SPONSOR’S CERTIFICATION OF AIRPORT IMPROVEMENT PROJECT
SPONSOR CERTIFICATION #1 – Consultant Selection and Engineering
Airport: ______
Sponsor's Name: ______
State Project Number: ______AIP Number: ______
Project Title: ______
The following list of certified items includes major requirements for selection of consultants and evaluation of their fees. Every certified item must be marked. Eachcertified item with a"No" response must be fully explained in anattachment to this certification. Iftheitem is not applicable to this project, mark the item AN/A@.
CONSULTANT SELECTION:
1. Advertisements for Consultants were placed in the Sponsor’s Journal of Record (i.e. local newspaper), the Baton Rouge Advocate andthe Daily Journal of Commerce.
Yes ______No ______N/A ______
2.An independent cost analysis was performed and the record of negotiations reflecting the considerations involved in the establishment of fees as well as a copy of the results has been maintained on file.
Yes ______No ______N/A ______
3. If consultant services are to be performed by sponsor force account, prior approval was obtained.
Yes ______No ______N/A ______
ENGINEERING SERVICE AGREEMENT / FEES:
1.The Engineering Services Agreement clearly established the scope of work and delineates the division ofresponsibilities of all parties engaged in carrying out elements of the project. (The Engineering Feesmust include a detailed scope, and a detailed man-hour estimate. It must also show LADOTD approved rates, overhead and profit that were used in their calculation.)
Yes ______No ______N/A ______
2.Costs associated with work ineligible for DOTD funding are clearly identified and separated from eligible items.
Yes ______No ______N/A ______
3.All mandatory contract provisions for contracts have been included in the Engineering Services Agreement in accordance with all applicable Louisiana Laws & Statues.
Yes ______No ______N/A ______
4.If the services being procured cover more than the project referenced in this certification, thescope of work was specifically described in the advertisement, and future work will not be initiated beyond five years.
Yes ______No ______N/A ______
5.The plans and specifications were developed in accordance with all applicable Federal and/or LADOTD standards and requirements, and no deviation from or modification to standards setforth in the FAA Advisory Circulars or LADOTD Standards was necessary, other than those previously approved by the FAA.
Yes ______No ______N/A ______
6. Development which is ineligible for Federal AIP and/or State funding, but will be sole responsibility of the Sponsor, has been clearly noted on the plans and specifications, and is shownas an additive alternate on the bid documents.
Yes ______No ______N/A ______
7.Process control and acceptance tests required for the project by standards contained in LADOTD=s StandardSpecificationsare included in theproject specifications.
Yes ______No ______N/A ______
8. The plans and specifications incorporate applicable requirements and recommendations set forth inthe Federalapproved environmental finding.
Yes ______No ______N/A______
9.For construction activities within or near aircraft operational areas, the requirements contained inthe FAA Advisory Circular 150/5370-2 (Operational Safety on Airports during Construction) have been incorporated into the specifications andasafety/phasing plan has beenprepared.
Yes ______No ______N/A______
10.The project will be physically completed without State participation in costs due to errors oromissions in the plans and specifications which were reasonably foreseeable at the time ofproject design.
Yes ______No ______N/A______
11.Specifications for the procurement of equipment are not proprietary or written so as to restrict competition. At least two manufacturers can meet the specification.
Yes ______No ______N/A______
12. The development included in the plans is depicted on an airport layout plan approved by FAA.
Yes ______No ______N/A______
CERTIFICATION:
I certify that, for the project identified herein, the responses to the foregoing items are true and correct as marked, and that the attachments, if any, are correct and complete; and
Furthermore, I understand that DOTD does not provide certification to any document nor work performed, and is not responsible for same in accordance with the Project Responsibilityarticle of the Sponsor State Agreement identified with this project, and that it is solely the responsibility of the Sponsor to certify to the appropriate development, completion and authenticity of all work and documents required of the Sponsor by this agreement in accordance with the Certification and Compliancearticle of the Sponsor State Agreement identified with this project.
Signed: ______Dated: ______
Sponsor's Authorized Representative
______Dated: ______
Typed Name and Title of Sponsor's Representative
SPONSOR’S CERTIFICATION OF AIRPORT IMPROVEMENT PROJECT
SPONSOR CERTIFICATION #2 – Real Property Acquisition
Airport: ______
Sponsor's Name: ______
State Project Number: ______AIP Number: ______
Project Title: ______
The following list of certified items that include major requirements for real property acquisition. Every certified item must be marked. Eachcertified item with a"No" response must be fully explained in anattachment to this certification. Iftheitem is not applicable to this project, mark the item AN/A@. Youalso need to scratch out (is) or (will be) depending on whether the property has been purchased orisstill to be purchased.
REAL PROPERTY ACQUISITION:
1.Good and sufficient title isheld on the property in the project; and the Sponsor's attorney orother official has on file, and has submitted to DOTD, title evidence on the property.
Yes ______No ______N/A______
2.If defects and/or encumbrances exist in the title which adversely impact the sponsor's intended useofproperty in the project, they have been extinguished, modified, or subordinated.
Yes ______No ______N/A ______
3.If property for airport development isleased, the term is for a minimum 20years and the lessor is a public agency and the lease contains no provisions which prevent full compliance with the grant agreement.
Yes ______No ______N/A ______
4.Property in the project is in conformance with the current property map and theproperty mapis based on deeds, title opinions, land surveys, the approved airport layout plan, andproject documentation.
Yes ______No ______N/A ______
5.For any acquisition of property interest in noise sensitive approach zones, comparable land use zones and related areas, property interest was obtained to ensure land is used for purposes compatible with noise levels associated with operation of an airport.
Yes ______No ______N/A ______
6.For any acquisition of property interest in runway protection zones and areas related to FAR Part77 surfaces, property interest was obtained for the right of flight and right of ingressand egress to remove obstructions. Interest wasobtained for the right to restrictthe establishment of future obstructions.
Yes ______No ______N/A ______
7.Appraisals include valuation data to estimate the current market value for the property interest acquired on each parcel and were prepared by qualified real estate appraisers hired by the sponsor and an opportunity was provided the property owner or representative to accompany appraisers during inspections.
Yes ______No ______N/A ______
8.Each appraisal has been reviewed by a State Certified Appraiser to recommend an amount for the offer of just compensation and the written appraisals and review appraisal are available to LADOTD forreview.
Yes ______No ______N/A ______
9.A written offer to acquire each parcel was presented to the property owner for not less thanthe approved amount of just compensation.
Yes ______No ______N/A ______
10.Effort was made to acquire each property through negotiation with no coercive action toinduce agreement and if negotiation was successful, project files contain supporting documents for settlements.
Yes ______No ______N/A ______
11.If a negotiated settlement is not reached, condemnation was initiated and a court deposit notless than the just compensation was made prior to possession of the property andproject files contain supporting documents for awards.
Yes ______No ______N/A ______
12.If displacement of persons, businesses, farm operations, or nonprofit organizations is involved, a relocation assistance program was established,displaced persons received general information on the relocation program in writing, notice of relocation eligibility, and a 90-day notice to vacate.
Yes ______No ______N/A ______
13.Relocation assistance services, comparable replacement housing, and payment of necessary relocation expenses (were) (will be) provided within a reasonable time period for each displaced occupant in accordance with the Uniform Act.
Yes ______No ______N/A ______
CERTIFICATION:
I certify that, for the project identified herein, the responses to the foregoing items are true and correct as marked, and that the attachments, if any, are correct and complete; and
Furthermore, I understand that DOTD does not provide certification to any document nor work performed, and is not responsible for same in accordance with the Project Responsibilityarticle of the Sponsor State Agreement identified with this project, and that it is solely the responsibility of the Sponsor to certify to the appropriate development, completion and authenticity of all work and documents required of the Sponsor by this agreement in accordance with the Certification and Compliancearticle of the Sponsor State Agreement identified with this project.
Signed: ______Dated: ______
Sponsor's Authorized Representative
______Dated: ______
Typed Name and Title of Sponsor's Representative
SPONSOR’S CERTIFICATION OF AIRPORT IMPROVEMENT PROJECT
SPONSOR CERTIFICATION #3 – Construction / Equipment and Final Acceptance
Airport: ______
Sponsor's Name: ______
State Project Number: ______AIP Number: ______
Project Title: ______
The following list of certified items includes major requirements for construction / equipment contracts and project final acceptance. Every certified item must be marked. Eachcertified item with a"No" response must be fully explained inanattachment to this certification. Iftheitem is not applicable to this project, mark the item AN/A@.
Standards for advertising and awarding equipment and construction contracts within State grant programs are described in 49 CFR 18.36. Sponsors may use theirlocal procurement procedures provided no State and Federal laws or regulations are broken.
CONSTRUCTION / EQUIPMENT:
1.A code or standard of conduct is in effect governing the performance of the sponsor's officers, employees, or agents in soliciting and awarding procurement contracts.
Yes ______No ______N/A ______
2.Qualified personnel are engaged to perform contract administration, engineering supervision andconstruction inspection and testing.
Yes ______No ______N/A ______
3. The project was publicly advertised using the competitive sealed bid method of procurement.
Yes ______No ______N/A ______
4.The request for bids clearly and accurately describes contract requirements to include all administrative, equipment, and/or services to be provided.
Yes ______No ______N/A ______
5.Concurrence was obtained from the FAA in writing, prior to contract award and especially when any of the following circumstances existed:
a.Only one qualified person/firm submits a responsive bid,
b.The contract is to be awarded to other than the lowest responsive and responsible bidder,
c.Life cycle costing is a factor in selecting the lowest responsive bidder, and
d.Proposed contract prices are more than 10 percent over the sponsor's cost estimate.
Yes ______No ______N/A ______
6. All contracts require a bid guarantee of 5 percent, a retainage or retainage bond as required by state bid laws, a
performance bond of100 percent, anda payment bond of 100 percent.
Yes ______No ______N/A ______
7.All Contracts contain provisions or conditions specifying administrative, contractual, and legal remedies, including contract termination, for those instances in which contractors violate or breach contract terms.
Yes ______No ______N/A ______
8.All construction contracts involving labor contain provisions insuring that in the employment of labor honorably discharged Vietnam era veterans and disabled veterans will be given preference.
Yes ______No ______N/A ______
9.All construction contracts follow all Local and State Laws, as appropriate.
Yes ______No ______N/A ______
10.Appropriate checks have been made to assure that contracts or subcontracts are not awarded to thoseindividuals or firms suspended, debarred, or voluntarily excluded from doing business under DOTD's Unqualified List.
Yes ______No ______N/A ______
FINAL ACCEPTANCE:
The sponsor shall determine that project costs are accurate andproper in accordance with specific requirements of theCityState Agreement and contract documents.
1.The personnel engaged in project administration, engineering supervision and construction inspection and testing were determined to be qualified and competent to perform the work.
Yes ______No ______N/A ______
2.Daily construction records were kept by the resident engineer/construction inspector, and the records document work in progress, quality and quantity of materials delivered, test locations andresults, instructions provided the contractor, weather, equipment use, labor requirements, safety problems, andchanges required.
Yes ______No ______N/A ______
3. Complaints regarding the mandated State and Federal provisions set forth in the contract documents have been submitted to LADOTD Aviation.
Yes ______No ______N/A ______
4.All tests specified in the plans and specifications were performed and the test results documented.
Yes ______No ______N/A ______
5. For any test results outside allowable tolerances, appropriate corrective actions were taken, and theresults were approved in writing by the FAA.
Yes ______No ______N/A ______
6.Payments to the contractor were made in compliance with contract provisions and verified by thesponsor's internal audit of contract records kept by the resident engineer, and if appropriate, pay reduction factors required by the specifications were applied in computing final payments and asummary of pay reductions has been submitted to LADOTD Aviation.
Yes ______No ______N/A ______
7.The project was accomplished without significant deviations, changes, or modifications from the approved plans and specifications, except where written approval was obtained.
Yes ______No ______N/A ______
8.A final project inspection was conducted with representatives of the sponsor andthe contractor, and project files contain documentation of the final inspection (and LADOTD was notified prior to the final inspection of the inspection date and time).
Yes ______No ______N/A ______
9.All corrective actions required as a resultof the final inspection have been completed to the satisfaction of the sponsor.
Yes ______No ______N/A ______
10.The as-built plans and specifications with final quantities, an equipment inventory if applicable, have been submitted to LADOTD Aviation on a CAD CD, and an updated Airport Layout Plan if applicable, has been submitted.
Yes ______No ______N/A ______
11.All remaining applicable close-out documents andSponsor's letter of acceptance are attached along with the final payrequest andthe contractor's final invoice, clear lien certificate, etc, as required in the Final Inspection, Acceptance & Reimbursementarticle of the Sponsor State Agreement identified with this project.
Yes ______No ______N/A ______
CERTIFICATION:
I certify that, for the project identified herein, the responses to the foregoing items are true and correct as marked, and that the attachments, if any, are correct and complete; and
Furthermore, I understand that DOTD does not provide certification to any document nor work performed, and is not responsible for same in accordance with the Project Responsibilityarticle of the Sponsor State Agreement identified with this project, and that it is solely the responsibility of the Sponsor to certify to the appropriate development, completion and authenticity of all work and documents required of the Sponsor by this agreement in accordance with theCertification and Compliancearticle of the Sponsor State Agreement identified with this project.
Signed: ______Dated: ______
Sponsor's Authorized Representative
______Dated: ______
Typed Name and Title of Sponsor's Representative