FAA
San Francisco Airports District Office (SFO-ADO)
FY23 AIP Pre-Application Checklist
Date: 11/28/22Airport: Salinas Municipal Airport
Project Description: Taxiway B and Taxilane Rehabilitation Design We will pursue an FY23 ACIP identified proposed project.
If you plan to pursue an FY23 Project, please complete the following Checklist & submit with App:
No. Document Yes No N/A Comments
Attached
1. Project Schedule (NOTE FAA DUE DATES - pg 3)
2. Standard Form 424 (Application), Form 5100-100 (parts II-IV for airport Development grants), Form 5100-101 (parts II-IV for Planning grants) (Includes project cost breakdown and sketch)
3. Form 5100-100, Part IV – Program Narrative - Provide a clear Narrative and Justification. For proposed pavement projects include a Pavement Condition Index (PCI) information. Provide linear feet for runway and taxiways, and square yards for aprons.
4. Proposed project is currently depicted on an FAA-approved ALP FAA Approved ALP
date ______________________
5. Exhibit A Airport Property Map (attached or previously submitted to ADO) Exhibit A date ______________________
6. Environmental Documentation (NEPA Determination Completed)
7. 60% Design & Construction Safety Phasing Plan (CSPP) completed/submitted Some of the items can be answered by simply checking the “Yes” and “No” boxes, while others require additional information (please provide additional info/justification on Page 2).
Date:
Sponsor’s Designated Representative (Signature) Date:
Please sign and return Application Checklist Pages 1-2 to your assigned ADO Program Manager.
The purpose of this checklist is to identify some requirements and considerations associated with Airport Improvement Program (AIP) fund requests. Airport Sponsors should read and consider each item carefully.
We do not plan on having a project this FY23. The FAA is to
Carryover entitlements into the next
Transfer the Entitlements (Submit separate request to ADO).
X
LOCATION:
FY23 AIRPORT PROJECT SCHEDULE
No. ITEM
(If appropriate)
DATE
SFO ADO
(Target dates)
COMMENTS
1 Execute Design Contract/Submit to ADO: Also: SOW and IFE/Negotiated Fees 2 Submission NEPA docs for ADO review by: Due 10/01/2022 Complete & Quality 3 Completion of NEPA no later than: 12/31/2022
4 Submission of Pre-Application Checklist to ADO by: 11/30 /2022 5 Preliminary Design at 30% level (submit as needed)
6 Initial CSPP submittal (SMS as applicable)) PM will notify the sponsor when the CSPP is acceptable for FAA LOB review through the
OE/AAA system
7 Design completed at 60% level. CSPP
Complete, SMS & RSAD Complete, as
applicable
01/1/2023
8 Sponsor submits 90% Design level to ADO by:
9 Sponsor submits 100% Design level to ADO by:
10 Sponsor advertises project by:
11 Sponsor opens Bids, evaluation by: 04/15/2023 Design Only: SOW and IFE/Negotiated Fees 12 Bid Guarantee (No. of days) ex. 30, 60 90 days
13 Final Application with amount based on Bids no
later than: 05/01/2023
14 ADO Issues Grant Offer (GO) to Sponsor. After Grant Announcement & If Ready
FAA Form 5100-100 (8/20) SUPERSEDES PREVIOUS EDITION Page 1 of 7 U.S. Department of Transportation
Federal Aviation Administration
OMB CONTROL NUMBER: 2120-0569
EXPIRATION DATE: 6/30/2023
Application for Federal Assistance (Development and Equipment Projects) PART II – PROJECT APPROVAL INFORMATION
Part II - SECTION A
The term “Sponsor” refers to the applicant name provided in box 8 of the associated SF-424 form.
Item 1.
Does Sponsor maintain an active registration in the System for Award Management (www.SAM.gov)? Yes No
Item 2.
Can Sponsor commence the work identified in the application in the fiscal year the grant is made or within six months after the grant is made, whichever is later? Yes No N/A Item 3.
Are there any foreseeable events that would delay completion of the project? If yes, provide attachment to this form that lists the events. Yes No N/A Item 4.
Will the project(s) covered by this request have impacts or effects on the environment that require mitigating measures? If yes, attach a summary listing of mitigating measures to this application and identify the name and date of the environmental document(s).
Yes No N/A
Item 5.
Is the project covered by this request included in an approved Passenger Facility Charge (PFC) application or other Federal assistance program? If yes, please identify other funding sources by checking all applicable boxes.
Yes No N/A
The project is included in an approved PFC application.
If included in an approved PFC application,
does the application only address AIP matching share? Yes No The project is included in another Federal Assistance program. Its CFDA number is below.
Item 6.
Will the requested Federal assistance include Sponsor indirect costs as described in 2 CFR Appendix VII to Part 200, States and Local Government and Indian Tribe Indirect Cost Proposals?
Yes No N/A
If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate the Sponsor proposes to apply:
De Minimis rate of 10% as permitted by 2 CFR § 200.414.
Negotiated Rate equal to % as approved by (the Cognizant Agency) on (Date) (2 CFR part 200, appendix VII).
Note: Refer to the instructions for limitations of application associated with claiming Sponsor indirect costs.
OMB CONTROL NUMBER: 2120-0569 OMB
EXPIRATION DATE: 6/30/2023
FAA Form 5100-100 (8/20) SUPERSEDES PREVIOUS EDITION Page 2 of 7
PART II - SECTION B
Certification Regarding Lobbying
The declarations made on this page are under the signature of the authorized representative as identified in box 21 of form SF-424, to which this form is attached. The term “Sponsor” refers to the applicant name provided in box 8 of the associated SF-424 form.
The Authorized Representative certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the Authorized Representative shall complete and submit Standard Form-LLL, ‘‘Disclosure Form to Report Lobbying,’’ in accordance with its instructions. (3) The Authorized Representative shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
OMB CONTROL NUMBER: 2120-0569 OMB
EXPIRATION DATE: 6/30/2023
FAA Form 5100-100 (8/20) SUPERSEDES PREVIOUS EDITION Page 3 of 7 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 the Grant Assurances, 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 an airport development project under Title 49, United States Code, it has consulted with airport users that will potentially be affected by the project (§ 47105(a)(2)).
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.
OMB CONTROL NUMBER: 2120-0569 OMB
EXPIRATION DATE: 6/30/2023
FAA Form 5100-100 (8/20) SUPERSEDES PREVIOUS EDITION Page 4 of 7 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”. [1] 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”. [1] (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”. [1]
1 State the 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.
OMB CONTROL NUMBER: 2120-0569 OMB
EXPIRATION DATE: 6/30/2023
FAA Form 5100-100 (8/20) SUPERSEDES PREVIOUS EDITION Page 5 of 7 PART III – BUDGET INFORMATION – CONSTRUCTION
SECTION A – GENERAL
1. Assistance Listing Number:
2. Functional or Other Breakout:
SECTION B – CALCULATION OF FEDERAL GRANT
Cost Classification
Latest Approved
Amount
(Use only for
revisions)
Adjustment
+ or (-) Amount
(Use only for
revisions)
Total
Amount
Required
1. Administration expense
2. Preliminary expense
3. Land, structures, right-of-way
4. Architectural engineering basic fees
5. Other Architectural engineering fees
6. Project inspection fees
7. Land development
8. Relocation Expenses
9. Relocation payments to Individuals and Businesses
10. Demolition and removal
11. Construction and project improvement
12. Equipment
13. Miscellaneous
14. Subtotal (Lines 1 through 13)
15. Estimated Income (if applicable)
16. Net Project Amount (Line 14 minus 15)
17. Less: Ineligible Exclusions (Section C, line 23 g.)
18. Subtotal (Lines 16 through 17)
19. Federal Share requested of Line 18
20. Grantee share
21. Other shares
22. TOTAL PROJECT (Lines 19, 20 & 21)
OMB CONTROL NUMBER: 2120-0569 OMB
EXPIRATION DATE: 6/30/2023
FAA Form 5100-100 (8/20) SUPERSEDES PREVIOUS EDITION Page 6 of 7 SECTION C – EXCLUSIONS
23. Classification (Description of non-participating work) Amount Ineligible for
Participation
a.
b.
c.
d.
e.
f.
g. Total
SECTION D – PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
24. Grantee Share – Fund Categories Amount
a. Securities
b. Mortgages
c. Appropriations (by Applicant)
d. Bonds
e. Tax Levies
f. Non-Cash
g. Other (Explain):
h. TOTAL - Grantee share
25. Other Shares
a. State
b. Other
c. TOTAL - Other Shares
26. TOTAL NON-FEDERAL FINANCING
SECTION E – REMARKS
(Attach sheets if additional space is required)
Amount
OMB CONTROL NUMBER: 2120-0569
OMB EXPIRATION DATE: 6/30/2023
FAA Form 5100-100 (8/20) SUPERSEDES PREVIOUS EDITION Page 7 of 7 PART IV – PROGRAM NARRATIVE
(Suggested Format)
PROJECT:
AIRPORT:
1. Objective:
2. Benefits Anticipated:
3. Approach: (See approved Scope of Work in Final Application)
4. Geographic Location:
5. If Applicable, Provide Additional Information:
6. Sponsor’s Representative: (include address & telephone number)