Fill - Free fillable Faa Form 5100 131 Sponsor Cert Equip Constr 2019 (Federal Aviation Administration) PDF form

FAA Form 5100-131

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: Information Collection

Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX

76177-1524.

FAA Form 5100-131 (4/19) SUPERSEDES PREVIOUS EDITION Page 1 of 4

U.S. Department of Transportation

Federal Aviation Administration

OMB CONTROL NUMBER: 2120-0569

EXPIRATION DATE: 8/31/2019

Equipment and Construction Contracts

Airport Improvement Sponsor Certification

Sponsor:

Airport:

Project Number:

Description of Work:

Application

49 USC § 47105(d) authorizes the Secretary to require certification from the sponsor that it will comply

with the statutory and administrative requirements in carrying out a project under the Airport Improvement

Program (AIP). General procurement standards for equipment and construction contracts within Federal

grant programs are described in 2 CFR §§ 200.317-200.326. Labor and Civil Rights Standards

applicable to the AIP are established by the Department of Labor (www.dol.gov) AIP Grant Assurance

C.1—General Federal Requirements identifies all applicable Federal Laws, regulations, executive orders,

policies, guidelines and requirements for assistance under the AIP. Sponsors may use state and local

procedures provided the procurement conforms to these federal standards.

This certification applies to all equipment and construction projects. Equipment projects may or may not

employ laborers and mechanics that qualify the project as a “covered contract” under requirements

established by the Department of Labor requirements. Sponsor shall provide appropriate responses to

the certification statements that reflect the character of the project regardless of whether the contract is

for a construction project or an equipment project.

Certification Statements

Except for certification statements below marked as not applicable (N/A), this list includes major

requirements of the construction project. Selecting “Yes” represents sponsor acknowledgement and

confirmation of the certification statement. The term “will” means Sponsor action taken at appropriate

time based on the certification statement focus area, but no later than the end of the project period of

performance. This list is not comprehensive and does not relieve the sponsor from fully complying with all

applicable statutory and administrative standards. The source of the requirement is referenced within

parenthesis.

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).

Yes No N/A

FAA Form 5100-131 (4/19) SUPERSEDES PREVIOUS EDITION Page 2 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).

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.

Yes No N/A

4. Sponsors required to have a DBE program on file with the FAA have implemented or will

implement monitoring and enforcement measures that:

a. Ensure work committed to Disadvantaged Business Enterprises at contract award is

actually performed by the named DBEs (49 CFR § 26.37(b));

Include written certification that the sponsor has reviewed contract records and has

monitored work sites for performance by DBE firms (49 CFR § 26.37(b)); and

c. Provides for a running tally of payments made to DBE firms and a means for comparing

actual attainments (i.e. payments) to original commitments (49 CFR § 26.37(c)).

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;

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.

Yes No N/A

6. For projects the Sponsor proposes to use the competitive proposal procurement method (2 CFR §

200.320(d)), Sponsor has requested or will request FAA approval prior to proceeding with a

competitive proposal procurement by submitting to the FAA the following:

a. Written justification that supports use of competitive proposal method in lieu of the

preferred sealed bid procurement method;

b. Plan for publicizing and soliciting an adequate number of qualified sources; and

Listing of evaluation factors along with relative importance of the factors.

Yes No N/A

For construction and equipment installation projects, the bid solicitation includes or will include the

current federal wage rate schedule(s) for the appropriate type of work classifications (2 CFR Part

200, Appendix II).

Yes No N/A

FAA Form 5100-131 (4/19) SUPERSEDES PREVIOUS EDITION Page 3 of 4

8. Concurrence was or will be obtained from the Federal Aviation Administration (FAA) prior to

contract award under any of the following circumstances (Order 5100.38D):

a. Only one qualified person/firm submits a responsive bid;

Award is to be made to other than the lowest responsible bidder; and

c. Life cycle costing is a factor in selecting the lowest responsive bidder.

Yes No N/A

All construction and equipment installation contracts contain or will contain provisions for:

a. Access to Records (§ 200.336)

Buy American Preferences (Title 49 U.S.C. § 50101)

c. Civil Rights - General Provisions and Title VI Assurances( 41 CFR part 60)

Federal Fair Labor Standards (29 U.S.C. § 201, et seq)

e. Occupational Safety and Health Act requirements (20 CFR part 1920)

f. Seismic Safety – building construction (49 CFR part 41)

State Energy Conservation Requirements - as applicable(2 CFR part 200, Appendix II)

h. U.S. Trade Restriction (49 CFR part 30)

Veterans Preference (49 USC § 47112(c))

Yes No N/A

10. All construction and equipment installation contracts exceeding $2,000 contain or will contain the

provisions established by:

Davis-Bacon and Related Acts (29 CFR part 5)

b. Copeland “Anti-Kickback” Act (29 CFR parts 3 and 5)

Yes No N/A

11.

All construction and equipment installation contracts exceeding $3,000 contain or will contain a

contract provision that discourages distracted driving (E.O. 13513).

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;

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).

Yes No N/A

FAA Form 5100-131 (4/19) SUPERSEDES PREVIOUS EDITION Page 4 of 4

13. All contracts and subcontracts exceeding $25,000: Measures are in place or will be in place (e.g.

checking the System for Award Management) that ensure contracts and subcontracts are not

awarded to individuals or firms suspended, debarred, or excluded from participating in federally

assisted projects (2 CFR parts 180 and 1200).

Yes No N/A

14. Contracts exceeding the simplified acquisition threshold (currently $250,000) include or will include

provisions, as applicable, that address the following:

a. Construction and equipment installation contracts - a bid guarantee of 5%, a performance

bond of 100%, and a payment bond of 100% (2 CFR § 200.325);

b. Construction and equipment installation contracts - requirements of the Contract Work

Hours and Safety Standards Act (40 USC 3701-3708, Sections 103 and 107);

c. Restrictions on Lobbying and Influencing (2 CFR part 200, Appendix II);

d. Conditions specifying administrative, contractual and legal remedies for instances where

contractor of vendor violate or breach the terms and conditions of the contract (2 CFR

§200, Appendix II); and

e. All Contracts - Applicable standards and requirements issued under Section 306 of the

Clean Air Act (42 USC 7401-7671q), Section 508 of the Clean Water Act (33 USC

1251-1387, and Executive Order 11738.

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 day of , .

Name of Sponsor:

Name of Sponsor’s Authorized Official:

Title of Sponsor’s Authorized Official:

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.

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