Okaloosa County BOCC — July 2, 2013 — FAA Grant Application for ARFF Building — reading text

OMB Number: 4040-0004 Expiration Date; 03/31/2012 Application for Federal Assistance SF-424 *41, Type of Submission * 2. Type of Application * If Revision, select appropriate letter(s): [_] Preapplication New Application [-] Continuation * Other (Specify) [_] Changed/Corrected Application | |] Revision *3. Date Received: 4. Application Identifier: 5a. Federal Entity Identifier: * 5b. Federal Award Identifier: State Use Only: 6. Date Received by State: | 7. State Application Identifier: 8. APPLICANT INFORMATION: * a. LegalName: OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS *b, Employer/Taxpayer Identification Nurmber (EIN/TIN): 59-6000795 *c. Organizational DUNS: 613277649 d. Address; “Streetl’ 1804 Lewis Turner Blvd (Ste 206) Street 2: * City: Fort Walton Beach. County: Okaloosa *State: Florida, Province: Country: *Zip/ Postal Code: 32547 e. Organizationaf Unit: Department Name: Northwest Florida Regional Airport (VPS) Division Narne: Administration f, Name and contact information of person to be contacted on matters involving this application: Middle Name: *LastName: Bailey Suffix: Prefix: Ms. FirstName: Brenda Title: me Grants and Contracts Manager Organizational Affiliation: * Telephone Number: (850)651-7200, ext 4381 Fax Number: (850)609-5029 “Email; bbailey@clerkofcourts.cc OMB Number: 4040-0004 Expiration Date: 03/31/2012 pplication for Federal Assistance SF-424 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 Administration 11. Catalog of Federal Domestic Assistance Number: 20.106 CFDA Title: Airport Improvement Program 42. Funding Opportunity Number: Title: 13, Competition Identification Number: Title: 14, Areas Affected by Project (Cities, Counties, States, etc.): Counties, State of Florida, Air Force Base * 15, Descriptive Title of Applicant's Project: Construct Quick Response ARFF building on Eglin AFB to satisfy VPS' Part 139 requirement Attach supporting documents as specified in agency instructions. aaaarenerttent OMB Number: 4040-0004 Expiration Date: 03/31/2012 Application for Federal Assistance SF-424 16. Congressional Districts Of: *a, Applicant 1st *b. Program/Project: 1st Attach an additional list of Program/Project Congressional Districts if needed. 17. Proposed Project: * a. Start Date: September 2013 *b. End Date: July 2014 18, Estimated Funding ($): “a. Federal $2,743,526.00 wb Applicant PECs $152,418.00 *c. State *d. Local $152,418.00 *e. Other “f, Program Income *g. TOTAL $3,048, 362.00 *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 March 12, 2013 [_]b. Program is subject to E.O. 12372 but has not been selected by the State for review. [_]c. Program is not covered by E.O, 12372. *20. Is the Applicant Delinquent On Any Federal Debt? (If “Yes”, provide explanation.) [] Yes No 24. “By signing this application, | 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. | also provide the required assurances*™* and agree to comply with any resulting terms if | accept an award. | 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). “| 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. “FirstName: Don Middle Name: R, *Last Name: Amunds Suffix: “Title: Chairman, Okaloosa County Board of Commissioners *Telephone Number: (850)651-7105 Fax Number: (850)651-7142 “Email: damunds@co.okaloosa.fl.us *Signature of Authorized Representative: (_+J OX t sss odd Date Signed: 7-25 -2Z0/3 U.S, DEPARTMENT OF TRANSPORTATION OMB NO. 80-RO184 FEDERAL AVIATION ADMINISTRATION PART Il PROJECT APPROVAL INFORMATION SECTION A Item 1 Does this assistance request require State, local, regional, or other priority rating? LlYes XINo Name of Governing Body Priority Item 2. Does this assistance request require State, local advisory, educational or health clearances? ClYes EX]No Name of Agency or Board (Attach Documentation) Item 3 Does this assistance request require clearinghouse review in accordance with OMB Circular A-95? (Attach Comments) Provided with pre-application Yes CINo Item 4 Does this assistance request require State, local, Name of Approving Agency ___ regional or other planning approval? Date ClYes KINo Check One: State CJ Item 5. Local is the proposed project covered by an approved Regional OF comprehensive plan? []Yes XJNo Location of plan_ Item 6. Will the assistance requested serve a Federal Name of Federai Installation installation? Federal Population benefiting from Project XlYes [[JNo Item 7 Wiil the assistance requested be on Federal land Name of Federal Installation or installation? Location of Federal Land dyes CINo percent of Project Item 8 Will the assistance requested have an impact or effect on the environment? LlyYes KXJNo Number of: Item 9. Individuals Will the assistance requested cause the displacement of Families individuals, families, businesses, or farms? Businesses Lives EXINo Farms Item 10. Is there other related Federal assistance on this project previous, pending, or anticipated? ClYes [KXJNo FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 Page 2 OMB NO. 80-RO184 U.S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION PART II — SECTION C The Sponsor hereby represents and certifies as follows: 1. Compatible Land Use. - The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity of the airport: N/A 2. Defaults. - The Sponsor is not in default on any obligation to the United States or any agency of the United States Government relative to the development, operation, or maintenance of any airport, except as stated herewith: N/A 3. Possible Disabilities. — There are no facts or circumstances (including the existence of effective or proposed leases, use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other tegal proceedings) which in reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of Part V of this Application, either by limiting its egal or financial ability or otherwise, except as follows: N/A 4, Land. —(a) The sponsor holds the following property interest in the following areas of land* which are to be developed or used as part of or in connection with the Airport. subject to the following exceptions, encumbrances, and adverse interests, all of which areas are identified on the aforementioned property map designated as Exhibit “A”: A lease with the Air Force is being prepared and will be executed prior to construction beginning *State character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of every kind and nature, including liens, easements, leases, etc. The separate areas of land need only be identified here by the area numbers shown on the property map. FAA Form 5100-100 (4-76) cAKAC ante, 32 OMB NO, 80-RO184 U.S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION PART I[- SECTION C (Continued) The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and that such attorney or title company has determined that the Sponsor holds the above property interests. (a)The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work under the Project, the following property interest in the following areas of land* on which such construction work is to be performed, all of which areas are identified on the aforementioned property map designated as Exhibit “A”: The lease with the Air Force has been agreed to, and is in the signature process. No work will commence before signature is obtained. (c) The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction work under the Project, the following property interest in the following areas of land* which are to be developed or used as part of or in connection with the Airport as it will be upon completion of the Project, all of which areas are identified on the aforementioned property map designated as Exhibit “A”: Location of site provided with pre-application. Site survey to be furnished with lease to be acquired before construction begins. 5. Exclusive Rights. - There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport owned or controlled by the Sponsor except as follows: N/A *State character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse interests of every kind and nature, including liens, easements, leases, etc. The separate areas of land need only be identified here by the area numbers shown on the property map. Page 3b FAA Form 5100-100 (4-76) FAA AC 81-06913 U.S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION OMB NO. 80-RO184 PART IIl- BUDGET INFORMATION - CONSTRUCTION SECTION A - GENERAL 1. Federal Domestic Assistance Catalog No 2. Functional or Other Breakout... 0... eee SECTION B - CALCULATION OF FEDERAL GRANT Use only for revisions Cost Classification Latest Approved Adjustment Total Amount + or (-) Amount Required 1. Administration---- Independent Cost Estimate (ICE) $ 2,000 | $ $ 2. Preliminary Expense 3. Land, structures, right-of-way 4. Architectural engineering basic ---- Design 198,935 5. Other architectural engineering fees 6. Project inspection ---- Construction Phase Serivces 230,633 7, Land development 8. Relocation Expenses 9. Relocation payments to individuals and businesses 10. Demolition and removal 11. Construction and project improvement 2,616,794 12. Equipment 13. Miscellaneous 14. Total (Lines 1 through 13) 3,048,362 15. Estimated Income (if applicabie) 16. Net Project Amount (Line 14 minus 15) 17. Less: Ineligible Exclusions 18, Add: Contingencies 19. Total Project Amt. (Excluding Rehabilitation Grants) 3,048,362 20, Federal Share requested of Line 19 2,743,526 21. Add Rehabilitation Grants Requested (100 percent) 22. Total Federal grant requested (Lines 20 & 21) 2,743,526 23. Grantee share 152,418 24, Other shares 152,418 25. Total project (Lines 22, 23, & 24) 3,048,362 Page 4 FAA Form 8100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 FEDERAL AVIATION ADMINISTRATION OMB NO. 80-RO184 SECTION C - EXCLUSIONS U.S. DEPARTMENT OF TRANSPORTATION Classification Ineligible for Excluded from Participation Contingency Provision 26 (1) (2) a. $ $ b.. c. d. @. f. g- Totals SECTION D - PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE 27. Grantee Share $ 152,418 a. Securities b, Mortgages c. Appropriations (By Applicant) d. Bonds e. Tax Levies f. Non Cash g .Other (Explain) Passenger Facility Charges h .TOTAL — Grantee share Passenger Facility Charges 152,418 28. Other Shares a. State 152,418 b. Other c. Total Other Shares 29. TOTAL $ 304,836 SECTION E - REMARKS PAGE 5 FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 FAA AC 75-023 AVCON, INC. ENGINEERS & PLANNERS 320 Bayshore Drive, Suite A Niceville, Florida 32578 Phone: (850) 678-0050 2012.050.09/Recommendation of Award 7-25-13 Fax: (850) 678-0040 www. avconine.com July 25, 2013