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Agenda 05/26/2020 Item #16G 2 (FAA Grant Application)
05/26/2020 EXECUTIVE SUMMARY Recommendation to approve the submittal of an Airport Improvement Program (AIP) grant application to the Federal Aviation Administration as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, requesting $462,000 to construct taxiway fillets and mill/overlay existing pavement sections Taxiway C at the Immokalee Regional Airport with a total estimated cost of $462,000. OBJECTIVE: To submit a grant application to the Federal Aviation Administration (FAA) for Taxiway C Construction Bid Alternate 1 (construction of taxiway fillets and mill/overlay existing pavement sections between Taxiway C and Taxiway C3) at the Immokalee Regional Airport (IMM), which aims to modernize the airport’s infrastructure. CONSIDERATIONS: Milling/overlaying the existing segment of Taxiway C to Taxiway C3 will create a consistent pavement section and consistent (LED) lighting the full length of Taxiway C. If FAA fillets (pavement tapers at taxiway intersections) are constructed at Taxiway C 3, the entire length of Taxiway C geometry will be consistent with current FAA standards. The separate Runway 18/36 rehabilitation project, being funded by FDOT, intends to adjust pavement and lighting geometry from Runway 18/36 to the hold bar location on Taxiway C3 to comply with the new FAA standard fillet geometry. If this bid alternate is not constructed at this time, the taxiway geometry from Runway 18/36 to the hold bar would remain non-standard. Not constructing the alternate now would also result in a mix of LED and Incandescent lighting on this segment of the Taxiway. Additionally, performing this work in the future would result in unnecessary runway closure and additional mobilization expenses. On October 22, 2019, Agenda Item 16G2, the Board of County Commissioners (Board) accepted an FAA grant to fund the design and bid of the extension of Taxiway C at the IMM. Based on a pre-grant application submitted in November 2019, the FAA determined that construction of the extension of Taxiway C is eligible for AIP funding. The FAA instructed the Airport Authority to submit a separate grant application for potential Coronavirus Aid, Relief, and Economic Security (CARES) funding for Bid Alternate 1. It is anticipated that grants awarded under the CARES Act will be funded at one hundred percent (100%), with no required match. The grant application for this project is due to the FAA by June 1, 2020. The bid is scheduled to be advertised on April 15, 2020, and due in late May 2020. Once bids are received and reviewed, there will not be sufficient time to receive Board approval before the application is due. This item will only be brought back to the Board to accept the grant if awarded to the Authority. FISCAL IMPACT: Should the grant be awarded, the County anticipates receiving FAA funding for 100% of the project in an estimated amount of $462,000. GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with the Board’s approval to submit this grant application. LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote for Board action. - JAB RECOMMENDATION: To approve submittal of an FAA grant application in an estimated amount of $462,000 for Bid Alternate 1 of Taxiway C construction at the Immokalee Regional Airport, and 16.G.2 Packet Pg. 1285 05/26/2020 authorize the Airports Executive Manager, Justin Lobb, to execute all documents necessary to submit the grant application. Prepared by: Justin Lobb, Executive Manager, Airport Authority ATTACHMENT(S) 1. [Linked] IMM TW C - Bid Alt 1 FY20 FAA Grant Application (PDF) 16.G.2 Packet Pg. 1286 05/26/2020 COLLIER COUNTY Board of County Commissioners Item Number: 16.G.2 Doc ID: 12253 Item Summary: Recommendation to approve the submittal of an Airport Improvement Program (AIP) grant application to the Federal Aviation Administration as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, requesting $462,000 to construct taxiway fillets and mill/overlay existing pavement sections Taxiway C at the Immokalee Regional Airport with a total estimated cost of $462,000. Meeting Date: 05/26/2020 Prepared by: Title: Operations Coordinator – Airport Authority Name: Debra Brueggeman 04/21/2020 3:56 PM Submitted by: Title: Division Director - Operations Support – Growth Management Department Name: Gene Shue 04/21/2020 3:56 PM Approved By: Review: Growth Management Department Judy Puig Level 1 Reviewer Completed 04/21/2020 4:49 PM Capital Project Planning, Impact Fees, and Program Management Rookmin Nauth Additional Reviewer Completed 04/22/2020 9:11 AM Airport Authority Justin Lobb Additional Reviewer Completed 04/22/2020 1:11 PM Growth Management Operations Support Christopher Johnson Additional Reviewer Completed 04/27/2020 9:53 AM Growth Management Department Gene Shue Additional Reviewer Completed 04/28/2020 3:48 PM Growth Management Department Debra Brueggeman Deputy Department Head Review Skipped 04/21/2020 10:38 AM Growth Management Department Thaddeus Cohen Department Head Review Completed 04/28/2020 4:08 PM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 04/29/2020 9:21 AM Grants Erica Robinson Level 2 Grants Review Completed 04/29/2020 1:07 PM Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 04/29/2020 1:41 PM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 04/29/2020 2:02 PM Office of Management and Budget Laura Zautcke Additional Reviewer Completed 04/29/2020 4:03 PM Office of Management and Budget Susan Usher Additional Reviewer Completed 05/04/2020 3:41 PM Grants Therese Stanley Additional Reviewer Completed 05/16/2020 11:12 AM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 05/18/2020 10:49 AM 16.G.2 Packet Pg. 1287 05/26/2020 Board of County Commissioners MaryJo Brock Meeting Pending 05/26/2020 9:00 AM 16.G.2 Packet Pg. 1288 �Pp1 Ay�4 / Federal Aviation Administration (FAA) ~ e I Orlando Airports District Office °��NlS PPA�O Airport Grant Application Checklist (COMPLETE ONE CHECKLIST PER GRANT REQUES7) Airport: Immokalee Regional Airport Sponsor: Collier County Airport Authority City, State: Immokalee, Florida Date of Application: June 1, 2020 ❑ We do not plan on having a project this fiscal year. The FAA is authorized to carry our entitlements into the next fiscal year. (If checked, skip below pre -application checklist, sign/date and return to ADO) Items Required with Application (select N/A only if applicable to the project) 1Jo � Aocument` ;� Letter Yes =-`NIA Detailed Project Information Sheet (per project item) ScopeCover Project Description and Justification (for Planning or Environmental Projects include Special Circumstances Project dollars)/1 Project ProjectPreliminary Project Schedule ProjectProposed Q Environmental letermination locumentation (per project item) -�1 Justin Lobb, Executive Airports Manager Sponsor's Designated Official Representative (Type or Print) Sponsor's Designated Official Representative (Signature) Date The purpose of this checklist is to identify some of the requirements and considerations associated with requesting Airport Improvement Program (AIP) funds. This checklist was created by the Orlando ADO for Florida airport sponsors to submit in lieu of SF 424, 51 00-1 00 1101 (OMB 4040-004, 2120-0569) in order to simplify the AIP pre -application package. Note SF 424 and the 5100 forms are still required components of the AIP APPLICATION package. oy,� �11 atr+Poyr4G� �-1 v ^t June 15 2020 COLLIER COUNTY AIRPORT AUTHORITY Ms. Krystal Ritchey, P.E. Federal Aviation Administration Orlando Airports District Office South Park Building 8427 South Park Circle, 51h Floor Orlando, FL 32819 Dear Ms. Ritchey, 2005 Mainsail Drive, Suite 1 Naples, FL 34114-8955 (239)642-7878 Fax (239) 394-3515 www.collieraviati on.com Subject: Immokalee Regional Airport, Imrnokalee, Florida FY 2020 Airport Improvement Program Application Cover Letter In accordance with the Airport Improvement Program (AIP) and as established in our 3-year Capital Improvement Plan (CIP), enclosed please find the 2020 AIP application for Coronavirus Aid, Relief, and Economic Security (CARES) funding for the following project: Taxiway C Extension (Bid Alternate 1: MilUoverlay of existing segment of Taxiway C to Taxiway C3 and fillets at Taxiway C3) — Construction Phase The following items are enclosed for the above project in the grant application: ✓ Airport Grant Application Checklist ✓ Application for Federal Assistance SF-424 ✓ Detailed Project Information Sheet o Description and Justification (scope of work for planning or environmental projects) o Project Funding o Project Cost Estimate o Project Preliminary Checklist o Proposed Project Schedule o Project Sketch ✓ Environmental Determination Documentation ✓ Attachment A (Property Map Exhibit "A") ✓ Attachment B (Title Opinion and Boundary Survey) ✓ Attachment C (Proposed Scope for Construction Phase Engineering Services) Marco Island Executive Airport Immokalee Regional Airport Everglades Airpark 2005 Mainsail Drive, Suite 1 165 Airpark Boulevard P.O. Box 689,650 EC Airpark Blvd Naples, FL 34114-8955 Immokalee, FL 34142 Everglades City, FL 34139 239,394,3355 239,657,9003 239,695.2778 239.642.5427 Fax 239.657.9191 Fax 239.695.3558 Fax Cp0 ✓ Attachment D (IFE for Construction Phase Engineering) ✓ Attachment E (Engineer's Recommendation & Bid Tabs) ✓ Attachment F (Low Bid Package) ✓ Attachment E (F5100 Certifications) Construction costs in the attached application are based on bids, and construction phase engineering services costs are based on the proposed scope and fee provided by the selected engineering consultant, TBD, for this project. At this time, we are requesting one hundred percent (100%) funding of $462,000 for this project under the CARES Act. Sincerely, Justin Lobb Executive Airports Manager Copy to: Wendy Sands, FDOT Pedro Blanco, FAA OMB Number: 4040-0004 Expiration Date: 08/31/2016 Application for Federal Assistance SF424 * 1. Type of Submission * 2. Type of Application If Revision, select appropriate letter(s): 0 Preapplication Fr-alNew - Select One - Q Application E] Continuation Other (Specify) 0 Changed/Corrected Application El Revision 3. Date Received: 4. Application Identifier: 06/01/2020 5a, Federal Entity Identifier: 5b. Federal Award Identifier: State Use Only: 6. Date Received by State: 7. State Application Identifier: 8. APPLICANT INFORMATION: ` a. Legal Name: Collier County Board of County Commissioners b. Employer/Taxpayer Identification Number (EIN/TIN): c. Organizational DUNS: 59-6000558 1076997790 d. Address: * Streed: 2005 Mainsail Drive, Suite 1 Street 2: * City: Naples County: Collier * State: Florida Province: Country: USA *Zip/ Postal Code: 34114 e. Organizational Unit: DepartmentName: DivisionName: Board of County Commissioners Airport Authority - Immokalee Regional Airport f, Name and contact information o person to be contacted on matters involving this application: Prefix: Mr. FirstName: Justin Middle Name: Last Name: Lobb Suffix: Title: Executive Airports Manager Organizational Affiliation: * Telephone Number: (239) 642-7878 Fax Number: (239) 394-3515 * Email: Justln.Lobb@colliercountyfl.gov OMB Number: 4040.0004 Expiration Date: 08131/2016 Application for Federal Assistance SF424 *9.Type of Applicant 1: Select Applicant Type: B. County Government Type of Applicant 2: Select Applicant Type: - Select One - Type of Applicant 3: Select Applicant Type: - Select One - * Other (specify): * 10. Name of Federal Agency: Federal Aviation Administratin (FAA) 11. Catalog of Federal Domestic Assistance Number: 20,106 CFDA Title: Airport Improvement Program *12, Funding Opportunity Number: Title: 13. Competition Identification Number: Title: 14, Areas Affected by Project (Cities, Counties, States, etc.): Immokalee Regional Airport, Immokalee, Collier County, Florida 15, Descriptive Title of Applicant's Project: Bid Alternate 1 for Extend Taxiway C Project ((Mill/Overlay of existing segment of Taxiway C to Taxiway C3 and fillets at Taxiway C3 Construction Phase Phase Attach supporting documents as specified in agency instructions. OMB Number: 4040-0004 Expirotian Date: 08/31/2018 Application for Federal Assistance SF-424 16, Congressional Districts Of: *a. Applicant: 19 *b. Program/Project: 25 Attach an additional list of Program/Project Congressional Districts if needed. 17. Proposed Project; *a. Start Date: 10/01/2020 *b. End Date: 12/31/2021 18, Estimated Funding ($): *a. Federal 462,000,00 *b. Applicant *c. State *d. Local *a, Other *f. Program Income *g. TOTAL 462,000.00 *19. Is Application Subject to Review By State Under Executive Order 12372 Process? ❑ a. This application was made available to the State under the Executive Order 12372 Process for review on It b. Program is subject to E.O. 12372 but has not been selected by the State for review. 0 c. Program is not covered by E.O. 12372 *20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide explanation on next page.) © Yes❑ No 21, *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) p ** 1 AGREE ** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: Mr- *First Name: Justin Middle Name: *Last Name: Lobb Suffix: *Title: Executive Airports Manager *Telephone Number: (239) 642-7878 Fax Number: (239) 394-3615 * Email: Justin.Lobb@colliercountyFl.gov *Signature of Authorized Representative: *Date Signed: Approve as to orm and 1CBd1RV Assis ant County Attu —4\a t`ypblb o Airport Improvement Program (AIP) Airport : Immokalee Regional Airport City, ST: Immokalee, FL DUNS / TAX ID No. 076997790/59-6000558 SAM Expiration Date: Not Applicable Project Title: Taxiway C Extension (Bid Alternate #1) — Construction Phase This project will be bid as bid alternate to the construction of Taxiway C extension. It includes (1) the mill/overlay of the existing segment of Taxiway C to Taxiway C3, and (2) constructing FAA TDG-II fillets at Taxiway C3. Milling/overlaying the existing segment of Taxiway C to Taxiway C3 will create a consistent pavement section and consistent (LED) lighting the full length of Taxiway C. The entire length of Taxiway C geometry will be consistent with current FAA standards, if FAA fillets are constructed at Taxiway C3. The Runway 18/36 rehabilitation project, which is not funded by the FAA, intends to adjust pavement and lighting geometry from Runway 18/36 to the hold bar location on Taxiway C3 to comply with the new FAA standard fillet geometry. If this bid alternate is not constructed at this time, the taxiway geometry from the Runway to the hold bar would likely need to remain non-standard. Any future adjustment in fillet geometry will require reworking pavement geometry and relocating new lighting all the way to the Runway. Not constructing the alternate now would also result in a mix of LED and Incandescent lighting on this segment of the Taxiway. Additionally, performing this work in the future would result in an unnecessary runway closure. The design and bid of this project were completed under AIP Grant 3-12-0031-012-2019. Was this project in the airport's Capital Improvement Plan (CIP) in JACIP and accepted as eligible/justified in the FAA's Airport Capital Improvement Plan (ACIPI ® Yes ❑ No (explain below) S check if applicable o the ro"ect): ecial'Circumstances ❑ Force Account Services ❑ Benefit Cost Analysis ❑ [Enter Other] ❑ Mods. To Standards ❑ Design -build or CMR ❑ (Enter Other] ❑ AIP eligible & non -eligible ❑ Exceeds FAA Stds. ❑ [Enter Other] You may use this "additional information box" to expand on the special circumstance(s) selected above. Page 1 of 4 Total Cost iono FAA Share 100% State N/A Local N/A $462,000 $4622000 Type of Funding Proposed FAA Share Only) Fund Type Funds Available Funds to be Used Funds Remaining CARES/Discretionary $462,000 $462,000 $0 Total $462,000 $462,000 $0 Alternate Funding Plan: Provide an alternate funding plan if discretionary funding is unavailable, such as a substitute entitlement only project, reduce scope through bid alternates, move the project out to a future year, etc. Page 2 of 4 Proiect Cost Estimate Breakdown: Taxiway C Extension (Bid Alternate 1) — Construction Phase Cost (100%) Construction Mgmt. & Inspection Services (Engineering) $ 42,000 Construction — Bid Alt #1 $420,000 Subtotal Amount $462,000 Total Estimated Project Cost (100%) $462,000 Total FAA Share Cost (100%) $462,000 FAA (100%) $ 42,000 01000 $462,000 "NOTE: FAA does not participate on allowances /contingencies. By FAA policy, a line item for estimated administrative costs can be included in the grant application if the sponsor cannot accurately calculate the total administrative costs. However, these estimated administrative costs must not exceed 2% of the grant amount or $10,000, whichever is less. Project`Preliminary Checklist: AIP Dev,ocument Pre-requisitesell ellDate I Dates of Approved 1 1 Date of 1 0 Airport MasterRecord verification fordata corrections,Date of last FAA approved Exhibit "A" Property Inventory Map w/ 1 Exhibit, of Opinion.1 Date of • - D' -mination1 Date of •• Pavement - - Program.Date of Land Acquisition (if applicable) — Not Applicable A . .ImpactstoFAAFacilities'e. Yes.-'No.�"�, �.- s the project impact If yes, provide a statement with the status of FAA Reimbursable• Requirements Page 3 of 4 Project #1: Taxiway C Extension — Construction Phase PROPOSED PROJECT SCHEDULE �% 'Proposed Project Scheduler Selectiong Dates:. . - pplication Submittal to FAA All* e Pre -design Conference Completion of Plans, Specifications and Engineers Report, Submit Plans . Specs to FAA' ..� �� Advertisement Project for:. Tabulation Submittal and Recommendation of Award 5126/2020 ApplicationBid •• Engineer' r r • r .1.I Execution of FAA Grant Premconstruction Conference���■ Notice . • . ®� Substantial Completion r Final Inspection ProjectClose-Outs = To be coordinated with the ADO Engineer prior to grant application submittal. � For any construction grants, Plans /Specs &the Engineers Report must be submitted to the ADO PM for review and approval prior to bid advertisement in accordance witf� 2 CFR 200. Sponsor will be responsible for removing /prorating ali non-AIP eligible bid items identified prior to grant execution. 2 Once all contract documents have been executed, the sponsor will issue a notice to proceed to the contractor. The sponsor must send a copy of the notice to proceed to the ADO PM. J Project shall remain on schedule as shown above. Note that closeout of an AIP grant must not exceed four (4) years after grant execution date. You may refer to the AIP Handbook - Chapter 5, Section 8, Grant Closeout for additional details. Page 4 of 4 LOW PROFILE BARRICADE NOTES: - RED HASHING UGHT IMMOKALEE REGIONAL WARM oEDxmTOSYE BkMENADMITHE CERED SCAPE MASSS. THEw RED INxUARAND FeN,ou,xFn..xomoaE,xFxDMoMMUSI�axn DRaN TRID �wxiiE — AIRPORT cEI �s't iAXIWAYCEXTENSION wx OF IDAROM WORTH ON WE PIAM TO Es clWxrsMUST eEnwU J_ E eAwuoEsa,E NOT PENUSEON AMAcrwEsuCnMrx ucxTTwiDM r Am Iow MUSIC suArnDmANETO BE FRAUD AT m MUMMEWIOF MR CEO END TO END VICAL 96 RAW ONE WEDNDAT EPA °R11ETawsr saroMus Rnu wsro EAwEE LOW PROFILE BARRICADES ,SVC1 UMPp i11 I� D®aD o,LEGEMSEOF nPauw MO Eo� // 1 if 1. PRIME 3I(BID ALTERNATEWLL CONSIST OF ------ EXISTING EDGE OF PAYMENT E PACKAGE. R INVOLVING THEBD ALTERNATE �,R�� L� THIS INCLUDES MILL, OVERIAY, EDGE �r HAUL , HOLE CONSTRUCTION OF NEW FILLET GEOMETRY —ea,— OBJECT AREA Pao-- BA w,h'FSRFnuPFrtrtM — _ �\ AND ELECTRICAL WORK. IXSTNG FENCE°� + 'y/` 2 PNASE 2101DALTENUTEI SNALL EXTEND FOR f.: G4OO VNNRIP" Creek ONE a-- - 3� . PROPOSED ASPHALT Fort V \ A DURATION OF 90 CALENDAR DAYS. ® 7, ne r1239 eee 1200 4 STAGINGARFA <, pAurbortziffol DE rim I Acccss If f STAGINGif ?/•J F AREA O } J 1 kD 'c ��' + 1 r-C IS �.. a. PZAlm P2 >ti B ka I I P2 _ _ _ _____ �s. )IT BIDALTERNATE- �5 1 r RUNWAY I B- - 3— PHASING PLAN - - } fill __ IFS s'f — - -- ED a A•. w t£Irl'4 "S sti, i YTV"MN Lj I01 Hui .sksyla a T -,; l - ` Pik 1 A,, � F I SA TEf I 9 i if if i411Y I1 dJ _ AS il IF ® ft TEP ISAR ovma0» rr IS a 'I JL. ,y Is`�-L• .-- '-� .. � . Y :i�l�!��( 1 L�I.I .5�"w 4�I�N Z-DO1-T 1A59 RMUCR IMMOKALEE REGIONAL AIRPORT ------ MISTING EDGE OF PAYMENT TAXIWAYCEXTENSION PROPOSED EDGE OF PAYMENT RUNWAY OBJECT FREE AREAs(Y/low g BENCNMAm — NEW PAYMENT ® PAYMENT REHABILITATION - — PROJECT LIMITS �M HOLE MONTES roOwSFC-HIS OCH RM EAsrxoxENoRiNAxuwwoniuN xmu. akey CeeekpNe RHATIOD EFON MYe 39 L 39918 BbAYDN). NxTameiwRuu.YBRuNvu.NuwRuvo.INS B:1E Bes FkpIIdaCiufifiI �...� : Authon..nm.Naf P. isIu . o Y> +w �aKK o Lt .�� i ti m tabt i — TTT `,}j TIVYEEXTFNSION 9ASF 91Di �^y �T TYYCE%TENSIO_N DID ALTERNATE SITE AERIAL, CONTROL& DEVELOPMENTPIAN �_. L a r- rT ,�KF. .mA �— —� I CON ;A INCA RUCA-W)VA :— E RUNWAY 18-36 - - - ».gym ..ssa � I — — --- ---- ,Tws r E --- .. , e;�` 1 Y?T�.P Ia�R, 'A j:.T_ rl ,;;, �; I , . IS CAtUT 1458 CONTROL POINT DATA o..eyum FAA ORLANDO AIRPORTS DISTRICT OFFICE— CATEGORICAL EXCLUSION (CATEX) SHORT FORM Airport: Immokalee Regional Airport Project Title: Taxiway C Extension (Bid Alt 1) Use this CATEX Short Form if the Proposed Action is a federal action subject to NEPA and normally would not individually or cumulatively have a significant effect on the human environment. Identify the applicable paragraph on the line below from FAA Order 1050.1F, paragraphs 5-6.1 through 5-6.6 for the Proposed Action. Paragraphs 5-6.49. 5-6.41 - List all components of the Proposed Action and Connected Actions (iFany) on a separate sheet. A CATEX should not be used for a segment or an interdependent part of a larger proposed action. Include a summary of existing conditions at the Proposed Action site. Attach a site map identifying the Proposed Action area on the airport's current ALP and a recent aerial of the Proposed Action area. Certify that the Proposed Action and Connected Actions are NOT likely to have extraordinary circumstances or significant impacts. Significance thresholds and factors to consider are in FAA Order 1050.1F Exhibit 4-1. Extraordinary circumstances are listed in FAA Order I050.117 paragraph 5-2, and summarized below: -An adverse effect on cultural resources protected under the National Historic Preservation Act ofl966, as amended, 54 U.S.C. §300101 etseq.; An impact on properties protected under Section 4(f); An impact on natural, ecological, or scenic resources of Federal, state, tribal, or local significance (e.g, federally listed or proposed endangered, threatened, or candidate species, or designated or proposed critical habitat under the Endangered Species Act, 16 U.S.C. §§ 1531-1544); An impact on the following resources: resources protected by the Fish and Wildlife Coordination Act, 16 U.S.C. §§ 661- 667d; wetlands; floodplains; coastal zones; national marine sanctuaries; wilderness areas: National Resource Conservation Service -designated prime and unique farmlands; energy supply and natural resources; resources protected under the Wild and Scenic Rivers Act, 16 U.S.C. §§ 1271-12871 and rivers or river segments listed on the Nationwide Rivers Inventory (NRI); and solid waste management; -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; An increase in congestion from surface transportation (by causing decrease in level of service below acceptable levels determined by appropriate transportation agency, such as a highway agency); An impact on noise levels of noise sensitive areas: An impact on air quality or violation of Federal, state, tribal, or local air quality standards under the Clean Air Act, 42 U.S.C. §§ 7401-7671q: An impact on water quality, sole source aquifers, a public water supply system, or state or tribal water quality standards established under the Clean Water Act, 33 U.S.C. §§ 1251A387, and the Safe Drinking Water Act, 42 U.S.C. §§ 300f-300j- 26; -Impacts on the quality of the human environment that are likely to be highly controversial on environmental grounds. The term "highly controversial on environmental grounds" means there is a substantial dispute involving reasonable disagreement over the degree, extent, or nature of a proposed action's environmental impacts or over the action's risks of causing environmental harm. -Likelihood to be inconsistent with any Federal, state, tribal, or local law relating to the environmental aspects of the proposed action; or -Likelihood to directly, indirectly, or cumulatively create a significant impact on the human environment, 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 cause environmental contamination by hazardous materials, or likely to disturb an existing hazardous material contamination site such that new environmental contamination risks are created. Based on the information in this Short Form CATEX and supporting information, I certify that the Proposed Action and Connected Actions meets) all requirements for a CATEX in accordance with FAA Order 1 OSO.F and do not have any extraordinary circumstances or significant impacts. Signature of Authorized Airport Representative Date FAA Determination (signature of Program Manager): Categorically Excluded: Date: Requires further environmental analysis: Date: Final 7-8-2016 Approved as to form anti legality Assistant County A 'ucy 4 `a \ \A OaCD Airport: CATEGORICAL EXCLUSION ENVIRONMENTAL DETERMINATION CHECKLIST IMMOKalee Regional Airport Prepared and certified by: Date: YES** NO COMMENTS THE PROPOSED ACTION MUST BE LISTED IN FAA ORDER 1050.1F PARAS, 5-6.1-5-6.6 AS AN ACTION THAT WOULD NORMALLY BE CATEGORICALLY EXCLUDED THE PROPOSED ACTION CONSISTS OF: Helicopter facilities or operations x Land acquisition x New airport serving general aviation x Access or service road construction x New airport location x New runway x Runway extension, strengthening, reconstruction, resurfacingor widenin X Converting rime or unique farmland x Runway Safety Area (RSA) improvements x ILS or ALS installation x Airport development (hangars, terminal expansion) x On -airport aboveground or underground fuel storage tanks x Construction, reconstruction, or relocation of an ATCT x THE PROPOSED ACTION WILL AFFECT: Historic/Archeological/Cultural Resources x Section 4(f) or 6(f) resources x Federally listed, endangered, threatened , or candidate species, or designated/proposed critical habitat X Per paragraph 5-6e, and 41. See Attached. Federal, state, tribal, or local natural, ecological, or scenic resources X Wetlands. floodplains, waterways x Energy supply or natural resources x Protected rivers or river segments x Established community(s), planned development, or plans/goals adopted b the local community X Surface vehicular traffic (reduce LOS) x Air quality or violate Federal, state, tribal or local standards x Water quality, a sole source aquifer, public water supply system, or federal, state, or tribal water qualitystandards X THE PROPOSED ACTION IS LIKELY TO: Be Highly Controversial on Environmental Grounds x Be Inconsistent with Federal, state, tribal, or local law relatingto environmental aspects X Cause residential or business relocations x Increase noise levels over Noise Sensitive Land Uses within the 65 dBA noise contour or newly include Noise Sensitive Land Uses within the 65 dBA noise contour. X Cause Environmental Justice Impacts x Contain Hazardous Materials or Affect Hazardous Materials/Sites X Create a Wildlife Hazard per AC 150/5200-33 x Increase lighting impacts on residential communities or impact the visual nature of surroundingland uses X #R Attach detailed explanations or analysis for all `yes" answers on a separate sheet that supports a Categorical Exclusion determination. Final 7-8-2016 IMMOKALEE REGIONAL AIRPORT SUPPLEMENTAL INFORMATION FOR CATEGORICAL EXCLUSION CHECKLIST Project Overview The primary focus of the grant pre -application is to design the extension of Taxiway C approximately 3,000 feet to the north to connect with Taxiway B. Endaneered or Threatened Snecies Listed species surveys were conducted within the limits of the airport on October 24 and 25, 2006 and November 1, 2, and 8, 2006. The surveys were conducted to determine if the airport was being utilized by wildlife species listed by the Florida Fish and Wildlife Conservation Commission (FWCC) and U.S. Fish and Wildlife Service (USFWS) as threatened, endangered, or species of special concern. While Gopher tortoise (Gopherus polyphemus) burrows were identified within the airport property during the surveys, none were identified within the proposed project limits. The gopher tortoise is listed as a threatened species by the FWCC. On November 3, 1999, the FWCC issued a Gopher Tortoise Incidental Take Permit (COL-36) to the Collier County Airport Authority (CCAA) allowing all gopher tortoises located within proposed development areas to be relocated to a 150t acre on -site preserve known as the Upland Management Area (UMA). A survey of the proposed project area will be conducted prior to the commencement of work activities. Any gopher tortoises observed during the survey will be relocated to the UMA prior to conducting the proposed activities. As such, no adverse impacts to gopher tortoise are anticipated as a result of the proposed project. On January 14, 1998, the USFWS issued a Biological Opinion (BO) for the Florida scrub jay (Aphelocoma coerulescens) for habitat modification proposed within the airport development area. According to the BO, the UMA was designated as mitigation for fixture impacts to scrub jay habitat within the airport facility. No Florida scrub jays were observed within the proposed project limits during the 2006 listed species surveys or during construction of Runway 9-27 rehabilitation completed in November 2014. As such, no adverse impacts to Florida scrub jays are anticipated as a result of the proposed project. The proposed project limits are not located within the USFWS' Florida panther (Puma concolor coiyi) focus area.' In addition, no Florida panthers were observed within the proposed project limits during the 2006 listed species surveys. As such, no adverse impacts to the Florida panther are anticipated as a result of the proposed project. U.S. Fish and Wildlife Service. 2007. Florida Panther Effect Determination Key. U.S. Fish and Wildlife Service. South Florida Ecological Services Office. Vero Beach, Florida. Pale 1 of 2 r ` J�J In summary, the project may impact gopher tortoises, but the CCAA has a FWCC incidental take permit to relocate any tortoises that may be found in the project area. Scrub jay habitat is not expected to be impacted as a result of the proposed activities, but the USFWS service has approved the UMA as mitigation for impacts to scrub jay habitat. Therefore, no significant impacts to gopher tortoises or scrub jays are anticipated as a result of the proposed project. Page 2 of 2 Attachments Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application Attachment A Exhibit "A" Property Map Attachment B Title Opinion and Boundary Survey Attachment C Proposed Scope and Fee for Construction Phase Engineering Management & Inspection Services Attachment D Independent Fee Estimate for Construction Phase Engineering Services Attachment E Engineer's Recommendation and Bid Tabs Attachment F Low Bid Package Attachment G F5100 Certification Forms IMM Bid Alternate 1 for Extend Taxiway CProject —Construction Grant Application Attachment A Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application Exhibit "A" Property Map IMM Bid Alternate 1 for Extend Taxiway C—Construction Phase Grant Application --.-.-1 I PEE w.. urrerv. xusw Enn21� .ee+••e.s�w 2825 34 35 , 26 8 Ia(5E_w 3536 .�.• . _ ww� aj� 52E UNE / xxx•Y6vn - x=?Tcrr �[xcm 36 31 ., I �v..w.—.w.� „. e Imur 0 +0 35 1 1 •I . - I �- I -I ¢I _ I I� - 1 I IA_ I I LEGEND luAf ..., . m'rnuxE _ _x Yx�unw?�wE,v�"".�u wux V o a,. P 1 — E=nW t,EMPA EE(t o xYWRENR.,EM:Aw Mmtke n mertule /�TKINS E AIRPORT LAYOUT PLAN UPDATE IRPORTAUTHORCOLLIER Y AIRPORT PROPERTY JN^�sl � ww� w"w• 39 S AIRPORT AUTHORITY IMMOKALEE REGIONAL AIRPORT INVENTORYMAP IMMOKALEE, FLORIDA axwa n.Iax1}n6exal wn 10 11 t s 3 NOTES: ClEta uwv�.DM�"° TKINSERE 4 i AIRPORT LAYOUT PLAN UPDATE COLDER COUNTY AIRPORT PROPERTY INVENTORY uv v cam- 3 AIRPLLIERC RORITY IMMOKALEEREE,FL REGIONAL MAP DATA " IMMONALEE, FLORIDA •e.P21 777 3 U.S. Department of Transportation Federal Aviation Administration December 1Q, 2019 Mr. Justin Lobb Airport Manager Collier County Airport Authority 2005 Mainsail Drive Naples, FL 34114 Dear Mr. Lobb; Orlando Airpons District Office 8427 SouthPark Circle, Suite 524 Orlando, FL>32819-9058 Phone: (q07) 487-1220 Fax: (407) 487-7135 RE: Immokalee RegionaLAirport (IMM), Immokalee, Florida ASN 2019-ASO-3115-NRA Conditional Airport Layout Plan Approval The Federal Aviation Administration (FAA) conditionally approves your Airport Layout Plan (ALP) for Immokalee Regional Airport, dated May 23, 2019. This approval is subject to the condition that any proposed airport development shown on the ALP requires environmental processing and may not be undertaken without the FAA's prior written environmental approval. All New On -Airport Development, to include: • Runway 09/27 Extension • Construction of Airport Access Roads • Future Aviation and Non -Aviation Development * Any other action requiring NEPA documentation action under FAA Order 5050,41 This ALP approval is conditioned on acknowledgement that any development on airport property requiring Federal environmental approval must receive such written approval from FAA prior to commencement of the subject development. This ALP approval is also conditioned on acceptance of the plan under local land use laws. We encourage appropriate agencies to adopt land use and height restrictive zoning based on the plan. Please make note and take action of the following comments: • Ultimate Runway 09/27 Extension is outside of the long-term planning period.. Refer to the notes on ALP sheet 3 of 11. ALP reviewed as a planning document and this evaluation does not include any obstacle evaluations. Any changes to the runway physical end latitude/longitude coordinates or elevations must be uploaded into this iOEAAA runway/data base, 2 to ensure the FAR Part 77 and TP calculations are run on the most recent data. All proposed construction projects (terminal buildings, taxiways, etc), and associated equipment must be filed separately as individual studies for impact on the National Airspace System. All future construction projects/relocation(s) will be subject to ,; a separate aeronautical study to insure current/future TERPs surfaces are protected. Review of this proposal is not considered a request for IFP development, FP Team must be notified at least 18 months prior to runway extension (and required NAVAID relocations) listed in this study to ensure timely instrument procedure amendments. An Obstacle survey meeting VG/PIR must be completed based on future threshold locations, new GS/PAPI location(s) (and likely close -in TERPs surface penetrations removed) to avoid loss of current IFR minimums [ILS and RNAV (GPS) wNVAAS-LPV minimums, see AC 150-5300-18B]. TERPs 20:1 visual surface penetrations (FAAO 8260.31D Para 3.3.2, formula 3-3-1) should be removed/mitigated or future procedures will be restricted to daytime only minimums. ----The Eastern Flight Procedures Team will start protecting for the future runway extension, unless the airport determines that protection is not needed. In making this determination., the FAA has considered matters such as the effects the Proposal would have on existing or planned traffic patterns of neighboring airports, the effects it would have on the existing airspace structure and projected programs of the FAA, the effects it would have on the safety of persons and property on the ground, and the effects that existing or proposed manmade objects (on file with the FAA), and known natural objects within the affected area would have on the airport proposal. The FAA has only limited means to preventthe construction of structures nearan airport. The airport sponsor has the primary responsibility to protect the airport environs through such means as local zoning ordinances, property acquisition, avigation easements, letters of agreement or other means. Approval of the plan does not indicate that the United States will participate in the cost of any development proposed. AIP funding requires evidence of eligibility and justification at the time a funding request is ripe for consideration. When construction of any proposed structure or development indicated on the plan is undertaken, such construction requires normal 60-day advance notification to FAA for review in accordance with applicable Federal Aviation Regulations (i.e., Parts 77, 1577 152, etc.). More notice is generally beneficial to ensure that all statutory, regulatory, technical and operational issues can be addressed in a timely manner. Furthermore, the design and location of any stormwater retention/detention facilities on or near the airport must comply with FAA Advisory Circular 150/5200-330 "Hazardous Wildlife Attractants on or Near Airports", and must be approved on the ALP prior to construction. 3 We look forward to working with you in the continued development of your airport: Sincerely, Pedro J. Blanco Community Planner Enclosure cc: FAA Lines -of -Business (via AGIS) FDOT/ 6 w/ALP FDOT Central Office Attachment B Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application Title Opinion and Boundary Survey IMM Bitl Alternate 1 for Extend Taxiway C—Construction Phase Grant Application Exhibit B - Title Opinion I.I�c.� CpL Office of the County Attorney Jeffrey A. Klatzkow Deputy CountyAttomey • Scott R Teach Managing Assistant CountyAttorney•Heidi F.Ashton-Cicke *Baud wwew City, County tad Loci ooeramer: uw Assistant County Attorneys • Colleen M. Greene Emily R Pepin Jennifer B. White Jeff E. Wright* July 16, 2012 Mrs. Krystal Ritchey, P.E. Program Manager Federal Aviation Administration Orlando Airports District Office 5950 Hazeltine National Dr., Ste. 400 Orlando, FL 32822-5024 Re: Collier County Boazd of County Commissioners Grant application requirement: Exhibit "C" Title Opinion Dear Ms. Ritchey: Attached please find the Title Commitments from Collier County's three airports: (1) Marco Island Executive Airport, (2) Everglades City Airport, and (3) the Immokalee Regional Airport This submission and certification is made in compliance with grant conditions to provide satisfactory title evidence. Collier County owns all three airports listed above in FEE SIMPLE. Collier County ("Sponsor', pursuant to Section 47105(d) of the Federal Aviation Administration Authorization Act of 1994 (and amendments), hereby certifies that satisfactory property interest to the land indicated herein is vested in the Sponsor, as required by obligations of the referenced Grant Agreement with the Federal Aviation Administration. I have made title examination and issue this Preliminary Opinion based upon my review of the attached three Title Commitments. This Preliminary Opinion is issued expressly for the benefit of the above named applicant for title examination and for the FAA in providing this Grant. Sincerely, Colleen M. Greene Assistant County Attorney cc: Chris Curry, Director, Collier County Airport Authority Attachments 04-APA-01096/3870 3299 East Tamiami 1Yai1, Suite 800 •Naples Florida 341123749 • (239) 25z-8400 •FAX: (z39) 28z-63oo Exhibit B - IMM Title Survey American Land Title Association Commitment -1966 COMMITMENT FOR TITLE INSURANCE ISSUED BY STE'WART TITLE GUARANTY COMPANY STEWART TITLE GUARANTY COMPANY, A Texas Corporation, herein called the Company, for a valuable consideration, hereby commits to issue its policy or policies of title insurance, as identified in Schedule A, in favor of the proposed Insured named in Schedule A, as owner or mortgagee of the estate or interest covered hereby in the. land described or referred to in Schedule A, upon payment of the premiums and charges therefor; all subject to the provisions of Schedules A and B and to the Conditions and Stipulations hereof. This Commitment shall be effective only when the identity of the proposed Insured and the amount of the policy or policies committed for have been inserted in Schedule A hereof by the Company, either at the time of the issuance of this Commitment or by subsequent endorsement. This Commitment is preliminary to the issuance of such policy or policies of title insurance and all liability and obligations hereunder shall cease and terminate six months after the effective date hereof or when the policy or policies committed for shall issue, whichever first occurs, provided that the failure to issue such policy or policies is not the fault of the Company. Signed under seal for the Company, but this Commitment shall not be valid or binding until it bears an authorized Countersignature. IN WITNESS WHEREOF, Stewart Title Guaranty Company has caused its corporate name and seat to be hereunto affixed by its duly authorized officers on the date shown in Schedule A. by: CSt@Wal"ny be guaranty company Stewart Title C.dmpany 3936 Tamiami Trail N:, Suite A Naples, Florida 34103-3592 �o commitment C-8004353 -1301 OOSN Rev. 3/78 SBNot Chairman of the Board Chairman of the Board COMMITMENT NO.: 8004353 FILE NO.: 8004353 -1301 COMNIITMENT SCHEDULE A EFFECTIVE DATE: December 16, 2008 at 8:00 AM Inquires should be directed to: Betty Huff Stewart Title Company 3936 Tamiami Trail N., Suite A Naples, Florida 34103-3592 1. Policies to be issued: Amount (a) ALTA Owner's Policy - (10-17-92) with Florida Modifications $495,000.00 Proposed Insured: Collier County, a political subdivision of the State of Florida 2. The estate or interest in the land described or referred fo in this Commitment and covered herein is: FEE SIMPLE 3. Title to said estate or interest in said land is at the effective date hereof vested in: Collier County, a political subdivision of the State of Florida 4. The land referred to in this Commitment is described as follows: A parcel of land located in Section 2, Township 47 South, Range 29 East, Collier County, Florida, being more particularly described as follows: Commence at the Northwest corner of Section 2, Township 47 South, Range 29 East, Collier County, Florida; thence run South Ol degrees 49'03" East along the West line of the Northwest Quarter of said Section 2, for a distance of 1,097.51 feet, to the Point of Beginning of the parcel of land herein described; thence run North 88 degrees 49'12" East, for a distance of 268.42 feet; thence run South 16 degrees 16'27" West, for a distance of 184.00 feet; thence run South 16 degrees 25'09" West, for a distance of 96.95 feet; thence run South 10 degrees 1 P09" West, for a distance of 118.32 feet; thence run South 88 degrees 24'S8 West, for a distance of 243.98 feet; thence run North 01 degrees 08'12" West, for a distance of 385.66 feet; thence run North 88 degrees 49'12" East, for a distance of 83.08 feet to the Point of$eg"RUng of the parcel of land herein described. END OF SCHEDULE A Reg. D 0012 Rev. Ol-95"Thls Commitmentis not valid unless Schedule A, Schedule B Section -I and Schedule B SecEon•II are included." STEWART TITLE This commitment is not an abstract, examination, report, or representation of factor title and does not create and shall not GUARANTY COMPANY be the basis of any claim for negligence, negligent misrepresentation or other tort claim or action. The sole liability of Company and its Title Insurance Agent shall arise under and be governed by paragraph 3 of the Conditions. COMMITMENT NO.: 8004353 FILE NO.: 8004353 -1301 COMMITMENT SCHEDULE B-I The following are the requirements to be complied with: A. instruments necessary to create the estate or interest to be inswr g must be properly executed, delivered and duly filed for record. B. Affidavit from the seller and the borrower stat ng: 1. That there are no matters pending against them that could give rise to a lien that would attach to the subject property between the effective date of the Commitment and the recording of instruments giving rise to the interest to be insured. 2. That the affiants have not executed and will not execute any instruments that would adversely affect the title to the subject property or the lien of any mortgage to be insured pursuant to the Commitment. C. The closing funds pertaining to the transaction must be disbursed by or at the direction ofthe instlror or its agent. D. An updated title examination, commencing as ofthe effective date ofthis Commitment, which shall be performed at or shortly prior to the closing of the transaction, should not reveal any title defects or other adverse matters appearing should be disposed of prior to closing to the satisfaction of the insuror or its agent. END OF SCHEDULE B -SECTION I Reg.D 0012 Rev. Ol-OS"This Commitment is not valid unless Schedule A, Schedule B Section -I aad Schedule B Secdon•u are includeU." STEWART TITLE GUARANTY COMPANY COMMITMENT NO.: 8004353 FILE NO.: 8004353 - 1301 COMNITTMENT SCHEDULE B-H Schedule B of the policy or policies to be issued will contain exceptions to the following matters unless the same are disposed of to the satisfaction of the Company: 1. Defects, liens, encumbrances; adverse claims or or matters, if any, created, fast appearing in the public records or attaching subsequent to the effective date hereof but prior to the date the Proposed Insured acquires for value of record the estate or interest or mortgage thereon covered by this Commitment. 2. Standard Exceptions: (a) Rights or claims of parties in possession not shown by the public records. (b) Easements, or claims of easements, not shown by the public records. (c) Encroachments, overlaps, boundary line disputes, or other matters which would be disclosed by an accurate survey and inspection of the premises.. (d) Any lien, or right to a lien, for services, labor, or material hereto or hereafter furnished, imposed by law and not shown by the public records. (e) Any adverse ownership claim by the State of Florida by right of sovereignty to any portion of the lands insured hereunder, including submerged, filled, and artificially exposed lands and lands accreted to such lands. Special Exceptions: 3. Taxes for 2009 will become a lien on the land on January 1, 2009 although not due and payable until on or after November 1, 2009 (folio #00115400003). Taxes for 2008 are less than $5.00 and have been waived by the BCC. 4. Any and all Special Assessments, Bills; Charges or Municipal liens leviedand/or assessed against subject property, which are currently due and payable. Restrictive covenants which may provide for association dues, fees and/or assessments, in addition to any easements, reservations, covenants, building set back requirements and any special assessments, which are due or may come due, if any, recorded in the Public Records of COLLIER County, Florida Restrictive covenants, conditions, reservations and easements as contained in Quit Claim Deed recorded in Official Records Book 57 page 5827 of the Public Records of COLLIER Couniy, Florida. The policy does not insure the nature or extent of riparian or littoral rights. Reg. D 0012 Rev. 01-05 °` This Commitment is not valid unlcss Schedule A, Schedule BSection-I and Sc6edutc B Section -II are included." STEWART TITLE GUARANTY COMPANY CONDITIONS AND STIPULATIONS 1. The term mortgage, when used herein, shall include deed of trust, trust deed, or other security instrument. 2. If the proposed Insured has or acquires actual knowledge of any defect, lien, encumbrance, adverse claim or other matter affecting the estate or interest or mortgage thereon covered by this Commitment other than those shown in Schedule B hereof, and shall fail to disclose such knowledge to the Company in writing, the Company shall be relieved from liability for any loss or damage resulting from any act of reliance hereon to the extent the Company is prejudiced by failure to so disclose such knowledge. If the proposed Insured shall disclose such knowledge to the Company, or if the Company otherwise acquires actual knowledge of any such defect, lien, encumbrance, adverse claim or other matter, the Company at its option may amend Schedule B of this Commitment accordingly, but such amendment shall not relieve the Company from liability previously incurred pursuant to paragraph 3 of these Conditions and Stipulations. Liability of the Company under this Commitment shall be only to .the named proposed Insured and such parties included under the definition of Insured in the form of policy or policies committed for and only for actual loss incurred in reliance 'hereon in undertaking in good faith (a) to comply with the requirements hereof or (b) to eliminate exceptions shown in Schedule B. or (c) to acquire or create the estate or interest or mortgage thereon covered by this Commitment. In no event shall such liability exceed the amount stated in Schedule A for the policy or policies committed for and such liability is subject to the insuring provisions and the Conditions and Stipulations and the exclusions from coverage of the form of Policy or policies committed for in favor of the proposed Insured which are hereby incorporated by reference and are made a part of this Commitment except as expressly modified herein. 4. Any action or actions or rights of action that the proposed Insured may have or may bring against the Company arising out of the status of the title to the estate or interest or the status of the mortgage thereon covered by this Commitment must be based on and are subject to the provisions of this Commitment. STEWART TITLE GUARANTY COMPANY A31 notices required to be given the Company and any statement in writing required to be famished the Company shall be addressed to it at P. O. Box 2029, ;Houston, Texas 77252, and identify this commitment by its printed COMMITMENT SERIAL NUMBER which appears on the bottom of the front of the first page of this commitment. Search Results Page 1 of 1 Collier County Tax Collector 3301 Tamiami Trail East Naples, FL 34112-4997 2008 Tax Roll Inquiry System OWNER INFORMATION PROPERTY INFORMATION Narne:11COLLIERMTY Address: ED SCOTT IMMOKALEE AIRPORT Address: 13301 TAMIAMI TRL E BLDG F Address: Address: Address: NAPLES, FL 34112 4902 Pareel: 00115400003 1 161,29 Loc: 1180 CR 846 IMMOKALEE MP. Le aI: 2 47 29 NW1/4 OF NW1/4, W1/2 Le al: OF SW7/40F NW7/467.29 AC Legai: Le al: PAYMENT INFO paid Dt: 00/0010000 Recpt: pa mt: 0.00 Mort: F VALUE/EXEMPTIONS Market Value: Taxable Value: Millage Code: Homested FJc:r� Agricltr Ex: Widow Ex: Blind Ex: Disabled: Wholly Ex: Civilian Ex: l4�,596,750 L� 67 L� 0 J� J� r459�67)0:1 L= TAX INFORMATION County: School SY. School Ioc:0 City Tax: De endE; Water. Independ: Voter Appr. Advertising: AO J O•� 0.00 0.00 0.00 0.00 0.00 0� PAY TERMS Nov:Jo Dec: Jan: Feb:J.5 Mar: Apr May: Now Due:.00 Pay Current Taxes Online .OJ 7 1.0 ® =10 0 1Maeh: STATUS INFD. Non Ad Va: Installment:0 beferred:� BankruPf: ;VTbA;ZID TDA: 0 2003 Parcel Information J 2004 ParceE Information J 2005 Parcel Information J 2006 Parcel Information J 2007 Parcel Information Last Updated: 01/02/2009 5:00pm http:/lwww.colliertax.cotn/search/view.php?ID=1821 &page=l &tc=1 &taxyear=2008 1 /5/2009 Wd -. - .:.t; rw. 'c�- _ .. .. ....i ��.. -- �'wi ' 1 i..�Y ..� ._.�� _ � .. r. .. ... t. .. .. I� � _ �.. .1.... lei. _ Exhibit B - IMM Legal Description/Boundary Survey SURVEYORS CER77FI 770M il£ HEREBY LICRTJFY TO THE BEST OF OUR KNOW"GE AND BELET THAT THIS DRANING 1S A TRUE AND CORRECT REPRESENTil77ON OF THE BOUNDARY SURVEY OF 1FIF REAL PROPERTY DESCRIBED HEREON HE FURTHER CEIHWY 7HAT 7HIS SURVEY WAS PREPARED /N ACCORDANCE INIH THE APPLICABLE PRONSIONS OF CHAPTER 61G17— 6, OR/VA ADM/N/S77?A77V£ CODE RLSOWILLER, INC. LICENSED BUSINESS NO. LB43 Oac 1B, 2008 — t7:52:36 crsaMlg:\sure\onc\wc�se\�t_ooz\oot—ooz—ccN 05-06 Cur.N K ="`so COLL&B COUNTY AIRPORT AUTHORITY NP: RCE REFERENCE FME NO PROJECT NO.: TASK CODE 9 Ef NUMBER ORAWBiO FR£ NUMBER; ao5aWm = I GCSOO 1 of 3 001- 002 DESCRIPTION as provided by Hole, Mantes and Associates: Commencing at the Northwest comer of Section 21 Township 47 South, Range 29 East, Collier County, Florida, run Si'30'24"W a distance of 20680.88 feet to the Point of Beginning of the lands herein described, said point lying on the Northerly right—of—way fine of State Route 846; thence the following courses and distances: i. N87042'39"W, 2580.11 feet along the Northerly right—of—way of State Route 846 to a concrete monument; 2. N87'43$00"W, 397,63 feet to a paint; 3, N19'15915"E, 669.65 feet to a point; 4. N01'25'45"E, 1,808.24 feet along the Westerly line of Airport Road to a point; 5. N21'20'05'W, 259.55 feet to a point; 6. N24'38'25"W, 856.39 feet to a point; 7. N192310S'E, 208.02 feet along the Easterly line of Seaboard Coast Line Railroad to a concrete monument; 8. MEM6749"E, 6019.66 feet along the Easterly line of Seaboard Coast Line Railroad to a concrete monument; 9. S87'48252"E, 11,636.03 feet to a concrete monument; 10. S87'06'44 E, 51316.59 feet to a concrete monument; 11. S864T44"E, 1,324.58 feet to a concrete monument; 12. SZ'41'15"W, 1,350.47 feet to a concrete monument; 13. S2'46'02"W, 2*647668 feet to a point; 14. N86'51150"W3 1,325.39 feet to a point; 15. N8740203'W, 1,982.30 feet to a point; 16. S303711"W, 664.71 feet to a point; 17. N87481370W, 686.54 feet to a point; 18. S315'13"W, 1,334.67 feet to a point; 19. N88'03100"W, 1,348.59 feet to a point; 20. S3031'S6"W, 670.32 feet to a point; 21. S718202"W, 1,337.74 feet to a point; 22. N88617937"W, 666.68 feet to a point; 23. S1054'11"W, 1,339.06 feet to a point; 24- N88024'51"W, 657.41 feet along the Northerly right—of—way of State Route 846 to the Point of Beginning, containing 1,396.9 acres, more or less. Y, ..':.:. ..., . .,. {.. ....:.: •;. .. .: .:�. >:.,r (:.� ::';:s;.::✓ "mot: _�Ijf.;1 .. .. ^ _ It ..: .':. .. i:I I: '-I, _ r;, ; K-::"{kit SURVEMS NOTES 1. BOUNDARY SURVEY OF A PARCEL OF LAND /N A PORTION OF SEC770NS 25 26 27 34, 35 36, 70WNSHIP 46 SOUTH, RANGE 29 EAST AND A PORTION of SEC770NS 2 d 3, TOWNSH/P 47 SOUTH RANGE 29 EAST. COLLIER COUNTY RORILK 2. BEARINGS ARE 84SED UPON 771E ROR/LW 567 STATE PLANE COORD/A(47E SYSYTEM, NAD 83 (1999) AND ARE DERNED FROM GPS OBSERVA)VM MUM NATIONAL GEODE77C SOCIETY CONTROL MONUMEMS IMMOPORT AND IMMOPORT A7 MK M MVERED DURING 711F COURSE OF 7NIS SURVEY. BMW REFERENCE OF N0134710W WAS ESTABL/SHED BETWEEN S41D NOS CONM& MONUMMS AS RED RECOVER@. 3. /MPROVENENIS OTHER THAN 7HO5E SHOWN HEREON 114VE NOT BEEN RED LOCATED. 4. 7H/5 SURVEY /S SUBJECT TO C42 MEMS, RESUMMONS, RESERVATIONS AND RMIS OF WAY OF RECORD. 5. THE NORM RIGHT OF WAY LINE FOR COUMY RV�w 846 /S LOGg7ID AS OCCUP/ED AND ALA/MAINED BY COMER COUNTY. 6. A/RPARK BOULEVARD RIGHT OF WAY /S BASED UPON A SKETCH AND LEGAL DESCRIP770N PREPARED BY HOLE MONIES, D47ED 1-04-02 PfivWED 771 THIS /7RM BY 7HE CUEM. 7. STA7US OF ASWOlOM0 130.00 fOOT AOL RM/L %W R/GHT OF WAY HAS NOT BEEN DLMWINE71 DURING THIS SURVEY, NOR WAS ANY INFORAf4770N PROMOED 8. /NTER/OR fENCES KERE NOT f7ELO LOG47E7J DUR/NG THE COURSE OF TH/S SURVEY 9. FENCES HERE LOC.47ED AT PROPERTY CORNERS ONLY AND 7ILS ARE NOTED HERL7N AT /NDIYIOUAL CORNER CALLS. 10. THE PARCEL RLTE/RENCE7J AS NOT /NCLUOED AS PER O.R. 70, PGS. 635-638' /S A 'LESS AND LXCEPIED" PARCEL FrA M O.R. BOOK AND PAGE WH/CH /S A DEED OF CL 6HC47iON' QUIT MW/NG CERTAIN PROPERLY IMRES75 /N COLLIER COUMY RORIM HELD BY THE UNITED STATES OF AAIERrA TO COLL" COUNTY, A POL ROV SUBDMSYON OF 77/E STATE OF FLOR/Qq D47E0 6 28-60. 14- THIS PhYJPERTY LS SUBJECT TO ANY FACTS THAT AG4Y BE REVFALED BY A COMPLETE AND ACCURATE' MILE SEARCH. SURVEYARS CER7IFICAAON WE HEREBY CER77FY TO 171E BEST OF OUR KNONLEDGE ANO BELIEF MAT IH/S DRA1f4NG lS A TRUE AND CORRECT REPRESENTA170N OF THE BOUNDARY SURVEY O" THE REAL PROPERTY DESCRIBED HEREON. AF R/RMER CfRAFY THAT THIS SURVEY WAS PREPARED IN ACCORDANCE Attachment L. Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application Proposed Scope and Fee for Engineering Construction Management & Inspection Services IMM Bid Alternate 1 for Extend Taxiway C—Construction Phase Grant Application Attachment D Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application Independent Fee Estimate for Construction Phase Engineering Services IMM Bid Alternate 1 for Extend Taxiway C—Construction Phase Grant Application Attachment E Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application Engineer's Recommendation and Bid Tabs IMM Bid Alternate 1 for Extend Taxiway C—Construction Phase Grant Application Attachment F Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application Low Bid Package IMM Bid Alternate 1 for Extend Taxiway C—Construction Phase Grant Application Attachment G Immokalee Regional Airport Bid Alternate 1 for Extend Taxiway C Project — Construction Phase Grant Application F5100 Certification Forms IMM Bid Alternate 1 for Extend Taxiway C—Construction Phase Grant Application aw U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-129, Construction Project Final Acceptance — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number, The OMB Control Number for this information collection is 2120-0569, Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200, Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer. ASP-110. FAA Form 5100-129 17 U.S. Department of Transportation i� Federal Aviation Administration OMB CONTROL NUMBER: 2120-0589 EXPIRATION DATE: 8/3112019 Construction Project Final Acceptance Airport Improvement Program Sponsor Certification Sponsor: Collier County Airport Authority Airport: Immokalee Regional Airport Project Number: Description of Work: Construct the extension of Taxiway C northward to connect with Taxiway B at the Immokalee Regional Airport - Construction Phase Application 49 USC § 47105(d), authorizes the Secretary to require me certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program. General standards for final acceptance and close out of federally funded construction projects are in 2 CFR § 200,343 — Closeout and supplemented by FAA Order 5100.38, The sponsor must determine that project costs are accurate and proper in accordance with specific requirements of the grant agreement and contract documents. Certification Statements Except for certification statements below marked nqt applicable (N/A), this list includes major requirements of the construction project. Selecting Yes" represents sponsor acknowledgment and confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. The personnel engaged in project administration, engineering supervision, project inspection, and acceptance testing were or will be determined to be qualified and competent to perform the work (Grant Assurance). ❑X Yes ❑ No ❑ N/A 2. Construction records, including daily logs, were or will be kept by the resident engineer/construction inspector that fully document contractor's performance in complying with: a. Technical standards (Advisory Circular (AC) 150/5370-12); b. Contract requirements (2 CFR part 200 and FAA Order 5100.38); and c. Construction safety and phasing plan measures (AC 150/5370-2). 0 Yes ❑ No ❑ N/A 3. All acceptance tests specified in the project specifications were or will be performed and documented. (AC 150/5370-12). QYes ❑ No ❑ N/A FAA Form 5100A29 (1117) SUPERSEDES PREVIOUS EDITION page 1 of 3 4. Sponsor has taken or will take appropriate corrective action for any test result outside of allowable tolerances (AC 15015370-12), ❑X Yes ❑ No ❑ N/A 5. Pay reduction factors required by the specifications were applied or will be applied in computing final payments with a summary made available to the FAA (AC 150/5370-10). ❑X Yes ❑ No ❑ N/A 6. Sponsor has notified, or will promptly notify the Federal Aviation Administration (FAA) of the following occurrences: a. Violations of any federal requirements set forth or included by reference in the contract documents (2 CFR part 200); b. Disputes or complaints concerning federal labor standards (29 CFR part'5); and c. Violations of or complaints addressing conformance with Equal Employment Opportunity or Disadvantaged Business Enterprise requirements (41 CFR Chapter 60 and 49 CFR part 26). ❑X Yes ❑ No ❑ N/A 7. Weekly payroll records and statements of compliance were or will be submitted by the prime contractor and reviewed by the sponsor for conformance with federal labor and civil rights requirements as required by FAA and U.S. Department of Labor (29 CFR Part 5). X❑Yes ❑ No ❑ N/A 8. Payments to the contractor were or will be made in conformance with federal requirements and contract provisions using sponsor internal controls that include: a. Retaining source documentation of -payments and verifying contractor billing statements against actual performance (2 CFR § 200.302 and FAA Order 5100.38); b. Prompt payment of subcontractors for satisfactory performance of work (49 CFR § 26,29); c. Release of applicable retainage upon satisfactory performance of work (49 CFR § 26.29); and d. Verification that payments to DBEs represent work the DBE performed by carrying out a commercially useful function (49 CFR §26.55). ❑X Yes ❑ No ❑ N/A, 9. A final project inspection was or will be conducted with representatives of the sponsor and the contractor present that ensure: a. Physical completion of project work in conformance with approved plans and specifications (Order 5100.38); b. Necessary actions to correct punch list items identified during final inspection are complete (Order 5100.38); and c. Preparation of a record of final inspection and distribution to parties to the contract (Order 5100.38); ❑X Yes ❑ No ❑ N/A 10. The project was or will be accomplished without material deviations, changes, or modifications from approved plans and specifications, except as approved by the FAA (Order 5100.38). ❑X Yes ❑ No ❑ N/A FAA Form 5100A29 (1/17) SUPERSEDES PREVIOUS EDITION page 2 of 3 11. The construction of all buildings have complied or will comply with the seismic construction requirements of 49 CFR § 41.120. ❑Yes ❑ No 0 N/A 12. For development projects, sponsor has taken or will take the following close-out actions: a. Submit to the FAA a final test and quality assurance report summarizing acceptance test results, as applicable (Grant Condition); b. Complete all environmental requirements as established within the project environmental determination (Oder 5100.38); and c. Prepare and retain as -built plans (Order 5100.38). QYes ❑ No ❑ N/A 13. Sponsor has revised or will revise their airport layout plan (ALP) that reflects improvements made and has submitted or will submit an updated ALP to the FAA no later than 90 days from the period of performance end date. (49 USC § 47107 and Order 5100.38). 0 Yes ❑ No ❑ N/A Attach documentation clarifying any above item marked with "No" response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. Executed on this 15th day of May , 2020 . Name of Sponsor: Collier County Airport Authority Name of Sponsor's Authorized Official: Justin Lobb Title of Sponsor's Authorized Official: Executive Airports Manager Signature of Sponsor's Authorized Official: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements) and could subject me to fines, imprisonment, or both. FAA Form 5100-129 (1/17) SUPERSEDES PREVIOUS EDITION page 3 of 3 4� U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-130, Drug - Free Workplace —Airport Improvement Program Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number, The OMB Control Number for this information collection is 2120-0569, Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200, Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-130 f1 U.S. Department of Transportation OMB CONTROL NUMBER: 2120-0569 41 Federal Aviation Administration EXPIRATION DATE: 813112019 Drug -Free Workplace Airport Improvement Program Sponsor Certification Sponsor: Collier County Air portAuthority Airport: Immokalee Regional Airport Project Number: Description of Work: Construct the extension of Taxiway C northward to connect with Taxiway B at the Immokalee Regional Airport - Construction Phase Application 49 USC § 47105(d) authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program (AIP). General requirements on the drug -free workplace within federal grant programs are described in 2 CFR part 182. Sponsors are required to certify they will be, or will continue to provide, a drug -free workplace in accordance with the regulation. The AIP project grant agreement contains specific assurances on the Drug -Free Workplace Act of 1988, Certification Statements Except for certification statements below marked as not applicable (N/A), this list includes major requirements of the construction project. Selecting "Yes' represents sponsor acknowledgement and confirmation of the certification statement. The term "will' means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. A statement has been or will be published prior to commencement of project notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the sponsor's workplace, and specifying the actions to be taken against employees for violation of such prohibition (2 CFR § 182.205). x❑ Yes ❑ No ❑ N/A 2. An ongoing drug -free awareness program (2 CFR § 182.215) has been or will be established prior to commencement of project to inform employees about: a. The dangers of drug abuse in the workplace; b. The sponsors policy of maintaining adrug-free workplace; c. Any available drug counseling, rehabilitation, and employee assistance programs; and d. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. ❑p Yes ❑ No ❑ N/A FAA Form 5100-130 (1/17) SUPERSEDES PREVIOUS EDITION Page 1 of 3 3. Each employee to be engaged in the performance of the work has been or will be given a copy of the statement required within item 1 above prior to commencement of project (2 CFR § 182.210), x❑ Yes ❑ No ❑ N/A 4. Employees have been or will be notified in the statement required by item 1 above that, as a condition employment under the grant (2 CFR § 182.205(c)), the employee will: aI Abide by the terms of the statement; and b. Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction. xp Yes ❑ No ❑ N/A 5. The Federal Aviation Administration (FAA) will be notified in writing within 10 calendar days after receiving notice under item 4b above from an employee or otherwise receiving actual notice of such conviction (2 CFR § 182.225). Employers of convicted employees must provide notice, including position title of the employee, to the FAA (2 CFR § 182.300). ❑x Yes ❑ No ❑ N/A 6. One of the following actions (2 CFR § 182.225(b)) will be taken within 30 calendar days of receiving a notice under item 4b above with respect to any employee who is so convicted: a. Take appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; and b. Require such employee to participate satisfactorily in drug abuse assistance or rehabilitation programs approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency. O Yes ❑ No ❑ N/A 7. A good faith effort will be made, on a continuous basis, to maintain adrug-free workplace through implementation of items 1 through 6 above (2 CFR § 182.200). ❑p Yes ❑ No ❑ N/A Sites) of performance of work (2 CFR § 182.230): Location 1 Name of Location: Immokalee Regional Airport Address: 165 Airpark Boulevard, Immokalee, FL 34142 Location 2 (if applicable) Name of Location: Address: Location 3 (if applicable) Name of Location: Address: FAA Form 5100-130 (1/17) SUPERSEDES PREVIOUS EDITION Page 2 of 3 Attach documentation clarifying any above item marked with a No response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. Executed on this 13th day of. May , 2020 Name of Sponsor: Collier County Airport Authority Name of Sponsor's Authorized Official: Justin Lobb Title of Sponsor's Authorized Official: Executive Airports Manager Signature of Sponsor's Authorized Official: 1 declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements) and could subject me to fines, imprisonment, or both. FAA Form 5100-130 (1/17) SUPERSEDES PREVIOUS EDITION Page 3 of 3 F� U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-131, Equipment and Construction Contracts — Airport Improvement Sponsor Certification Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200, Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-131 U.S. Department of Transportation OMB CONTROL NUMBER: 2120-0569 Federal Aviation Administration EXPIRATION DATE:8/31/2019 Equipment and Construction Contracts Airport Improvement Sponsor Certification Sponsor: Collier County Airport Authority Airport: Immokalee Regiona Airport Project Number: Description of Work: Construct the extension of Taxiway C northward to connect with Taxiway Bat the Immokalee Regional Airport- Construction Phase Application 49 USC § 47105(d) authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program (AIP). General procurement standards for equipment and construction contracts within Federal grant programs are described in 2 CFR §§ 200.317-200.326. Labor and Civil Rights Standards applicable to the AIP are established by the Department of Labor (www.dol.gov) AIP Grant Assurance CA —General Federal Requirements identifies all applicable Federal Laws, regulations, executive orders, policies, guidelines and requirements for assistance under the AIP. Sponsors may use state and local procedures provided the procurement conforms to these federal standards. This certification applies to all equipment and construction projects. Equipment projects may or may not employ laborers and mechanics that qualify the project as a "covered contract under requirements established by the Department of Labor requirements. Sponsor shall provide appropriate responses to the certification statements that reflect the character of the project regardless of whether the contract is for a construction project or an equipment project. Certification Statements Except for certification statements -below marked as not applicable (N/A), this list includes major requirements of the construction project. Selecting "Yes" represents sponsor acknowledgement and confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. A written code or standard of conduct is or will be in effect prior to commencement of the project that governs the performance of the sponsor's officers, employees, or agents in soliciting, awarding and administering procurement contracts (2 CFR § 200.318). pYes []No ❑ N/A FAA Form 5100-131 (1/17) SUPERSEDES PREVIOUS EDITION Page 1 of 4 2. For all contracts, qualified and competent personnel are or will be engaged to perform contract administration, engineering supervision, construction inspection, and testing (Grant Assurance C.17), O Yes ❑ No ❑ N/A 3. Sponsors that are required to have a Disadvantage Business Enterprise (DBE) program on file with the FAA have included or will include clauses required by Title VI of the Civil Rights Act and 49 CFR Part 26 for Disadvantaged Business Enterprises in all contracts and subcontracts. p Yes ❑ No ❑ N/A 4. Sponsors required to have a DBE program on file with the FAA have implemented orwill implement monitoring and enforcement measures that: a. Ensure work committed to Disadvantaged Business Enterprises at contract award is actually performed by the named DBEs (49 CFR § 26.37(b)); b. Include written cert�cation that the sponsor has reviewed contract records and has monitored work sites for performance by DBE firms (49 CFR § 26.37(b)); and c. Provides for a running tally of payments made to DBE firms and a means for comparing actual attainments (i.e. payments) to original commitments (49 CFR § 26.37(c)). ❑x Yes ❑ No ❑ N/A 5. Sponsor procurement actions using the competitive sealed bid method (2 CFR § 200.320(c)). was or will be: a. Publicly advertised, allowing a sufficient response time to solicit an adequate number of interested contractors or vendors; b. Prepared to include a complete, adequate and realistic specification that defines the items or services in sufficient detail to allow prospective bidders to respond; c. Publicly opened at a time and place prescribed in the invitation for bids; and d. Prepared in a manner that result in a firm fixed price contract award to the lowest responsive and responsible bidder. ❑x Yes ❑ No ❑ N/A 6. For projects the Sponsor proposes to use the competitive proposal procurement method (2 CFR § 200.320(d)), Sponsor has requested orwill request FAA approval prior to proceeding with a competitive proposal procurement by submitting to the FAA the following: a. Written justification that supports use of competitive proposal method in lieu of the preferred sealed bid procurement method; b. Plan for publicizing and soliciting an adequate number of qualified sources; and c. Listing of evaluation factors along with relative importance of the factors. ❑ Yes ❑ No ❑p N/A 7. For construction and equipment installation projects, the bid solicitation includes orwill include the current federal wage rate schedules) for the appropriate type of work classifications (2 CFR Part 200, Appendix II). ❑x Yes ❑ No ❑ N/A FAA Form 5100-131 (1/17) SUPERSEDES PREVIOUS EDITION Page 2 of 8. Concurrence was or will be obtained from the Federal Aviation Administration (FAA) prior to contract award under any of the following circumstances (Order 5100.38D): a. Only one qualified person/firm subm is a responsive bid; b. Award is to be made to other than the lowest responsible bidder; and c. Life cycle costing is a factor in selecting the lowest responsive bidder. ❑x Yes []No ❑ N/A 9. All construction and equipment installation contracts contain or will contain provisions for: a. Access to Records (§ 200.336) b. Buy American Preferences (Title 49 U.S.C. § 50101) c. Civil Rights - General Provisions and Title VI Assurances(41 CFR part 60) d. Federal Fair Labor Standards (29 U.S.C. § 201, at seq) e. Occupational Safety and Health Act requirements (20 CFR part 1920) f. Seismic Safety— building construction (49 CFR part 41) g. State Energy Conservation Requirements - as applicable(2 CFR part 200, Appendix II) h. U.S. Trade Restriction (49 CFR part 30) i. Veterans Preference (49 USC § 47112(c)) ❑p Yes ❑ No ❑ N/A 10. All construction and equipment installation contracts exceeding $2,000 contain or will contain the provisions established by: a. Davis -Bacon and Related Acts (29 CFR part 5) b. Copeland "Anti -Kickback" Act (29 CFR parts 3 and 5) ❑p as ❑ No ❑ N/A 11. All construction and equipment installation contracts exceeding $3,000 contain or will contain a contract provision that discourages distracted driving (E.O. 13513). ❑X Yes ❑ No ❑ N/A 12. All contracts exceeding $10,000 contain or will contain the following provisions as applicable: a. Construction and equipment installation projects -Applicable clauses from 41 CFR Part 60 for compliance with Executive Orders 11246 and 11375 on Equal Employment Opportunity; b. Construction and equipment installation - Contract Clause prohibiting segregated facilities in accordance with 41 CFR part 60-1.8; c. Requirement to maximize use of products containing recovered materials in accordance with 2 CFR § 200.322 and 40 CFR part 247; and d. Provisions that address termination for cause and termination for convenience (2 CFR Part 200, Appendix II). ❑x Yes ❑ No ❑ N/A FAA Form 5100-131 (4147) SUPERSEDES PREVIOUS EDITION Page 3 of 4 13, All contracts and subcontracts exceeding $25,000: Measures are in place or will be in place (e.g1 checking the System for Award Management) that ensure contracts and subcontracts are not awarded to individuals or firms suspended, debarred, or excluded from participating in federally assisted projects (2 CFR parts 180 and 1200). x❑ Yes ❑ No ❑ N/A 14. Contracts exceeding the simplified acquisition threshold (currently $150,000) include or will include provisions, as applicable, that address the following: a. Construction and equipment installation contracts - a bid guarantee of 5%, a performance bond of 100%, and a payment bond of 100% (2 CFR § 200.325); b. Construction and equipment installation contracts -requirements of the Contract Work Hours and Safety Standards Act (40 USC 3701-3708, Sections 103 and 107); c. Restrictions on Lobbying and Influencing (2 CFR part 200, Appendix II); d. Conditions specifying administrative, contractual and legal remedies for instances where contractor of vendor violate or breach the terms and conditions of the contract (2 CFR §200, Appendix II); and e. All Contracts -Applicable standards and requirements issued under Section 306 of the Clean Air Act (42 USC 7401-7671 q), Section 508 of the Clean Water Act (33 USC 1251- 1387, and Executive Order 11738. ❑x Yes ❑ No ❑ N/A Attach documentation clarifying any above item marked with "No' response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked no is correct and complete. Executed on this 13th day of May 2020 Name of Sponsor: Collier County Airport Authority Name of Sponsor's Authorized Official: Justin Lobb Title of Sponsors Authorized Official: Executive Airports Manager Signature of Sponsor's Authorized Official: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements) and could subject me to fines, imprisonment, or both. FAA Form 5100-131 (1/17) SUPERSEDES PREVIOUS EDITION Page 4 of 4 ACM U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-1327 Project Plans and Specifications port Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200, Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-132 1 U.S. Department of Transportation OMB CONTROL NUMBER: 2120-0569 Federal Aviation Administration EXPIRATION DATE: 8/31/2019 Project Plans and Specifications Airport Improvement Program Sponsor Certification SpOnSOr: CollierCouniyAirportAuthority Airport: Immokalee Regional Airport Project Number: Description of Work: Construct the extension of Taxiway C northward to connect with Taxiway B at the Immokalee Regional Airport - Construction Phase Application 49 USC § 47105(d) authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program (AIP). Labor and civil rights standards applicable to AIP are established by the Department of Labor (www.dol.gov/). AIP Grant Assurance CA —General Federal Requirements identifies applicable federal laws, regulations, executive orders, policies, guidelines and requirements for assistance under AIP. A list of current advisory circulars with specific standards for procurement, design or construction of airports, and installation of equipment and facilities is referenced in standard airport sponsor Grant Assurance 34 contained in the grant agreement. Certification Statements Except for certification statements below marked as not applicable (N/A), this list includes major requirements of the construction project. Selecting "Yes" represents sponsor acknowledgement and confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. The plans and specifications were or will be prepared in accordance with applicable federal standards and requirements, so that no deviation or modification to standards set forth in the advisory circulars, or FAA -accepted state standard, is necessary other than those explicitly approved by the Federal Aviation Administration (FAA) (14 USC § 47105). ❑X Yes ❑ No ❑ N/A 2. Specifications incorporate or will incorporate a clear and accurate description of the technical requirement for the material or product that does not contain limiting or proprietary features that unduly restrict competition (2 CFR §200.319). p Yes ❑ No ❑ N/A FAA Form 5100-132 (1/17) SUPERSEDES PREVIOUS EDITION Page 1 of 3 3. The development that is included or will be included in the plans is depicted on the current airport layout plan as approved by the FAA (14 USC § 47107). 0 Yes ❑ No ❑ N/A 4. Development and features that are ineligible or unallowable for AIP funding have been or will be omitted from the plans and specifications (FAA Order 5100.38, par. 3-43). � Yes ❑ No ❑ N/A 5. The specification does not use or will not use "brand name" or equal to convey requirements unless sponsor requests and receives approval from the FAA to use brand name (FAA Order 5100.38, Table U-5). 0 Yes ❑. No ❑ N/A 6. The specification does not impose or will not impose geographical preference in their procurement requirements (2 CFR §200.319(b) and FAA Order 5100.38, Table U-5). � Yes ❑ No ❑ N/A 7. The use of prequalified lists of individuals, firms or products include or will include sufficient qualified sources that ensure open and free competition and that does not preclude potential entities from qualifying during the solicitation period (2 CFR §319(d)). O Yes ❑ No ❑ N/A 8. Solicitations with bid alternates include or will include explicit information that establish a basis for award of contract that is free of arbitrary decisions by the sponsor (2 CFR § 200.319(a)(7)). p Yes ❑ No ❑ N/A 9. Concurrence was or will be obtained from the FAA if Sponsor incorporates a value engineering clause into the contract (FAA Order 5100.38, par. 3-57). O Yes ❑ No ❑ N/A 10. The plans and specifications incorporate dr will incorporate applicable requirements and recommendations set forth in the federally approved environmental finding (49 USC §47106(c)). 0 Yes ❑ No ❑ N/A 11. The design of all buildings comply or will comply with the seismic design requirements of 49 CFR § 41.120. (FAA Order 5100.38d, par. 3-92) ❑ Yes ❑ No 0 N/A 12. The project specification include or will include process control and acceptance tests required for the project by as per the applicable standard: a. Construction and installation as contained in Advisory Circular (AC) 150/5370-10. ❑X Yes ❑ No ❑ N/A FAA Form 5100-132 (1/17) SUPERSEDES PREVIOUS EDITION Page 2 of 3 b. Snow Removal Equipment as contained in AC 15015220-20. ❑Yes ❑ No ❑x N/A c. Aircraft Rescue and Fire Fighting %ARFF) vehicles as contained in AC 150/5220-10. ❑ Yes ❑ No ❑x N/A 13. For construction activities within or near aircraft operational areas(AOA): a. The Sponsor has or will prepare a construction safety and phasing plan (CSPP) conforming to Advisory Circular 150/5370-2. b. Compliance with CSPP safety provisions has been or will be incorporated into the plans and specifications as a contractor requirement. c. Sponsor will not initiate work until receiving FAA's concurrence with the CSPP (FAA Order 5100.38, Par. 5-29). ❑x Yes []No ❑ N/A 14. The project was or will be physically completed without federal participation in costs due to errors and omissions in the plans and specifications that were foreseeable at the time of project design (49 USC §47110(b)(1) and FAA Order5100.38d, par. 3-100). p Yes ❑ No ❑ N/A Attach documentation clarifying any above item marked with "No" response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. Executed on this 13th day of May 2020 Name of Sponsor: Collier County Airport Authority Name of Sponsor's Authorized Official: Justin Lobb Title of Sponsor's Authorized Official: Executive Airports Manager Signature of Sponsor's Authorized Official: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements) and could subject me to fines, imprisonment, or both. FAA Form 5100-132 (1/17) SUPERSEDES PREVIOUS EDITION Page 3 of 3 fS U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-134, Selection of Consultants —Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-134 U.S. Department of Transportation OMB CONTROL NUMBER: 2120-0569 fir/ Federal Aviation Administration EXPIRATION DATE: 8/31/2019 Selection of Consultants Airport Improvement Program Sponsor Certification Sponsor: Collier County Airport Authority Airport: Immokalee Regional Airport Project Number: Description of Work: Construct the extension of Taxiway C northward to connect with Taxiway Bat the Immokalee Regional Airport - Construction Phase Application 49 USC § 47105(d) authorizes the Secretary to require certification from the sponsor that it will comply with the statutory and administrative requirements in carrying out a project under the Airport Improvement Program (AIP). General requirements for selection of consultant services within federal grant programs are described in 2 CFR §§ 200.317-200.326. Sponsors may use other qualifications -based procedures provided they are equivalent to standards of Title 40 chapter 11 and FAA Advisory Circular 150/5100-14, Architectural, Engineering, and Planning Consultant Services for Airport Grant Projects, Certification Statements Except for certification statements below marked as not applicable (N/A), this list includes major requirementsof the construction project. Selecting "Yes" represents sponsor acknowledgement and confirmation of the certification statement. The term "will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all applicable statutory and administrative standards. The source of the requirement is referenced within parenthesis. 1. Sponsor acknowledges their responsibility for the settlement of all contractual and administrative issues arising out of their procurement actions (2 CFR § 200.318(k)). O Yes ❑ No ❑ N/A 2. Sponsor procurement actions ensure or will ensure full and open competition that does not unduly limit competition (2 CFR § 200.319). ❑x Yes []No ❑ N/A 3. Sponsor has excluded or will exclude any entity that develops or drafts specifications, requirements, or statements of work associated with the development of a request -for - qualifications (RFQ) from competing for the advertised services (2 CFR § 200,319), ❑x Yes ❑ No ❑ N/A FAA Form 5100-134 (2/17) SUPERSEDES PREVIOUS EDITION Page 1 of 3 4. The advertisement describes or will describe specific project statements -of -work that provide clear detail of required services without unduly restricting competition (2 CFR § 200.319). ❑p Yes ❑ No ❑ N/A 5. Sponsor has publicized or will publicize a RFQ that: a. Solicits an adequate number of qualified sources (2 CFR § 200.320(d)); and b: Identifies all evaluation criteria and relative importance (2 CFR § 200.320(d)). ❑x Yes ❑ No ❑ N/A 6. Sponsor has based or will base selection on qualifications, experience, and disadvantaged business enterprise participation with price not being a selection factor (2 CFR § 200.320(d)). ❑x Yes ❑ No ❑ N/A 7. Sponsor has verified or will verify that agreements exceeding $25,000 are not awarded to individuals or firms suspended, debarred or otherwise excluded from participating in federally assisted projects (2 CFR §180.300). ❑p Yes ❑ No ❑ N/A 8. A/E services covering multiple projects: Sponsor has agreed to or will agree to: a. Refrain from initiating work covered by this procurement beyond five years from the date of selection (AC 150/5100-14); and b. Retain the right to conduct new procurement actions for projects identified or not identified in the RFQ (AC 150/5100-14). ❑'es ❑ No 0 N/A 9. Sponsor has negotiated or will negotiate a fair and reasonable fee with the firm they select as most qualified for the services identified in the RFQ (2 CFR § 200.323). pYes ❑ No ❑ N/A 10. The Sponsor's contract identifies or will identify costs associated with ineligible work separately from costs associated with eligible work (2 CFR § 200.302). ❑x Yes ❑ No ❑ N/A 11. Sponsor has prepared or will prepare a record of negotiations detailing the history of the procurement action, rationale for contract type and basis for contract fees (2 CFR §200.318(i)). ❑x Yes ❑ No ❑ N/A 12. Sponsor has incorporated or will incorporate mandatory contact provisions in the consultant contract for AIP-assisted work (49 U.S.C. Chapter 471 and 2 CFR part 200 Appendix II) O Yes ❑ No ❑ N/A FAA Form 5100-134 (2/17) SUPERSEDES PREVIOUS EDITION Page 2 of 3 13, For contracts that apply a time -and -material payment provision (also known as hourly rates, specific rates of compensation, and labor rates), the Sponsor has established or will establish: a. Justification that there is no other suitable contract method for the services (2 CFR §200.3180)); b. A ceiling price that the consultant exceeds at their risk (2 CFR §200.3180)); and c. A high degree of oversight that assures consultant is performing work in an efficient manner with effective cost controls in place 2 CFR §200.3180)). ❑Yes ❑ No ❑x N/A 14. Sponsor is not using or will not use the prohibited cost -plus -percentage -of -cost (CPPC) contract method. (2 CFR § 200.323(d)). O Yes ❑ No ❑ N/A Attach documentation clarifying any above item marked with "no" response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and additional documentation for any item marked "no" is correct and complete. I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements) and could subject me to fines, imprisonment, or both. Executed on this 13th day of May , 2020 Name of Sponsor: Collier County Airport Authority Name of Sponsor's Authorized Official: Justin Lobb Title of Sponsor's Authorized Official: Executive Airports Manager Signature of Sponsor's Authorized Official: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements) and could subject me to fines, imprisonment, or both. FAA Form 5100-134 (2/17) SUPERSEDES PREVIOUS EDITION Page 3 of 3 U.S. Department of Transportation Federal Aviation Administration FAA Form 5100-1357 Certcation and Disclosure Regarding Potential Conflicts of Interest — Airport Improvement Program Sponsor Certification Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting requirements of 2 CFR 200. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Federal Aviation Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110. FAA Form 5100-135 U.S. Department of Transportation OMB CONTROL NUMBER: 2120-0569 a/ Federal Aviation Administration EXPIRATION DATE: 8/31/2019 Certification and Disclosure Regarding Potential Conflicts of Interest Airport Improvement Program Sponsor Certification Sponsor: Collier County Airport Authority Airport: Immokalee Regional Airport Project Number. Description of Work: Construct the extension of Taxiway C northward to connect with Taxiway B at the Immokalee Regional Airport - Construction Phase Application Title 2 CFR § 200.112 and § 1201.112 address Federal Aviation Administration (FAA) requirements for conflict of interest. As a condition of eligibility under the Airport Improvement Program (AIP), sponsors must comply with FAA policy on conflict of interest. Such a conflict would arise when any of the following have a financial or other interest in the firm selected for award: a) The employee, officer or agent, b) Any member of his immediate family, c) His or her partner, or d) An organization which employs, or is about to employ, any of the above. Selecting "Yes" represents sponsor orsub-recipient acknowledgement and confirmation of the certification statement. Selecting No represents sponsor or sub -recipient disclosure that it cannot fully comply with the certification statement. If "No" is selected, provide support information explaining the negative response as an attachment to this form. This includes whether the sponsor has established standards for financial interest that are not substantial or unsolicited gifts are of nominal value (2 CFR § 200.318(c)). The term 'will" means Sponsor action taken at appropriate time based on the certification statement focus area, but no later than the end of the project period of performance. Certification Statements The sponsor or sub maintains a written standards of conduct governing conflict of interest and the performance of their employees engaged in the award and administration of contracts (2 CFR § 200.318(c)). To the extent permitted by state or local law or regulations, such standards of conduct provide for penalties, sanctions, or other disciplinary actions for violations of such standards by the sponsor's and sub -recipient's officers, employees, or agents, or by contractors or their agents. pp Yes ❑ No FAA Form 5100-135 (2/17) SUPERSEDES PREVIOUS EDITION Page 1 of 2 2. The sponsors or sub -recipient's officers, employees or agents have not and will not solicitor accept gratuities, favors or anything of monetary value from contractors, potential contractors, or parties to sub -agreements (2 CFR § 200.318(c)). ❑X Yes ❑ No 3. The sponsor or sub recipient certifies that is has disclosed and will disclose to the FAA any known potential conflict of interest (2 CFR § 1200.112). Attach documentation clarifying any above item marked with "no" response. Sponsor's Certification I certify, for the project identified herein, responses to the forgoing items are accurate as marked and have the explanation for any item marked "no" is correct and complete. Executed on this 13th day of May , 2020 Name of Sponsor: Collier County Airport Authority Name of Sponsor's Authorized Official: Justin Lobb Title of Sponsor's Authorized Official: Executive Airports Manager Signature of Sponsor's Authorized Official: I declare under penalty of perjury that the foregoing is true and correct. I understand that knowingly and willfully providing false information to the federal government is a violation of 18 USC § 1001 (False Statements) and could subject me to fines, imprisonment, or both. FAA Form 5100-135 (2/17) SUPERSEDES PREVIOUS EDITION Page 2 of 2