local
comprehensive plan?
Regional
❑ Yes 0 No
Location of Plan:
Item 6.
Name of Federal Installation:
Will the assistance requested serve a Federal
Federal Population benefiting from Project:
installation?
❑ Yes �X No
Item 7.
Name of Federal Installation:
Will the assistance requested be on Federal land
Location of Federal Land:
or installation?
❑ Yes �X No
Percent of Project:
Item 8.
Will the assistance requested have an impact or effect on
See instruction for additional information to be
the environment?
provided
❑ Yes �X No
Item 9.
Number of:
Will the assistance requested cause the displacement of
Individuals:
Families:
individuals, families, businesses, or farms?
Businesses:
❑ Yes [Z No
Farms:
Item 10.
Is there other related Federal assistance on this
See instructions for additional information to be
project previous, pending, or anticipated?
provided.
❑ Yes �X No
FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-1 (9-03)
Page 2
INSTRUCTIONS FOR 5100-100 PART II A
Project Approval Information
Negative answers will not require an explanation unless the federal agency requests more information at a later date.
Provide supplementary data for all "Yes" answers in the space provided in accordance with the following instructions.
Item 1 - Provide the name of the governing body establishing
the priority system and the priority rating assigned to this
project.
Item 2 - Provide the name of the agency or board which issued
the clearance and attach the documentation of status or
approval
Item 3 - Attach the clearinghouse comments for the application
in accordance with the instructions contained in Office of
Management and Budget Circular No. A-95. If comments were
submitted previously with a preapplication, do not submit them
again but any additional comments received from the
clearinghouse should be submitted with this application.
Item 4 - Furnish the name of the approving agency and the
approval date.
Item 5 - Show whether the approved comprehensive plan is
State, local, or regional, or if none of these, explain the scope
of the plan. Give the location where the approved plan is
available for examination and state whether this project is in
conformance with the plan.
Item 6 - Show the Federal population residing or working on
the federal installation who will benefit from this project.
Item 7 - Show the percentage of the project work that will be
conducted on federally -owned or leased land. Give the name of
the Federal installation and its location.
Item 8 - Briefly describe the possible beneficial and/or harmful
impact on the environment because of the proposed project. If
an adverse environment impact is anticipated, explain what
action will be taken to minimize the impact. Federal agencies
will provide separate instructions if additional data is needed.
Item 9 - State the number of individuals, families, businesses,
or farms this project will displace. Federal agencies will provide
separate instructions if additional data is needed.
Item 10 -Show the Federal Domestic Assistance Catalog
number, the program name, the type of assistance, the status
and amount of each project where there is related previous,
pending, or anticipated assistance. Use additional sheets, if
needed
Paperwork Reduction Act Statement: The information collected on this form allows sponsors of public use airports or public
agencies to apply for one or more projects in a form prescribed by the Secretary of Transportation.
Title 49, United States Code (U.S.C.), Section 47105, identifies the information required to apply for this program. The forms
prescribed to meet this requirement are developed to provide a comprehensive format that allows sponsors to provide the data
needed to evaluate the request for funds. The burden for each response is estimated to be 28 hours. Approved applications
benefit the sponsor by providing Federal funding to protect the Federal interest in safety, efficiency, and utility of the Nation's
airport system. No assurance of confidentiality can be given since these become public records. If you wish to make any
comments concerning the accuracy of this burden estimate or any suggestions for reducing this burden, send to Federal Aviation
Administration, ARP-10, 800 Independence AVE, SW, Washington, DC 20591. Please note that an agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number, which is 2120-0569 for this collection. Comments concerning the accuracy of this burden and suggestions for reducing
the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ABA-20
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C
The Sponsor hereby represents and certifies as follows:
1. Compatible Land Use. - The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity
of the airport:
2. Defaults. - The Sponsor is not in default on any obligation to the United States or any agency of the United States Government
relative to the development, operation, or maintenance of any airport, except as stated herewith:
3. Possible Disabilities. - There are no facts or circumstances (including the existence of effective or proposed leases, use agreements
or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings) which in
reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of
Part V of this Application, either by limiting its legal or financial ability or otherwise, except as follows:
4. Consistency with Local Plans. — The project is reasonably consistent with plans existing at the time of submission of this application)
of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding
the airport.
5. Consideration of Local Interest - It has given fair consideration to the interest of communities in or near where the project may be
located.
6. Consultation with Users. In making a decision to undertake any airport development project under Title 49, United States Code, it
has undertaken reasonable consultations with affected parties using the airport which project is proposed.
7. Public Hearings. — In projects involving the location of an airport, an airport runway or a major runway extension, it has afforded the
opportunity for public hearings for the purpose of considering the economic, social, and environmental effects of the airport or runway
location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall, when
requested by the Secretary, submit a copy of the transcript of such hearings to the Secretary. Further, for such projects, it has on its
management board either voting representation from the communities where the project is located or has advised the communities that
they have the right to petition the Secretary concerning a proposed project.
8. Air and Water Quality Standards. — In projects involving airport location, a major runway extension, or runway location it will provide
for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located,
designed, constructed, and operated so as to comply with applicable and air and water quality standards. In any case where such
standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator
of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to
certify shall be provided within sixty days after the project application has been received by the Secretary.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 3a
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C (Continued)
9. Exclusive Rights — There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or
controlled by the Sponsor except as follows:
10. Land. — (a) The sponsor holds the following property interest in the following areas of land* which are to be developed or used as
part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse interests, all of which areas
are identified on the aforementioned property map designated as Exhibit "A":
The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such
attorney or title company has determined that the Sponsor holds the above property interests.
(b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work under the
Project, the following property interest in the following areas of land* on which such construction work is to be performed, all of which
areas are identified on the aforementioned property map designated as Exhibit "A":
(c) The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the
Project, the following property interest in the following areas of land* which are to be developed or used as part of or in connection with
the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated
as Exhibit "A"
*State character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of
every kind and nature, including liens, easements, leases, etc. The separate areas of land need only be identified here by the area
numbers shown on the property map.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100(4-76) Page 3b
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
PART III - BUDGET INFORMATION - CONSTRUCTION
SECTION A - GENERAL
1. Federal Domestic Assistance Catalog No ................................. 20-106
2. Functional or Other Breakout ....................................................
SECTION B -CALCULATION OF FEDERAL GRANT
Cost Classification
Use only for revisions
Total
Amount
Required
Latest Approved
Amount
Adjustment
+ or (-)
1. Administration expense
$
$
$
2. Preliminary expense
3. Land, structures, right-of-way
4. Architectural engineering basic fees
5. Other Architectural engineering fees
6. Project inspection fees
7. Land development
8. Relocation Expenses
9. Relocation payments to Individuals and Businesses
10. Demolition and removal
11. Construction and project improvement
12. Equipment
13. Miscellaneous
14. Total (Lines 1 through 13)
15. Estimated Income (if applicable)
16. Net Project Amount (Line 14 minus 15)
17. Less: Ineligible Exclusions
18. Add: Contingencies
19. Total Project Amt. (Excluding Rehabilitation Grants)
$1,815,852
20. Federal Share requested of Line 19
$ 1,634,267
21. Add Rehabilitation Grants Requested (100 Percent)
22. Total Federal grant requested (lines 20 & 21)
$ 1,634,267
23. Grantee share
$ 181,585
24. Other shares
25. Total Project (Lines 22, 23 & 24)
$
$
$1,815,852
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 4
INSTRUCTIONS
PART III
SECTION A. GENERAL
1. Show the Federal Domestic Assistance Catalog Number However, show the total amounts for all programs in
from which the assistance is requested. When more than one Section B of the basic application form.
program or Catalog Number is involved and the amount cannot
be distributed to the Federal grant program or catalog number 2. Show the functional or other categorical breakouts, if
on an over-all percentage basis, prepare a separate set of Part required by the Federal grantor agency. Prepare a separate
III forms for each program or Catalog Number. set of Part III forms for each category.
SECTION B. CALCULATION OF FEDERAL GRANT
When applying for a new grant, use the Total Amount Column only. When requesting revisions of previously awarded amounts, use all
columns.
Line 1 - Enter amounts needed for administration expenses Line 12 - Enter amounts for equipment both fixed and movable
including such items as travel, legal fees, rental of vehicles and exclusive of equipment used in construction. For example,
any other expense items expected to be incurred to administer include amounts for permanently attached laboratory tables,
the grant. Include the amount of interest expense when built-in audio visual systems, movable desks, chairs, and
authorized by program legislation and also show this amount laboratory equipment.
under Section E Remarks. Line 13 - Enter amounts for items not specifically mentioned
Line 2 - Enter amounts pertaining to the work of locating and above.
designing, making surveys and maps, sinking test holes, and
all other work required prior to actual construction. Line 14 - Enter the sum of Lines 1-13.
Line 3 - Enter amounts directly associated with the acquisition
of land, existing structures, and related right-of-way.
Line 4 - Enter basic fees for architectural engineering services.
Line 5 - Enter amounts for other architectural engineering
services, such as surveys, tests, and borings.
Line 6 - Enter fees for inspection and audit of construction and
related programs.
Line 7 - Enter amounts associated with the development of
land where the primary purpose of the grant is land
improvement. Site work normally associated with major
construction should be excluded from this category and shown
on line 11.
Line 8 - Enter the dollar amounts needed to provide relocation
advisory assistance, and the net amounts for replacement (last
resort) housing. Do not include relocation administration
expenses on this Line; include them on Line 1.
Line 9 - Enter the estimated amount of relocation payments to
be made to displaced persons, business concerns, and non-
profit organizations for moving expenses and replacement
housing.
Line 10 - Enter the gross salaries and wages of employees of
the grantee who will be directly engaged in performing
demolition or removal of structures from developed land. This
line should show also the cost of demolition or removal of
improvements on developed land under a third party contract.
Reduce the costs on this line by the amount of expected
proceeds from the sale of salvage, if so instructed by the
Federal grantor agency. Otherwise, show the proceeds on Line
15.
Line 11 - Enter amounts for the actual construction of, addition
to, or restoration of a facility. Also, include in this category the
amounts of project improvements such as sewers, streets,
landscaping, and lighting.
Line 15 - Enter the estimated amount of program income that
will be earned during the grant period and applied to the
program.
Line 16 - Enter the difference between the amount on Line 14
and the estimated income shown on Line 15.
Line 17 - Enter the amounts for those items, which are a part
of the project but not subject to Federal participation (See
Section C, Line 26g, Column (1)).
Line 18 - Enter the estimated amount for contingencies.
Compute this amount as follows. Subtract from the net project
amount shown on Line 16 the ineligible project exclusions
shown on Line 17 and the amount, which is excluded from the
contingency provisions shown in Section C, Line 26g, Column
(2). Multiply the computed amount by the percentage factor
allowed by the grantor agency in accordance with the Federal
program guidance. For those grants, which provide for a fixed
dollar allowance in lieu of a percentage allowance, enter the
dollar amount of this allowance.
Line 19 - Show the total amount of Lines 16, 17, and 18. (This
is the amount to which the matching share ratio prescribed in
program legislation is applied.)
Line 20 - Show the amount of Federal funds requested
exclusive of funds for rehabilitation purposes.
Line 21 - Enter the estimated amounts needed for
rehabilitation expense if rehabilitation grants to individuals are
made for which grantees are reimbursed 100 percent by the
Federal grantor agency in accordance with program legislation.
If the grantee shares in part of this expense, show the total
amount on Line 13 instead of on Line 21 and explain in Section
E.
Line 22 - Show the total amount of the Federal grant
requested.
Line 23 - Show the amount from Section D. Line 27h.
Line 24 - Show the amount from Section D, Line 28c.
Line 25 - Self-explanatory.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
SECTION C - EXCLUSIONS
Classification
Ineligible for
Participation
1
Excluded From
Contingency Provision
2
a.
$
$
b.
C.
d.
e.
f.
g.
Totals
$
$
SECTION D - PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
27.
Grantee Share
$
a. Securities
b. Mortgages
c. Appropriations (By Applicant)
d. Bonds
e. Tax Levies
f. Non Cash
g. Other (Explain)
$181,585
h. TOTAL - Grantee share
$181,585
28.
Other Shares
a. State
b. Other
c. Total Other Shares
29.
TOTAL
$
181,585
SECTION E - REMARKS
PART IV PROGRAM NARRATIVE (Attach - See Instructions)
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 5
INSTRUCTIONS
PART III
SECTION C. EXCLUSIONS
Line 26 a-g - Identify and list those costs in Column (1), which
are part of the project cost but are not subject to Federal
participation because of program legislation or Federal grantor
agency instructions. The total amount on Line g should agree
with the amount shown on Line 17 of Section B.
Show in Column (2) those project costs that are subject to
Federal participation but are not eligible for inclusion in the
amount used to compute contingency amounts as provided in
the Federal grantor agency instructions.
SECTION D. PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
Line 27 a-g - Show the source of the grantee's share. If cash is Line 28b - Show the amount that will be contributed from other
not immediately available, specify the actions completed to sources. If there is a non -cash contribution, explain what the
date and those actions remaining to make cash available under contribution will consist of under Section E Remarks.
Section E Remarks. Indicate also the period of time that will be
required after execution of the grant agreement to obtain the Line 28c -Show the total of Lines 28a and 28b. This amount
funds. If there is a non -cash contribution, explain what this must be the same as the amount shown in Section B, Line 24.
contribution will consist of. Line 29 - Enter the totals of Line 27h and 28c.
Line 27h - Show the total of Lines 27 a-g. This amount must
equal the amount shown in Section B, Line 23.
Line 28a - Show the amount that will be contributed by a State
or state agency, only if the applicant is not a State or state
agency. If there is a non -cash contribution, explain what the
contribution will consist of under Section E Re -marks.
SECTION E. OTHER REMARKS
Make any remarks pertinent to the project and provide any other information required by these instructions or the grantor agency. Attach
additional sheets, if necessary.
PART IV
PROGRAM NARRATIVE
(Suggested Format)
DEPARTMENT OF TRANSPORTATION -FEDERAL AVIATION ADMINISTRATION
PROJECT: Bond Repayment for Terminal Construction
AIRPORT: Key West International Airport
1. Objective:
Construct a new Terminal Building, rehabilitation and remodeling of existing Terminal building.
2. Benefits Anticipated:
Accommodate present and near term requirements per Terminal Concept Study.
3. Approach : (See approved Scope of Work in Final Application)
Consultant's means and methods using standard construction practices
4. Geographic Location:
This project will take place at Key West International Airport, Key West, Florida
5. If Applicable, Provide Additional Information:
N/A
6. Sponsor's Representative: (include address & telephone number)
Peter J. Horton
3491 South Roosevelt Boulevard
Key West, Florida 33040
(305) 809-5200
OMB NO.2120-0569
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 6
INSTRUCTIONS
PART IV
PROGRAM NARRATIVE
Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests for
supplemental assistance should be responsive to Item 5b only. Requests for continuation or refunding or other changes of an approved
project should be responsive to Item 5c only.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE.
Pinpoint any relevant physical, economic, social, financial,
institutional, or other problems requiring a solution.
Demonstrate the need for assistance and state the principal
and subordinate objectives of the project. Supporting
documentation or other testimonies from concerned interests
other than the applicant may be used. Any relevant data based
on planning studies should be included or footnoted.
2. RESULTS OR BENEFITS EXPECTED.
Identify results and benefits to be derived. For example, include
a description of who will occupy the facility and show how the
facility will be used. For land acquisition or development
projects, explain how the project will benefit the public.
3.APPROACH
a. Outline a plan of action pertaining to the scope and detail of
how the proposed work will be accomplished for each grant
program. Cite factors, which might accelerate or decelerate the
work, and your reason for taking this approach as opposed to
others. Describe any unusual features of the project such as
design or technological innovations, reductions in cost or time,
or extraordinary social and community involvements.
b. Provide each grant program monthly or quarterly quantitative
projections of the accomplishments to be achieved, if possible.
When accomplishments cannot be quantified, list the activities
in chronological order to show the schedule of
accomplishments and their target dates.
c. Identify the kinds of data to be collected and maintained, and
discuss the criteria to be used to evaluate the results and
success of the project. Explain the methodology that will be
used to determine if the needs identified and discussed are
being met and if the results and benefits identified in Item 2 are
being achieved.
d. List each organization, cooperator, consultant, or other key
individuals who will work on the project along with a short
description of the nature of their effort or contribution.
Give a precise location of the project and area to be served by
the proposed project. Maps or other graphic aids may be
attached.
5. IF APPLICABLE, PROVIDE THE FOLLOWING
INFORMATION:
a. Describe the relationship between this project and other
work planned, anticipated, or underway under the Federal
Assistance listed under Part II, Section A, Item 10.
b. Explain the reason for all requests for supplemental
assistance and justify the need for additional funding.
c. Discuss accomplishments to date and list in chronological
order a schedule of accomplishments, progress, or milestones
anticipated with the new funding re -quest. If there have been
significant changes in the project objectives, location, approach
or time delays, explain and justify. For other requests for
changes or amendments, explain the reason for the change(s).
If the scope or objectives have changed or an extension of time
is necessary, explain the circumstances and justify. If the total
budget has been exceeded or if individual budget items have
changed more than the prescribed limits contained in
Attachment K, Office of Management and Budget Circular No.
A-102, explain and justify the change and its effect on the
project.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
11/30/2007
PART II
PROJECT APPROVAL INFORMATION
SECTION A
Item 1.
Does this assistance request require State, local, regional,
Name of Governing Body:
or other priority rating?
Priority:
❑ Yes 0 No
Item 2.
Does this assistance request require State, or local
Name of Agency or Board:
(Attach Documentation)
advisory, educational or health clearances?
❑ Yes 0 No
Item 3.
Does this assistance request require clearinghouse review
(Attach Comments)
in accordance with OMB Circular A-95?
❑ Yes 0 No
Item 4.
Does this assistance request require State, local,
Name of Approving Agency:
regional or other planning approval?
Date:
❑ Yes 0 No
Item 5.
Check one: State
Is the proposal project covered by an approved
Local
comprehensive plan?
Regional
❑ Yes 0 No
Location of Plan:
Item 6.
Name of Federal Installation:
Will the assistance requested serve a Federal
Federal Population benefiting from Project:
installation?
❑ Yes �X No
Item 7.
Name of Federal Installation:
Will the assistance requested be on Federal land
Location of Federal Land:
or installation?
❑ Yes �X No
Percent of Project:
Item 8.
Will the assistance requested have an impact or effect on
See instruction for additional information to be
the environment?
provided
❑ Yes �X No
Item 9.
Number of:
Will the assistance requested cause the displacement of
Individuals:
Families:
individuals, families, businesses, or farms?
Businesses:
❑ Yes [Z No
Farms:
Item 10.
Is there other related Federal assistance on this
See instructions for additional information to be
project previous, pending, or anticipated?
provided.
❑ Yes �X No
FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-1 (9-03)
Page 2
INSTRUCTIONS FOR 5100-100 PART II A
Project Approval Information
Negative answers will not require an explanation unless the federal agency requests more information at a later date.
Provide supplementary data for all "Yes" answers in the space provided in accordance with the following instructions.
Item 1 - Provide the name of the governing body establishing
the priority system and the priority rating assigned to this
project.
Item 2 - Provide the name of the agency or board which issued
the clearance and attach the documentation of status or
approval
Item 3 - Attach the clearinghouse comments for the application
in accordance with the instructions contained in Office of
Management and Budget Circular No. A-95. If comments were
submitted previously with a preapplication, do not submit them
again but any additional comments received from the
clearinghouse should be submitted with this application.
Item 4 - Furnish the name of the approving agency and the
approval date.
Item 5 - Show whether the approved comprehensive plan is
State, local, or regional, or if none of these, explain the scope
of the plan. Give the location where the approved plan is
available for examination and state whether this project is in
conformance with the plan.
Item 6 - Show the Federal population residing or working on
the federal installation who will benefit from this project.
Item 7 - Show the percentage of the project work that will be
conducted on federally -owned or leased land. Give the name of
the Federal installation and its location.
Item 8 - Briefly describe the possible beneficial and/or harmful
impact on the environment because of the proposed project. If
an adverse environment impact is anticipated, explain what
action will be taken to minimize the impact. Federal agencies
will provide separate instructions if additional data is needed.
Item 9 - State the number of individuals, families, businesses,
or farms this project will displace. Federal agencies will provide
separate instructions if additional data is needed.
Item 10 -Show the Federal Domestic Assistance Catalog
number, the program name, the type of assistance, the status
and amount of each project where there is related previous,
pending, or anticipated assistance. Use additional sheets, if
needed
Paperwork Reduction Act Statement: The information collected on this form allows sponsors of public use airports or public
agencies to apply for one or more projects in a form prescribed by the Secretary of Transportation.
Title 49, United States Code (U.S.C.), Section 47105, identifies the information required to apply for this program. The forms
prescribed to meet this requirement are developed to provide a comprehensive format that allows sponsors to provide the data
needed to evaluate the request for funds. The burden for each response is estimated to be 28 hours. Approved applications
benefit the sponsor by providing Federal funding to protect the Federal interest in safety, efficiency, and utility of the Nation's
airport system. No assurance of confidentiality can be given since these become public records. If you wish to make any
comments concerning the accuracy of this burden estimate or any suggestions for reducing this burden, send to Federal Aviation
Administration, ARP-10, 800 Independence AVE, SW, Washington, DC 20591. Please note that an agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number, which is 2120-0569 for this collection. Comments concerning the accuracy of this burden and suggestions for reducing
the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ABA-20
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C
The Sponsor hereby represents and certifies as follows:
1. Compatible Land Use. - The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity
of the airport:
2. Defaults. - The Sponsor is not in default on any obligation to the United States or any agency of the United States Government
relative to the development, operation, or maintenance of any airport, except as stated herewith:
3. Possible Disabilities. - There are no facts or circumstances (including the existence of effective or proposed leases, use agreements
or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings) which in
reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of
Part V of this Application, either by limiting its legal or financial ability or otherwise, except as follows:
4. Consistency with Local Plans. — The project is reasonably consistent with plans existing at the time of submission of this application)
of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding
the airport.
5. Consideration of Local Interest - It has given fair consideration to the interest of communities in or near where the project may be
located.
6. Consultation with Users. In making a decision to undertake any airport development project under Title 49, United States Code, it
has undertaken reasonable consultations with affected parties using the airport which project is proposed.
7. Public Hearings. — In projects involving the location of an airport, an airport runway or a major runway extension, it has afforded the
opportunity for public hearings for the purpose of considering the economic, social, and environmental effects of the airport or runway
location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall, when
requested by the Secretary, submit a copy of the transcript of such hearings to the Secretary. Further, for such projects, it has on its
management board either voting representation from the communities where the project is located or has advised the communities that
they have the right to petition the Secretary concerning a proposed project.
8. Air and Water Quality Standards. — In projects involving airport location, a major runway extension, or runway location it will provide
for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located,
designed, constructed, and operated so as to comply with applicable and air and water quality standards. In any case where such
standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator
of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to
certify shall be provided within sixty days after the project application has been received by the Secretary.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 3a
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C (Continued)
9. Exclusive Rights — There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or
controlled by the Sponsor except as follows:
10. Land. — (a) The sponsor holds the following property interest in the following areas of land* which are to be developed or used as
part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse interests, all of which areas
are identified on the aforementioned property map designated as Exhibit "A":
The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such
attorney or title company has determined that the Sponsor holds the above property interests.
(b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work under the
Project, the following property interest in the following areas of land* on which such construction work is to be performed, all of which
areas are identified on the aforementioned property map designated as Exhibit "A":
(c) The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the
Project, the following property interest in the following areas of land* which are to be developed or used as part of or in connection with
the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated
as Exhibit "A"
*State character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of
every kind and nature, including liens, easements, leases, etc. The separate areas of land need only be identified here by the area
numbers shown on the property map.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100(4-76) Page 3b
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
PART III - BUDGET INFORMATION - CONSTRUCTION
SECTION A - GENERAL
1. Federal Domestic Assistance Catalog No ................................. 20-106
2. Functional or Other Breakout ....................................................
SECTION B -CALCULATION OF FEDERAL GRANT
Cost Classification
Use only for revisions
Total
Amount
Required
Latest Approved
Amount
Adjustment
+ or (-)
1. Administration expense
$
$
$
2. Preliminary expense
3. Land, structures, right-of-way
4. Architectural engineering basic fees
5. Other Architectural engineering fees
6. Project inspection fees
7. Land development
8. Relocation Expenses
9. Relocation payments to Individuals and Businesses
10. Demolition and removal
11. Construction and project improvement
12. Equipment
13. Miscellaneous
14. Total (Lines 1 through 13)
15. Estimated Income (if applicable)
16. Net Project Amount (Line 14 minus 15)
17. Less: Ineligible Exclusions
18. Add: Contingencies
19. Total Project Amt. (Excluding Rehabilitation Grants)
$55,556
20. Federal Share requested of Line 19
$ 50,000
21. Add Rehabilitation Grants Requested (100 Percent)
22. Total Federal grant requested (lines 20 & 21)
$ 50,000
23. Grantee share
$ 5,556
24. Other shares
25. Total Project (Lines 22, 23 & 24)
$
$
$55,556
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 4
INSTRUCTIONS
PART III
SECTION A. GENERAL
1. Show the Federal Domestic Assistance Catalog Number However, show the total amounts for all programs in
from which the assistance is requested. When more than one Section B of the basic application form.
program or Catalog Number is involved and the amount cannot
be distributed to the Federal grant program or catalog number 2. Show the functional or other categorical breakouts, if
on an over-all percentage basis, prepare a separate set of Part required by the Federal grantor agency. Prepare a separate
III forms for each program or Catalog Number. set of Part III forms for each category.
SECTION B. CALCULATION OF FEDERAL GRANT
When applying for a new grant, use the Total Amount Column only. When requesting revisions of previously awarded amounts, use all
columns.
Line 1 - Enter amounts needed for administration expenses Line 12 - Enter amounts for equipment both fixed and movable
including such items as travel, legal fees, rental of vehicles and exclusive of equipment used in construction. For example,
any other expense items expected to be incurred to administer include amounts for permanently attached laboratory tables,
the grant. Include the amount of interest expense when built-in audio visual systems, movable desks, chairs, and
authorized by program legislation and also show this amount laboratory equipment.
under Section E Remarks. Line 13 - Enter amounts for items not specifically mentioned
Line 2 - Enter amounts pertaining to the work of locating and above.
designing, making surveys and maps, sinking test holes, and
all other work required prior to actual construction. Line 14 - Enter the sum of Lines 1-13.
Line 3 - Enter amounts directly associated with the acquisition
of land, existing structures, and related right-of-way.
Line 4 - Enter basic fees for architectural engineering services.
Line 5 - Enter amounts for other architectural engineering
services, such as surveys, tests, and borings.
Line 6 - Enter fees for inspection and audit of construction and
related programs.
Line 7 - Enter amounts associated with the development of
land where the primary purpose of the grant is land
improvement. Site work normally associated with major
construction should be excluded from this category and shown
on line 11.
Line 8 - Enter the dollar amounts needed to provide relocation
advisory assistance, and the net amounts for replacement (last
resort) housing. Do not include relocation administration
expenses on this Line; include them on Line 1.
Line 9 - Enter the estimated amount of relocation payments to
be made to displaced persons, business concerns, and non-
profit organizations for moving expenses and replacement
housing.
Line 10 - Enter the gross salaries and wages of employees of
the grantee who will be directly engaged in performing
demolition or removal of structures from developed land. This
line should show also the cost of demolition or removal of
improvements on developed land under a third party contract.
Reduce the costs on this line by the amount of expected
proceeds from the sale of salvage, if so instructed by the
Federal grantor agency. Otherwise, show the proceeds on Line
15.
Line 11 - Enter amounts for the actual construction of, addition
to, or restoration of a facility. Also, include in this category the
amounts of project improvements such as sewers, streets,
landscaping, and lighting.
Line 15 - Enter the estimated amount of program income that
will be earned during the grant period and applied to the
program.
Line 16 - Enter the difference between the amount on Line 14
and the estimated income shown on Line 15.
Line 17 - Enter the amounts for those items, which are a part
of the project but not subject to Federal participation (See
Section C, Line 26g, Column (1)).
Line 18 - Enter the estimated amount for contingencies.
Compute this amount as follows. Subtract from the net project
amount shown on Line 16 the ineligible project exclusions
shown on Line 17 and the amount, which is excluded from the
contingency provisions shown in Section C, Line 26g, Column
(2). Multiply the computed amount by the percentage factor
allowed by the grantor agency in accordance with the Federal
program guidance. For those grants, which provide for a fixed
dollar allowance in lieu of a percentage allowance, enter the
dollar amount of this allowance.
Line 19 - Show the total amount of Lines 16, 17, and 18. (This
is the amount to which the matching share ratio prescribed in
program legislation is applied.)
Line 20 - Show the amount of Federal funds requested
exclusive of funds for rehabilitation purposes.
Line 21 - Enter the estimated amounts needed for
rehabilitation expense if rehabilitation grants to individuals are
made for which grantees are reimbursed 100 percent by the
Federal grantor agency in accordance with program legislation.
If the grantee shares in part of this expense, show the total
amount on Line 13 instead of on Line 21 and explain in Section
E.
Line 22 - Show the total amount of the Federal grant
requested.
Line 23 - Show the amount from Section D. Line 27h.
Line 24 - Show the amount from Section D, Line 28c.
Line 25 - Self-explanatory.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
SECTION C - EXCLUSIONS
Classification
Ineligible for
Participation
1
Excluded From
Contingency Provision
2
a.
$
$
b.
C.
d.
e.
f.
g.
Totals
$
$
SECTION D - PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
27.
Grantee Share
$
a. Securities
b. Mortgages
c. Appropriations (By Applicant)
d. Bonds
e. Tax Levies
f. Non Cash
g. Other (Explain)
$5,556
h. TOTAL - Grantee share
$5,556
28.
Other Shares
a. State
b. Other
c. Total Other Shares
29.
TOTAL
$
5,556
SECTION E - REMARKS
PART IV PROGRAM NARRATIVE (Attach - See Instructions)
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 5
INSTRUCTIONS
PART III
SECTION C. EXCLUSIONS
Line 26 a-g - Identify and list those costs in Column (1), which
are part of the project cost but are not subject to Federal
participation because of program legislation or Federal grantor
agency instructions. The total amount on Line g should agree
with the amount shown on Line 17 of Section B.
Show in Column (2) those project costs that are subject to
Federal participation but are not eligible for inclusion in the
amount used to compute contingency amounts as provided in
the Federal grantor agency instructions.
SECTION D. PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
Line 27 a-g - Show the source of the grantee's share. If cash is Line 28b - Show the amount that will be contributed from other
not immediately available, specify the actions completed to sources. If there is a non -cash contribution, explain what the
date and those actions remaining to make cash available under contribution will consist of under Section E Remarks.
Section E Remarks. Indicate also the period of time that will be
required after execution of the grant agreement to obtain the Line 28c -Show the total of Lines 28a and 28b. This amount
funds. If there is a non -cash contribution, explain what this must be the same as the amount shown in Section B, Line 24.
contribution will consist of. Line 29 - Enter the totals of Line 27h and 28c.
Line 27h - Show the total of Lines 27 a-g. This amount must
equal the amount shown in Section B, Line 23.
Line 28a - Show the amount that will be contributed by a State
or state agency, only if the applicant is not a State or state
agency. If there is a non -cash contribution, explain what the
contribution will consist of under Section E Re -marks.
SECTION E. OTHER REMARKS
Make any remarks pertinent to the project and provide any other information required by these instructions or the grantor agency. Attach
additional sheets, if necessary.
PART IV
PROGRAM NARRATIVE
(Suggested Format)
DEPARTMENT OF TRANSPORTATION -FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
PROJECT: Airport Entrance Road, Plans and Specifications
AIRPORT: Key West International Airport
1. Objective:
The airport access road from A1A, Faraldo Circle is in need of a new surface course of Asphalt Concrete. This project
would provide the design services required to produce Plans and Specifications for a milling and overlay project. No
construction services are included
2. Benefits Anticipated:
This project is done to avoid further deterioration of Airport Access Road Pavement.
3. Approach : (See approved Scope of Work in Final Application)
Consultant's means and methods using standard construction practices
4. Geographic Location:
This project will take place at Key West International Airport, Key West, Florida
5. If Applicable, Provide Additional Information:
N/A
6. Sponsor's Representative: (include address & telephone number)
Peter J. Horton
3491 South Roosevelt Boulevard
Key West, Florida 33040
(305) 809-5200
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 6
INSTRUCTIONS
PART IV
PROGRAM NARRATIVE
Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests for
supplemental assistance should be responsive to Item 5b only. Requests for continuation or refunding or other changes of an approved
project should be responsive to Item 5c only.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE.
Pinpoint any relevant physical, economic, social, financial,
institutional, or other problems requiring a solution.
Demonstrate the need for assistance and state the principal
and subordinate objectives of the project. Supporting
documentation or other testimonies from concerned interests
other than the applicant may be used. Any relevant data based
on planning studies should be included or footnoted.
2. RESULTS OR BENEFITS EXPECTED.
Identify results and benefits to be derived. For example, include
a description of who will occupy the facility and show how the
facility will be used. For land acquisition or development
projects, explain how the project will benefit the public.
3.APPROACH
a. Outline a plan of action pertaining to the scope and detail of
how the proposed work will be accomplished for each grant
program. Cite factors, which might accelerate or decelerate the
work, and your reason for taking this approach as opposed to
others. Describe any unusual features of the project such as
design or technological innovations, reductions in cost or time,
or extraordinary social and community involvements.
b. Provide each grant program monthly or quarterly quantitative
projections of the accomplishments to be achieved, if possible.
When accomplishments cannot be quantified, list the activities
in chronological order to show the schedule of
accomplishments and their target dates.
c. Identify the kinds of data to be collected and maintained, and
discuss the criteria to be used to evaluate the results and
success of the project. Explain the methodology that will be
used to determine if the needs identified and discussed are
being met and if the results and benefits identified in Item 2 are
being achieved.
d. List each organization, cooperator, consultant, or other key
individuals who will work on the project along with a short
description of the nature of their effort or contribution.
Give a precise location of the project and area to be served by
the proposed project. Maps or other graphic aids may be
attached.
5. IF APPLICABLE, PROVIDE THE FOLLOWING
INFORMATION:
a. Describe the relationship between this project and other
work planned, anticipated, or underway under the Federal
Assistance listed under Part II, Section A, Item 10.
b. Explain the reason for all requests for supplemental
assistance and justify the need for additional funding.
c. Discuss accomplishments to date and list in chronological
order a schedule of accomplishments, progress, or milestones
anticipated with the new funding re -quest. If there have been
significant changes in the project objectives, location, approach
or time delays, explain and justify. For other requests for
changes or amendments, explain the reason for the change(s).
If the scope or objectives have changed or an extension of time
is necessary, explain the circumstances and justify. If the total
budget has been exceeded or if individual budget items have
changed more than the prescribed limits contained in
Attachment K, Office of Management and Budget Circular No.
A-102, explain and justify the change and its effect on the
project.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
11/30/2007
PART II
PROJECT APPROVAL INFORMATION
SECTION A
Item 1.
Does this assistance request require State, local, regional,
Name of Governing Body:
or other priority rating?
Priority:
❑ Yes 0 No
Item 2.
Does this assistance request require State, or local
Name of Agency or Board:
(Attach Documentation)
advisory, educational or health clearances?
❑ Yes 0 No
Item 3.
Does this assistance request require clearinghouse review
(Attach Comments)
in accordance with OMB Circular A-95?
❑ Yes 0 No
Item 4.
Does this assistance request require State, local,
Name of Approving Agency:
regional or other planning approval?
Date:
❑ Yes 0 No
Item 5.
Check one: State
Is the proposal project covered by an approved
Local
comprehensive plan?
Regional
❑ Yes 0 No
Location of Plan:
Item 6.
Name of Federal Installation:
Will the assistance requested serve a Federal
Federal Population benefiting from Project:
installation?
❑ Yes �X No
Item 7.
Name of Federal Installation:
Will the assistance requested be on Federal land
Location of Federal Land:
or installation?
❑ Yes �X No
Percent of Project:
Item 8.
Will the assistance requested have an impact or effect on
See instruction for additional information to be
the environment?
provided
❑ Yes �X No
Item 9.
Number of:
Will the assistance requested cause the displacement of
Individuals:
Families:
individuals, families, businesses, or farms?
Businesses:
❑ Yes [Z No
Farms:
Item 10.
Is there other related Federal assistance on this
See instructions for additional information to be
project previous, pending, or anticipated?
provided.
❑ Yes �X No
FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-1 (9-03)
Page 2
INSTRUCTIONS FOR 5100-100 PART II A
Project Approval Information
Negative answers will not require an explanation unless the federal agency requests more information at a later date.
Provide supplementary data for all "Yes" answers in the space provided in accordance with the following instructions.
Item 1 - Provide the name of the governing body establishing
the priority system and the priority rating assigned to this
project.
Item 2 - Provide the name of the agency or board which issued
the clearance and attach the documentation of status or
approval
Item 3 - Attach the clearinghouse comments for the application
in accordance with the instructions contained in Office of
Management and Budget Circular No. A-95. If comments were
submitted previously with a preapplication, do not submit them
again but any additional comments received from the
clearinghouse should be submitted with this application.
Item 4 - Furnish the name of the approving agency and the
approval date.
Item 5 - Show whether the approved comprehensive plan is
State, local, or regional, or if none of these, explain the scope
of the plan. Give the location where the approved plan is
available for examination and state whether this project is in
conformance with the plan.
Item 6 - Show the Federal population residing or working on
the federal installation who will benefit from this project.
Item 7 - Show the percentage of the project work that will be
conducted on federally -owned or leased land. Give the name of
the Federal installation and its location.
Item 8 - Briefly describe the possible beneficial and/or harmful
impact on the environment because of the proposed project. If
an adverse environment impact is anticipated, explain what
action will be taken to minimize the impact. Federal agencies
will provide separate instructions if additional data is needed.
Item 9 - State the number of individuals, families, businesses,
or farms this project will displace. Federal agencies will provide
separate instructions if additional data is needed.
Item 10 -Show the Federal Domestic Assistance Catalog
number, the program name, the type of assistance, the status
and amount of each project where there is related previous,
pending, or anticipated assistance. Use additional sheets, if
needed
Paperwork Reduction Act Statement: The information collected on this form allows sponsors of public use airports or public
agencies to apply for one or more projects in a form prescribed by the Secretary of Transportation.
Title 49, United States Code (U.S.C.), Section 47105, identifies the information required to apply for this program. The forms
prescribed to meet this requirement are developed to provide a comprehensive format that allows sponsors to provide the data
needed to evaluate the request for funds. The burden for each response is estimated to be 28 hours. Approved applications
benefit the sponsor by providing Federal funding to protect the Federal interest in safety, efficiency, and utility of the Nation's
airport system. No assurance of confidentiality can be given since these become public records. If you wish to make any
comments concerning the accuracy of this burden estimate or any suggestions for reducing this burden, send to Federal Aviation
Administration, ARP-10, 800 Independence AVE, SW, Washington, DC 20591. Please note that an agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number, which is 2120-0569 for this collection. Comments concerning the accuracy of this burden and suggestions for reducing
the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ABA-20
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C
The Sponsor hereby represents and certifies as follows:
1. Compatible Land Use. - The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity
of the airport:
2. Defaults. - The Sponsor is not in default on any obligation to the United States or any agency of the United States Government
relative to the development, operation, or maintenance of any airport, except as stated herewith:
3. Possible Disabilities. - There are no facts or circumstances (including the existence of effective or proposed leases, use agreements
or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings) which in
reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of
Part V of this Application, either by limiting its legal or financial ability or otherwise, except as follows:
4. Consistency with Local Plans. — The project is reasonably consistent with plans existing at the time of submission of this application)
of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding
the airport.
5. Consideration of Local Interest - It has given fair consideration to the interest of communities in or near where the project may be
located.
6. Consultation with Users. In making a decision to undertake any airport development project under Title 49, United States Code, it
has undertaken reasonable consultations with affected parties using the airport which project is proposed.
7. Public Hearings. — In projects involving the location of an airport, an airport runway or a major runway extension, it has afforded the
opportunity for public hearings for the purpose of considering the economic, social, and environmental effects of the airport or runway
location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall, when
requested by the Secretary, submit a copy of the transcript of such hearings to the Secretary. Further, for such projects, it has on its
management board either voting representation from the communities where the project is located or has advised the communities that
they have the right to petition the Secretary concerning a proposed project.
8. Air and Water Quality Standards. — In projects involving airport location, a major runway extension, or runway location it will provide
for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located,
designed, constructed, and operated so as to comply with applicable and air and water quality standards. In any case where such
standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator
of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to
certify shall be provided within sixty days after the project application has been received by the Secretary.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 3a
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C (Continued)
9. Exclusive Rights — There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or
controlled by the Sponsor except as follows:
10. Land. — (a) The sponsor holds the following property interest in the following areas of land* which are to be developed or used as
part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse interests, all of which areas
are identified on the aforementioned property map designated as Exhibit "A":
The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such
attorney or title company has determined that the Sponsor holds the above property interests.
(b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work under the
Project, the following property interest in the following areas of land* on which such construction work is to be performed, all of which
areas are identified on the aforementioned property map designated as Exhibit "A":
(c) The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the
Project, the following property interest in the following areas of land* which are to be developed or used as part of or in connection with
the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated
as Exhibit "A"
*State character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of
every kind and nature, including liens, easements, leases, etc. The separate areas of land need only be identified here by the area
numbers shown on the property map.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100(4-76) Page 3b
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
PART III - BUDGET INFORMATION - CONSTRUCTION
SECTION A - GENERAL
1. Federal Domestic Assistance Catalog No ................................. 20-106
2. Functional or Other Breakout ....................................................
SECTION B -CALCULATION OF FEDERAL GRANT
Cost Classification
Use only for revisions
Total
Amount
Required
Latest Approved
Amount
Adjustment
+ or (-)
1. Administration expense
$
$
$
2. Preliminary expense
3. Land, structures, right-of-way
4. Architectural engineering basic fees
5. Other Architectural engineering fees
6. Project inspection fees
7. Land development
8. Relocation Expenses
9. Relocation payments to Individuals and Businesses
10. Demolition and removal
11. Construction and project improvement
12. Equipment
13. Miscellaneous
14. Total (Lines 1 through 13)
15. Estimated Income (if applicable)
16. Net Project Amount (Line 14 minus 15)
17. Less: Ineligible Exclusions
18. Add: Contingencies
19. Total Project Amt. (Excluding Rehabilitation Grants)
$100,000
20. Federal Share requested of Line 19
$ 90,000
21. Add Rehabilitation Grants Requested (100 Percent)
22. Total Federal grant requested (lines 20 & 21)
$ 90,000
23. Grantee share
$ 10,000
24. Other shares
25. Total Project (Lines 22, 23 & 24)
$
$
$100,000
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 4
INSTRUCTIONS
PART III
SECTION A. GENERAL
1. Show the Federal Domestic Assistance Catalog Number However, show the total amounts for all programs in
from which the assistance is requested. When more than one Section B of the basic application form.
program or Catalog Number is involved and the amount cannot
be distributed to the Federal grant program or catalog number 2. Show the functional or other categorical breakouts, if
on an over-all percentage basis, prepare a separate set of Part required by the Federal grantor agency. Prepare a separate
III forms for each program or Catalog Number. set of Part III forms for each category.
SECTION B. CALCULATION OF FEDERAL GRANT
When applying for a new grant, use the Total Amount Column only. When requesting revisions of previously awarded amounts, use all
columns.
Line 1 - Enter amounts needed for administration expenses Line 12 - Enter amounts for equipment both fixed and movable
including such items as travel, legal fees, rental of vehicles and exclusive of equipment used in construction. For example,
any other expense items expected to be incurred to administer include amounts for permanently attached laboratory tables,
the grant. Include the amount of interest expense when built-in audio visual systems, movable desks, chairs, and
authorized by program legislation and also show this amount laboratory equipment.
under Section E Remarks. Line 13 - Enter amounts for items not specifically mentioned
Line 2 - Enter amounts pertaining to the work of locating and above.
designing, making surveys and maps, sinking test holes, and
all other work required prior to actual construction. Line 14 - Enter the sum of Lines 1-13.
Line 3 - Enter amounts directly associated with the acquisition
of land, existing structures, and related right-of-way.
Line 4 - Enter basic fees for architectural engineering services.
Line 5 - Enter amounts for other architectural engineering
services, such as surveys, tests, and borings.
Line 6 - Enter fees for inspection and audit of construction and
related programs.
Line 7 - Enter amounts associated with the development of
land where the primary purpose of the grant is land
improvement. Site work normally associated with major
construction should be excluded from this category and shown
on line 11.
Line 8 - Enter the dollar amounts needed to provide relocation
advisory assistance, and the net amounts for replacement (last
resort) housing. Do not include relocation administration
expenses on this Line; include them on Line 1.
Line 9 - Enter the estimated amount of relocation payments to
be made to displaced persons, business concerns, and non-
profit organizations for moving expenses and replacement
housing.
Line 10 - Enter the gross salaries and wages of employees of
the grantee who will be directly engaged in performing
demolition or removal of structures from developed land. This
line should show also the cost of demolition or removal of
improvements on developed land under a third party contract.
Reduce the costs on this line by the amount of expected
proceeds from the sale of salvage, if so instructed by the
Federal grantor agency. Otherwise, show the proceeds on Line
15.
Line 11 - Enter amounts for the actual construction of, addition
to, or restoration of a facility. Also, include in this category the
amounts of project improvements such as sewers, streets,
landscaping, and lighting.
Line 15 - Enter the estimated amount of program income that
will be earned during the grant period and applied to the
program.
Line 16 - Enter the difference between the amount on Line 14
and the estimated income shown on Line 15.
Line 17 - Enter the amounts for those items, which are a part
of the project but not subject to Federal participation (See
Section C, Line 26g, Column (1)).
Line 18 - Enter the estimated amount for contingencies.
Compute this amount as follows. Subtract from the net project
amount shown on Line 16 the ineligible project exclusions
shown on Line 17 and the amount, which is excluded from the
contingency provisions shown in Section C, Line 26g, Column
(2). Multiply the computed amount by the percentage factor
allowed by the grantor agency in accordance with the Federal
program guidance. For those grants, which provide for a fixed
dollar allowance in lieu of a percentage allowance, enter the
dollar amount of this allowance.
Line 19 - Show the total amount of Lines 16, 17, and 18. (This
is the amount to which the matching share ratio prescribed in
program legislation is applied.)
Line 20 - Show the amount of Federal funds requested
exclusive of funds for rehabilitation purposes.
Line 21 - Enter the estimated amounts needed for
rehabilitation expense if rehabilitation grants to individuals are
made for which grantees are reimbursed 100 percent by the
Federal grantor agency in accordance with program legislation.
If the grantee shares in part of this expense, show the total
amount on Line 13 instead of on Line 21 and explain in Section
E.
Line 22 - Show the total amount of the Federal grant
requested.
Line 23 - Show the amount from Section D. Line 27h.
Line 24 - Show the amount from Section D, Line 28c.
Line 25 - Self-explanatory.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
SECTION C - EXCLUSIONS
Classification
Ineligible for
Participation
1
Excluded From
Contingency Provision
2
a.
$
$
b.
C.
d.
e.
f.
g.
Totals
$
$
SECTION D - PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
27.
Grantee Share
$
a. Securities
b. Mortgages
c. Appropriations (By Applicant)
d. Bonds
e. Tax Levies
f. Non Cash
g. Other (Explain)
$10,000
h. TOTAL - Grantee share
$10,000
28.
Other Shares
a. State
b. Other
c. Total Other Shares
29.
TOTAL
$
10,000
SECTION E - REMARKS
PART IV PROGRAM NARRATIVE (Attach - See Instructions)
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 5
INSTRUCTIONS
PART III
SECTION C. EXCLUSIONS
Line 26 a-g - Identify and list those costs in Column (1), which
are part of the project cost but are not subject to Federal
participation because of program legislation or Federal grantor
agency instructions. The total amount on Line g should agree
with the amount shown on Line 17 of Section B.
Show in Column (2) those project costs that are subject to
Federal participation but are not eligible for inclusion in the
amount used to compute contingency amounts as provided in
the Federal grantor agency instructions.
SECTION D. PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
Line 27 a-g - Show the source of the grantee's share. If cash is Line 28b - Show the amount that will be contributed from other
not immediately available, specify the actions completed to sources. If there is a non -cash contribution, explain what the
date and those actions remaining to make cash available under contribution will consist of under Section E Remarks.
Section E Remarks. Indicate also the period of time that will be
required after execution of the grant agreement to obtain the Line 28c -Show the total of Lines 28a and 28b. This amount
funds. If there is a non -cash contribution, explain what this must be the same as the amount shown in Section B, Line 24.
contribution will consist of. Line 29 - Enter the totals of Line 27h and 28c.
Line 27h - Show the total of Lines 27 a-g. This amount must
equal the amount shown in Section B, Line 23.
Line 28a - Show the amount that will be contributed by a State
or state agency, only if the applicant is not a State or state
agency. If there is a non -cash contribution, explain what the
contribution will consist of under Section E Re -marks.
SECTION E. OTHER REMARKS
Make any remarks pertinent to the project and provide any other information required by these instructions or the grantor agency. Attach
additional sheets, if necessary.
PART IV
PROGRAM NARRATIVE
(Suggested Format)
DEPARTMENT OF TRANSPORTATION -FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
PROJECT: Commercial Ramp Rehabilitation Conceptual Plan
AIRPORT: Key West International Airport
1. Objective:
The existing asphalt apron has required significant maintenance due to the introduction of new flights of the B-737-700W.
Additional flights by the B-737 are anticipated due to the merger of Southwest Airlines and Air Tran Airlines. Temporary
PCC pads have been built and more may be needed as B-737 flights increase. The existing pavement strength for the
commercial apron is 95,000 Ibs Dual Gear (DG) while the B-737 is approximately 135,000 Ibs DG. Passenger numbers
have also been on the rise with new record annual enplanements for 2011
2. Benefits Anticipated:
To avoid deterioration of the pavement due to the increase in B-737 operations and improve the existing drainage
system to avoid flooding.
3. Approach : (See approved Scope of Work in Final Application)
Consultant's means and methods using standard construction practices
4. Geographic Location:
This project will take place at Key West International Airport, Key West, Florida
5. If Applicable, Provide Additional Information:
N/A
6. Sponsor's Representative: (include address & telephone number)
Peter J. Horton
3491 South Roosevelt Boulevard
Key West, Florida 33040
(305) 809-5200
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 6
INSTRUCTIONS
PART IV
PROGRAM NARRATIVE
Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests for
supplemental assistance should be responsive to Item 5b only. Requests for continuation or refunding or other changes of an approved
project should be responsive to Item 5c only.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE.
Pinpoint any relevant physical, economic, social, financial,
institutional, or other problems requiring a solution.
Demonstrate the need for assistance and state the principal
and subordinate objectives of the project. Supporting
documentation or other testimonies from concerned interests
other than the applicant may be used. Any relevant data based
on planning studies should be included or footnoted.
2. RESULTS OR BENEFITS EXPECTED.
Identify results and benefits to be derived. For example, include
a description of who will occupy the facility and show how the
facility will be used. For land acquisition or development
projects, explain how the project will benefit the public.
3.APPROACH
a. Outline a plan of action pertaining to the scope and detail of
how the proposed work will be accomplished for each grant
program. Cite factors, which might accelerate or decelerate the
work, and your reason for taking this approach as opposed to
others. Describe any unusual features of the project such as
design or technological innovations, reductions in cost or time,
or extraordinary social and community involvements.
b. Provide each grant program monthly or quarterly quantitative
projections of the accomplishments to be achieved, if possible.
When accomplishments cannot be quantified, list the activities
in chronological order to show the schedule of
accomplishments and their target dates.
c. Identify the kinds of data to be collected and maintained, and
discuss the criteria to be used to evaluate the results and
success of the project. Explain the methodology that will be
used to determine if the needs identified and discussed are
being met and if the results and benefits identified in Item 2 are
being achieved.
d. List each organization, cooperator, consultant, or other key
individuals who will work on the project along with a short
description of the nature of their effort or contribution.
Give a precise location of the project and area to be served by
the proposed project. Maps or other graphic aids may be
attached.
5. IF APPLICABLE, PROVIDE THE FOLLOWING
INFORMATION:
a. Describe the relationship between this project and other
work planned, anticipated, or underway under the Federal
Assistance listed under Part II, Section A, Item 10.
b. Explain the reason for all requests for supplemental
assistance and justify the need for additional funding.
c. Discuss accomplishments to date and list in chronological
order a schedule of accomplishments, progress, or milestones
anticipated with the new funding re -quest. If there have been
significant changes in the project objectives, location, approach
or time delays, explain and justify. For other requests for
changes or amendments, explain the reason for the change(s).
If the scope or objectives have changed or an extension of time
is necessary, explain the circumstances and justify. If the total
budget has been exceeded or if individual budget items have
changed more than the prescribed limits contained in
Attachment K, Office of Management and Budget Circular No.
A-102, explain and justify the change and its effect on the
project.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
11/30/2007
PART II
PROJECT APPROVAL INFORMATION
SECTION A
Item 1.
Does this assistance request require State, local, regional,
Name of Governing Body:
or other priority rating?
Priority:
❑ Yes 0 No
Item 2.
Does this assistance request require State, or local
Name of Agency or Board:
(Attach Documentation)
advisory, educational or health clearances?
❑ Yes 0 No
Item 3.
Does this assistance request require clearinghouse review
(Attach Comments)
in accordance with OMB Circular A-95?
❑ Yes 0 No
Item 4.
Does this assistance request require State, local,
Name of Approving Agency:
regional or other planning approval?
Date:
❑ Yes 0 No
Item 5.
Check one: State
Is the proposal project covered by an approved
Local
comprehensive plan?
Regional
❑ Yes 0 No
Location of Plan:
Item 6.
Name of Federal Installation:
Will the assistance requested serve a Federal
Federal Population benefiting from Project:
installation?
❑ Yes �X No
Item 7.
Name of Federal Installation:
Will the assistance requested be on Federal land
Location of Federal Land:
or installation?
❑ Yes �X No
Percent of Project:
Item 8.
Will the assistance requested have an impact or effect on
See instruction for additional information to be
the environment?
provided
❑ Yes �X No
Item 9.
Number of:
Will the assistance requested cause the displacement of
Individuals:
Families:
individuals, families, businesses, or farms?
Businesses:
❑ Yes [Z No
Farms:
Item 10.
Is there other related Federal assistance on this
See instructions for additional information to be
project previous, pending, or anticipated?
provided.
❑ Yes �X No
FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-1 (9-03)
Page 2
INSTRUCTIONS FOR 5100-100 PART II A
Project Approval Information
Negative answers will not require an explanation unless the federal agency requests more information at a later date.
Provide supplementary data for all "Yes" answers in the space provided in accordance with the following instructions.
Item 1 - Provide the name of the governing body establishing
the priority system and the priority rating assigned to this
project.
Item 2 - Provide the name of the agency or board which issued
the clearance and attach the documentation of status or
approval
Item 3 - Attach the clearinghouse comments for the application
in accordance with the instructions contained in Office of
Management and Budget Circular No. A-95. If comments were
submitted previously with a preapplication, do not submit them
again but any additional comments received from the
clearinghouse should be submitted with this application.
Item 4 - Furnish the name of the approving agency and the
approval date.
Item 5 - Show whether the approved comprehensive plan is
State, local, or regional, or if none of these, explain the scope
of the plan. Give the location where the approved plan is
available for examination and state whether this project is in
conformance with the plan.
Item 6 - Show the Federal population residing or working on
the federal installation who will benefit from this project.
Item 7 - Show the percentage of the project work that will be
conducted on federally -owned or leased land. Give the name of
the Federal installation and its location.
Item 8 - Briefly describe the possible beneficial and/or harmful
impact on the environment because of the proposed project. If
an adverse environment impact is anticipated, explain what
action will be taken to minimize the impact. Federal agencies
will provide separate instructions if additional data is needed.
Item 9 - State the number of individuals, families, businesses,
or farms this project will displace. Federal agencies will provide
separate instructions if additional data is needed.
Item 10 -Show the Federal Domestic Assistance Catalog
number, the program name, the type of assistance, the status
and amount of each project where there is related previous,
pending, or anticipated assistance. Use additional sheets, if
needed
Paperwork Reduction Act Statement: The information collected on this form allows sponsors of public use airports or public
agencies to apply for one or more projects in a form prescribed by the Secretary of Transportation.
Title 49, United States Code (U.S.C.), Section 47105, identifies the information required to apply for this program. The forms
prescribed to meet this requirement are developed to provide a comprehensive format that allows sponsors to provide the data
needed to evaluate the request for funds. The burden for each response is estimated to be 28 hours. Approved applications
benefit the sponsor by providing Federal funding to protect the Federal interest in safety, efficiency, and utility of the Nation's
airport system. No assurance of confidentiality can be given since these become public records. If you wish to make any
comments concerning the accuracy of this burden estimate or any suggestions for reducing this burden, send to Federal Aviation
Administration, ARP-10, 800 Independence AVE, SW, Washington, DC 20591. Please note that an agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number, which is 2120-0569 for this collection. Comments concerning the accuracy of this burden and suggestions for reducing
the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ABA-20
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C
The Sponsor hereby represents and certifies as follows:
1. Compatible Land Use. - The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity
of the airport:
2. Defaults. - The Sponsor is not in default on any obligation to the United States or any agency of the United States Government
relative to the development, operation, or maintenance of any airport, except as stated herewith:
3. Possible Disabilities. - There are no facts or circumstances (including the existence of effective or proposed leases, use agreements
or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings) which in
reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of
Part V of this Application, either by limiting its legal or financial ability or otherwise, except as follows:
4. Consistency with Local Plans. — The project is reasonably consistent with plans existing at the time of submission of this application)
of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding
the airport.
5. Consideration of Local Interest - It has given fair consideration to the interest of communities in or near where the project may be
located.
6. Consultation with Users. In making a decision to undertake any airport development project under Title 49, United States Code, it
has undertaken reasonable consultations with affected parties using the airport which project is proposed.
7. Public Hearings. — In projects involving the location of an airport, an airport runway or a major runway extension, it has afforded the
opportunity for public hearings for the purpose of considering the economic, social, and environmental effects of the airport or runway
location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall, when
requested by the Secretary, submit a copy of the transcript of such hearings to the Secretary. Further, for such projects, it has on its
management board either voting representation from the communities where the project is located or has advised the communities that
they have the right to petition the Secretary concerning a proposed project.
8. Air and Water Quality Standards. — In projects involving airport location, a major runway extension, or runway location it will provide
for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located,
designed, constructed, and operated so as to comply with applicable and air and water quality standards. In any case where such
standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator
of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to
certify shall be provided within sixty days after the project application has been received by the Secretary.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 3a
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO.2120-0569
PART II - SECTION C (Continued)
9. Exclusive Rights — There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or
controlled by the Sponsor except as follows:
10. Land. — (a) The sponsor holds the following property interest in the following areas of land* which are to be developed or used as
part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse interests, all of which areas
are identified on the aforementioned property map designated as Exhibit "A":
The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such
attorney or title company has determined that the Sponsor holds the above property interests.
(b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work under the
Project, the following property interest in the following areas of land* on which such construction work is to be performed, all of which
areas are identified on the aforementioned property map designated as Exhibit "A":
(c) The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the
Project, the following property interest in the following areas of land* which are to be developed or used as part of or in connection with
the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated
as Exhibit "A"
*State character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of
every kind and nature, including liens, easements, leases, etc. The separate areas of land need only be identified here by the area
numbers shown on the property map.
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100(4-76) Page 3b
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
PART III - BUDGET INFORMATION - CONSTRUCTION
SECTION A - GENERAL
1. Federal Domestic Assistance Catalog No ................................. 20-106
2. Functional or Other Breakout ....................................................
SECTION B -CALCULATION OF FEDERAL GRANT
Cost Classification
Use only for revisions
Total
Amount
Required
Latest Approved
Amount
Adjustment
+ or (-)
1. Administration expense
$
$
$
2. Preliminary expense
3. Land, structures, right-of-way
4. Architectural engineering basic fees
5. Other Architectural engineering fees
6. Project inspection fees
7. Land development
8. Relocation Expenses
9. Relocation payments to Individuals and Businesses
10. Demolition and removal
11. Construction and project improvement
12. Equipment
13. Miscellaneous
14. Total (Lines 1 through 13)
15. Estimated Income (if applicable)
16. Net Project Amount (Line 14 minus 15)
17. Less: Ineligible Exclusions
18. Add: Contingencies
19. Total Project Amt. (Excluding Rehabilitation Grants)
$100,000
20. Federal Share requested of Line 19
$ 90,000
21. Add Rehabilitation Grants Requested (100 Percent)
22. Total Federal grant requested (lines 20 & 21)
$ 90,000
23. Grantee share
$ 10,000
24. Other shares
25. Total Project (Lines 22, 23 & 24)
$
$
$100,000
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 4
INSTRUCTIONS
PART III
SECTION A. GENERAL
1. Show the Federal Domestic Assistance Catalog Number However, show the total amounts for all programs in
from which the assistance is requested. When more than one Section B of the basic application form.
program or Catalog Number is involved and the amount cannot
be distributed to the Federal grant program or catalog number 2. Show the functional or other categorical breakouts, if
on an over-all percentage basis, prepare a separate set of Part required by the Federal grantor agency. Prepare a separate
III forms for each program or Catalog Number. set of Part III forms for each category.
SECTION B. CALCULATION OF FEDERAL GRANT
When applying for a new grant, use the Total Amount Column only. When requesting revisions of previously awarded amounts, use all
columns.
Line 1 - Enter amounts needed for administration expenses Line 12 - Enter amounts for equipment both fixed and movable
including such items as travel, legal fees, rental of vehicles and exclusive of equipment used in construction. For example,
any other expense items expected to be incurred to administer include amounts for permanently attached laboratory tables,
the grant. Include the amount of interest expense when built-in audio visual systems, movable desks, chairs, and
authorized by program legislation and also show this amount laboratory equipment.
under Section E Remarks. Line 13 - Enter amounts for items not specifically mentioned
Line 2 - Enter amounts pertaining to the work of locating and above.
designing, making surveys and maps, sinking test holes, and
all other work required prior to actual construction. Line 14 - Enter the sum of Lines 1-13.
Line 3 - Enter amounts directly associated with the acquisition
of land, existing structures, and related right-of-way.
Line 4 - Enter basic fees for architectural engineering services.
Line 5 - Enter amounts for other architectural engineering
services, such as surveys, tests, and borings.
Line 6 - Enter fees for inspection and audit of construction and
related programs.
Line 7 - Enter amounts associated with the development of
land where the primary purpose of the grant is land
improvement. Site work normally associated with major
construction should be excluded from this category and shown
on line 11.
Line 8 - Enter the dollar amounts needed to provide relocation
advisory assistance, and the net amounts for replacement (last
resort) housing. Do not include relocation administration
expenses on this Line; include them on Line 1.
Line 9 - Enter the estimated amount of relocation payments to
be made to displaced persons, business concerns, and non-
profit organizations for moving expenses and replacement
housing.
Line 10 - Enter the gross salaries and wages of employees of
the grantee who will be directly engaged in performing
demolition or removal of structures from developed land. This
line should show also the cost of demolition or removal of
improvements on developed land under a third party contract.
Reduce the costs on this line by the amount of expected
proceeds from the sale of salvage, if so instructed by the
Federal grantor agency. Otherwise, show the proceeds on Line
15.
Line 11 - Enter amounts for the actual construction of, addition
to, or restoration of a facility. Also, include in this category the
amounts of project improvements such as sewers, streets,
landscaping, and lighting.
Line 15 - Enter the estimated amount of program income that
will be earned during the grant period and applied to the
program.
Line 16 - Enter the difference between the amount on Line 14
and the estimated income shown on Line 15.
Line 17 - Enter the amounts for those items, which are a part
of the project but not subject to Federal participation (See
Section C, Line 26g, Column (1)).
Line 18 - Enter the estimated amount for contingencies.
Compute this amount as follows. Subtract from the net project
amount shown on Line 16 the ineligible project exclusions
shown on Line 17 and the amount, which is excluded from the
contingency provisions shown in Section C, Line 26g, Column
(2). Multiply the computed amount by the percentage factor
allowed by the grantor agency in accordance with the Federal
program guidance. For those grants, which provide for a fixed
dollar allowance in lieu of a percentage allowance, enter the
dollar amount of this allowance.
Line 19 - Show the total amount of Lines 16, 17, and 18. (This
is the amount to which the matching share ratio prescribed in
program legislation is applied.)
Line 20 - Show the amount of Federal funds requested
exclusive of funds for rehabilitation purposes.
Line 21 - Enter the estimated amounts needed for
rehabilitation expense if rehabilitation grants to individuals are
made for which grantees are reimbursed 100 percent by the
Federal grantor agency in accordance with program legislation.
If the grantee shares in part of this expense, show the total
amount on Line 13 instead of on Line 21 and explain in Section
E.
Line 22 - Show the total amount of the Federal grant
requested.
Line 23 - Show the amount from Section D. Line 27h.
Line 24 - Show the amount from Section D, Line 28c.
Line 25 - Self-explanatory.
U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
SECTION C - EXCLUSIONS
Classification
Ineligible for
Participation
1
Excluded From
Contingency Provision
2
a.
$
$
b.
C.
d.
e.
f.
g.
Totals
$
$
SECTION D - PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
27.
Grantee Share
$
a. Securities
b. Mortgages
c. Appropriations (By Applicant)
d. Bonds
e. Tax Levies
f. Non Cash
g. Other (Explain)
$10,000
h. TOTAL - Grantee share
$10,000
28.
Other Shares
a. State
b. Other
c. Total Other Shares
29.
TOTAL
$
10,000
SECTION E - REMARKS
PART IV PROGRAM NARRATIVE (Attach - See Instructions)
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 5
INSTRUCTIONS
PART III
SECTION C. EXCLUSIONS
Line 26 a-g - Identify and list those costs in Column (1), which
are part of the project cost but are not subject to Federal
participation because of program legislation or Federal grantor
agency instructions. The total amount on Line g should agree
with the amount shown on Line 17 of Section B.
Show in Column (2) those project costs that are subject to
Federal participation but are not eligible for inclusion in the
amount used to compute contingency amounts as provided in
the Federal grantor agency instructions.
SECTION D. PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
Line 27 a-g - Show the source of the grantee's share. If cash is Line 28b - Show the amount that will be contributed from other
not immediately available, specify the actions completed to sources. If there is a non -cash contribution, explain what the
date and those actions remaining to make cash available under contribution will consist of under Section E Remarks.
Section E Remarks. Indicate also the period of time that will be
required after execution of the grant agreement to obtain the Line 28c -Show the total of Lines 28a and 28b. This amount
funds. If there is a non -cash contribution, explain what this must be the same as the amount shown in Section B, Line 24.
contribution will consist of. Line 29 - Enter the totals of Line 27h and 28c.
Line 27h - Show the total of Lines 27 a-g. This amount must
equal the amount shown in Section B, Line 23.
Line 28a - Show the amount that will be contributed by a State
or state agency, only if the applicant is not a State or state
agency. If there is a non -cash contribution, explain what the
contribution will consist of under Section E Re -marks.
SECTION E. OTHER REMARKS
Make any remarks pertinent to the project and provide any other information required by these instructions or the grantor agency. Attach
additional sheets, if necessary.
PART IV
PROGRAM NARRATIVE
(Suggested Format)
DEPARTMENT OF TRANSPORTATION -FEDERAL AVIATION ADMINISTRATION
OMB NO.2120-0569
PROJECT: Emergency Drainage Improvements
AIRPORT: Key West International Airport
1. Objective:
The airport Runway Safety Area will flood after rain storms and leave standing water up to 6 inches deep in the infield
area between Taxiway A and Runway 9-27. This project will accomplish the following; 1) Determine the current condition
of the existing storm drainage system and will clean the system; 2) Determine the cause of the flooding and develop a
phased Corrective Action Plan; 3) Permit the project with the South Florida Water Management District; 4) Advertise and
open Bids for Phase 1 Construction; 5) Provide Services During Construction.
2. Benefits Anticipated:
This project is done to remove a temporary safety hazard and bring the airport into compliance with FAA
Standards.
3. Approach : (See approved Scope of Work in Final Application)
Consultant's means and methods using standard construction practices
4. Geographic Location:
This project will take place at Key West International Airport, Key West, Florida
5. If Applicable, Provide Additional Information:
N/A
6. Sponsor's Representative: (include address & telephone number)
Peter J. Horton
3491 South Roosevelt Boulevard
Key West, Florida 33040
(305) 809-5200
FAA Form 5100-100 (9-03) SUPERSEDES FAA FORM 5100-100 (6-73) Page 6
INSTRUCTIONS
PART IV
PROGRAM NARRATIVE
Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests for
supplemental assistance should be responsive to Item 5b only. Requests for continuation or refunding or other changes of an approved
project should be responsive to Item 5c only.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE.
Pinpoint any relevant physical, economic, social, financial,
institutional, or other problems requiring a solution.
Demonstrate the need for assistance and state the principal
and subordinate objectives of the project. Supporting
documentation or other testimonies from concerned interests
other than the applicant may be used. Any relevant data based
on planning studies should be included or footnoted.
2. RESULTS OR BENEFITS EXPECTED.
Identify results and benefits to be derived. For example, include
a description of who will occupy the facility and show how the
facility will be used. For land acquisition or development
projects, explain how the project will benefit the public.
3.APPROACH
a. Outline a plan of action pertaining to the scope and detail of
how the proposed work will be accomplished for each grant
program. Cite factors, which might accelerate or decelerate the
work, and your reason for taking this approach as opposed to
others. Describe any unusual features of the project such as
design or technological innovations, reductions in cost or time,
or extraordinary social and community involvements.
b. Provide each grant program monthly or quarterly quantitative
projections of the accomplishments to be achieved, if possible.
When accomplishments cannot be quantified, list the activities
in chronological order to show the schedule of
accomplishments and their target dates.
c. Identify the kinds of data to be collected and maintained, and
discuss the criteria to be used to evaluate the results and
success of the project. Explain the methodology that will be
used to determine if the needs identified and discussed are
being met and if the results and benefits identified in Item 2 are
being achieved.
d. List each organization, cooperator, consultant, or other key
individuals who will work on the project along with a short
description of the nature of their effort or contribution.
Give a precise location of the project and area to be served by
the proposed project. Maps or other graphic aids may be
attached.
5. IF APPLICABLE, PROVIDE THE FOLLOWING
INFORMATION:
a. Describe the relationship between this project and other
work planned, anticipated, or underway under the Federal
Assistance listed under Part II, Section A, Item 10.
b. Explain the reason for all requests for supplemental
assistance and justify the need for additional funding.
c. Discuss accomplishments to date and list in chronological
order a schedule of accomplishments, progress, or milestones
anticipated with the new funding re -quest. If there have been
significant changes in the project objectives, location, approach
or time delays, explain and justify. For other requests for
changes or amendments, explain the reason for the change(s).
If the scope or objectives have changed or an extension of time
is necessary, explain the circumstances and justify. If the total
budget has been exceeded or if individual budget items have
changed more than the prescribed limits contained in
Attachment K, Office of Management and Budget Circular No.
A-102, explain and justify the change and its effect on the
project.