HomeMy WebLinkAboutbocc.con.203.2010CLERK'S CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR
SCANNING/ARCHIVING
CONTRACT #: 203-2010
ORIGINATING DEPARTMENT/DIVISION: Airport
CONTACT PERSON: Jim Elwood PHONE #: 970-428-2851
PROJECT NAME: FAA Other Transaction Agreement (ATCT Camera)
❑ BOCC AGENDA ITEM
(Requires BOCC Sig�ature)
CHECK PROCUREMENT TYPE:
�STAFF AUTHORIZED SIGNATURE
(per Revised Procurement Code 7/2005)
QNone ❑Informal �Formal ❑Sole Source ❑Emergency ❑State Bid ❑
❑Compliance with House Bills 06-1343 and 07-1073 (Under $10,00Q Letters of Engagement, etc.)
CHECK CONTRACT TYPE:
DOLLAR AMOUNT: $320,000 BUDGET LINE TTEM/LEDGER NUMBER: 404.69.94792.86000
❑Services/Maintenance
❑License/Use
❑Lease
❑Construction
❑Goods, Equipment, Supplies
�Other (e.g. revenue)
❑Employment (for county employees)
❑Intergovemmental Agreement (Requires BOCC Action)
�Non-Profit
❑Quasi-Public
❑Grant Agreements (Requires BOCC Action)
❑Change OrdedContract Amendment
CONTRACTOR/BUSINESS:FAA Complete Legal of Name of Business Federal Aviation
Administration
Contract Execution Date:8/18/2010 Contract End Date: N/A
Automatic Renewal ❑Yes �No Term of Contract: N/A
All Contracts should be proofed for the following: p11(IY'
✓ �No Pages Missing ry Y����� �,�/
✓❑If a Page is Left Intentionally Blank —Note on Page �"� r1 � f'
✓ �Page numbered consecutively ���
✓ �All Signatures Affixed
✓ �All Dates Filled In
✓ �All Other Blanks Filled In
✓ �All E�ibits Attached
✓❑HB 06-1343 and 07-1073 Legislation Included in RFP and/or Contract
✓ ❑All Legal Descriptions Attached (if appropriate)
✓ QNotice of Award/Proceed Attached (if appropriate)
✓ ❑Warranty, ifapplicable
❑Special Instructions for Finance Department:
�Sent to Clerk and Recorder for Scanning/Archiving
�Authorized Staff Person's Name: Hilary Fletcher
BY CHECKING ABOVE AND ENTERING NAME, THE AUTHORIZED STAFF
PERSON INDICATES THAT THE ATTACHED DOCUMENT HAS BEEN PROOFED
AND READY FOR SCANNING.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE
WITH COLORADO STATE ARCHNES RETAINAGE SCHEDULE.
AMENDED 04/Ol/08
OTHER TRANSACTION AGREEMENT (OTA) BETWEEN
FEDERAL AVIATION ADMINISTRATION (FAA)
AND
THE ASPEN/PITKIN COUNTY AIRPORT
ARTICLEI-PARTIES
The pazties to this Agreement aze the Federal Aviation Administration (FAA) and the Aspen/
Pitkin Counry Airport hereafter known as the "Airport."
ARTICLE 2 - SCOPE
a. The purpose of this Agreement between the FAA and d�e Airport is to provide funds, as set
forth in this Agreement, for the Aiiport to obtain permits and construct a Video Surveillance
Advisory System (VSAS) field site in accordance with the requirements of:
• FAA Specificauon G1217F — Electrical, Interior
• FAA Standard 019E — Lightning and Surge Protection, Grounding, Bonding and
Shielding Requirements for Facilities and Electronic Equipment
• IEEE C2 — National Electrical Safety Code
• NFPA 70 — Na[ional Electrical Code
• Criteria oudined in Title 14, Code of Federal Regulations (14 CFR) Parts 65, 91, 121, and
171.
b. Specific goals az�d objec[ives to be accomplished:
1. Provide the Airport with funds as specified in Article 8 for a VSAS field site.
2. After the Contractor Acceptance Inspection (CAI) of the construction activities for
the VSAS field site, the FAA will assume full responsibiliry for the facility
maintenance, repair, and upkeep of the VSAS field site.
3. The VSAS field si[e to be constructed must meet the requirements for
acceptance/continuance de[ailed in the approved construction package. It is understood at
the onset by all pazties that [he design used to construct this VSAS field site is based on
the facility being azi un-staffed facility and maintained by FAA personnel and that
Airport funds may Ue necessary to supplement the funding provided by the FAA.
c. Management of the Project:
1. The Auport will manage the VSAS field site construction. The VSAS siting has
already been completed by the FAA, and the final resultant report approved. The
Airport will construct the VSAS field site at the approved location iden[ified in
[he siting report.
2. The Airport will manage the installation of all equipmen[ required for the VSAS
field site, except those equipments supplied and installed by the FAA, as specified
in Attachment 1, "FAA Planned — Equipment List."
3. The Airport will manage, own, and maintain the VSAS field site facility and
equipment they install until completion of the CAI which will coiucide with the
transfer of utility services.
4. The FAA will provide oversight and approval of the field site construction through
inspections and CAI.
5. Upon accep[ance of the Airport's construc[ion via CAI, the FAA will complete the
installation of all remaining systems and conduct the necessary evaluation of
VSAS for FAA Air Traffic use at Aspen.
d. Roles and Responsibilities:
1. The Airport will install, in existing inner duct, 24 count Single Mode fiber
between the ATC Tower base fiber patch panel and the VSAS fiber junction box
per FAA approved plans and specifications.
2. The Airport will arrange for commercial power service from a utility transformer
to the VSAS field site lA, and provide elec[rical power terminations within the
exterior electrical Uox, excluding low vol[age systems and data transmission
systems, per FAA approved plans and specifications.
3. The Airport will lay die foundation for the field site lA infrastructure support pad
and camera mast including interconnecting conduits (pole, pad & manhole) per
FAA approved plans and specifications.
4. The Airport will procure and erect camera mast and support infrastructure
mounting system (masts/poles and unistrut) at field site lA based on plans and
specifications approved by the FAA.
5. The Airport will install the specified grounding system at field site lA as defined
by FAA approved plans and specifications.
6. The Airport is responsiUle for the installation of an exterior elect�ical rack,
roughly defined as a power disconnect switch, uninterrup[ed power supply, power
breaker panel, 24 volt power supply, fiber j-box and patch panel, and
camera/network equipment j Uox on die support infrastructure pad as defined by
FAA approved plans and specifications.
7. The Airport will run flex conduit and/or cable raceway for communication and
power interconnectiviry on the support infras[ructure pad as defined by FAA
approved plans and specifications.
8. The Aixport will back fill / compact / grade / seed ductba�ik and site lA and
prepare necessary gravel surface access to the site.
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9. The Airport is responsible for Post Installation painting / touchup for items
installed by the Airport up to transfer of responsibility.
10. The Airport will provide construction as-built drawings.
11. The FAA will conduct site survey and geotechnical surveys for the airfield
implementation.
12. The FAA will prepare the Site Engineering Report.
13. The FAA will provide and install the fiber patch panel and temunate the fiber
between the ATC Tower and the field site lA.
14. The FAA will structurally design and approve the functional design of the camera
mast (pole, obstruction light, ladder, safety rail, utility receptacle, lighting
arrestor) prior [o conshuction solicitation release.
15. The FAA will design the founda[ion and provide draft layouts, specification of
materials, and interconnectivity of the camera mast and infrastructure support pad.
16. The FAA will provide and install the VSAS equipment at field site lA.
17. The FAA will provide, install, and maintain, after CAI of the VSAS site
infrastructure, all specified and unspecified equipment necessary for a complete
and useable system preliminarily defined by the FAA and specified in Attachment
1, "FAA Planned — Equipment List "
18. The FAA will install all necessary equipment interior to the ATC Tower.
19. The FAA will provide, construction administration support, and design
clarification for approved plans in a timely manner to maintain planned
construction schedule for field site lA.
20. The FAA will install, operate and maintain the VSAS equipment at field site lA
after CAI.
21. The FAA will assume responsibility for telecommunications circuits from field
site lA to the ATCT after compleuon of the construc6on CAI.
22. The FAA will periodically brief the appropria[e stakeholders on overall VSAS
project status.
23. The pazties recognize the importance of a cohesive team approach to ensure tha[
all necessary program requirement submissions are reviewed and dispositioned on
a timely basis. The Airport will work closely with the FAA Offices as identified
in Article 7 to ensure that all requirements are met. In addition, the Airport will,
as a minimum, submit for review and concurrence by said FAA offices, 100%
design to ensure that coordination has occuned and requirements are adequately
addressed.
3
24. The FAA may choose [o install additional operationally required equipment at a
later date subject to local land use approvals and permitting. 5uch equipment
would be acquired, installed, and maintained by the FAA. This should not Ue
considered a promise or commitment for the FAA to supply equipment in the
future. The procurement and installation of future FAA equipment is subject to
the validation of a requirement for the equipment and budgeting priorities.
25. The FAA with Airport assistance will prepaze necessary environmen[al finding
documentation (proposed Environmen[al Checklist with Categorical Exclusion) to
fulfill the terms of NEPA regula[ions regarding the land use and cons[ruction. The
FAA is responsible for the approval and signature of the document.
e. Contributions of the Parties:
FAA funds are defined in Article 9.
f. Type of Agreement
This Agreement is an "Otlter Transaction.° It is not intended to be, nor will it be
construed as, a paztnership, corporation, or other business organization.
This Agreement is separate and distinct from any other associated agreements
entered into between the Airport and the FAA for the construction of the VSAS
field site. This Agreement will take precedence over any attachments in the event
that the terms and conditions of die attachments and this Agreement contradict
each o[her or that there is a dispute over the terms and conditions.
g. The Parties are bound by a duty of good faith and best effort in achieving the goals of
the Agreement.
h. The Airport is the recipient of these supplemental funds and agrees to adhere [o
reporflng requirements in Ar[icle 5.
ARTICLE 3- EFFECTIVE DATE and TERM
The effective date of this Agreement is the date on which it is signed by the FAA or
Airport, whichever is later. This Agreement will remain in effect until the Agreement is
concluded in accordance with Article 4 unless earlier terminated by the parties as
provided herein.
0
ARTICLE4-SCHEDULE
The Airport agrees to complete the development of specifications and design and release
bid approved specifications for the construction of VSAS facility within 10 days from the
effective date of this Agreement assuming all FAA input [o bid documents has been
received by this date.
The Aiiport agrees to have the VSAS field site lA ready for CAI within four (4) months
after the effective date of this Agreement subject to obtaining timely approval: (a) by
other federal agencies of pemu[s and plans required for construction; (b) by State and
local agencies of pemuts required for design and constiuction of the VSAS field site; and
(c) environmental documents, if applicable.
The Airport agrees to use its best efforts to obtain timely FAA and odier federal
approvals and County and State approvals, as required. However, unreasonable or
unforeseen failure or delay by the FAA or other federal agencies to issue approvals or
pernuts will be considered an excusable delay. Fur[her, delays caused by litigation or bid
protests or other circumstances beyond the control of [he Airport also will be considered
excusable. Such an excusable delay will entitle the Aiiport to an extension of the 4-
month completion schedule and will not be considered a breach of tltis Agreement.
ARTICLE 5 - REPORTING REQUIREMENTS
The Airport will provide the FAA with a written progress report every Month, or sooner
as needed, regarding (1) status of the desigu, construction, and environmental efforts, (2)
the efforts of the Airport in the award of the field site construction contract, (3) status of
FAA funds received, spent, and remaining, and (4) the estimated date the VSAS field site
IA will be available for inspections, CAI, and installation of equipment to be installed by
the FAA.
These progress reports will be provided to FAA until (a) all funds under this agreement
have been expended, or (b) the field site cons[ruction has been completed.
The progress report will be sent to the FAA Contracting Officer, the Terminal Planning
Account Manager, and the Temunal Surveillance Project Lead for the Aspen VSAS
project as set for[h in ARTICLE S, below.
5
ARTICLE 6. INTELLECTUAL PROPERTY
a. Rights in Data
The Govemment retains Govemment Purpose Rights in all data developed under
this agreement.
"Data" means recorded information, regardless of form or method of recording,
which includes but is no[ limi[ed to, technical data, computer software, trade
secrets, and mask works. The term does not include financial, adminis[rative,
cost, pricing or management infoimation.
"Govemment Purpose Righ[s" means the rights to —
(1) Use, modify, reproduce, release, perform, display, or disclose data within the
government without res[riction; and,
(2) Release or disclose technical data outside the govemment and authorize
persons to whom release or disclosure has been made to use, modify, reproduce,
release, perform, display, or disclose diat data for government purposes.
"Government Purpose" means any activity in which the United States
Government is a party, including cooperative agreements with intemational or
mul[i-national defense organizations, or sales or transfers by the United 5tates
Government to foreign govemments or international organizations. Government
purpose include compefltive acquisition by or on behalf of the govemment but do
not include the rights to use, modify, reproduce, release, perform, display, or
disclose data for commercial pmposes or au[horize others to do so.
U. Rights in Inventions
The respecdve rights of the Govemment and the other pazties to this agreement
aze the same as those found at T.5-10 "Patent Rights — Retention by the
Contractor (Short Form)".
ARTICLE 7 - LEGAL AUTHORITY
This Agreement is entered into uuder the authority of 49 U.S.C. 106(1) and (m), which
authorizes agreements and other [ransactions on such terms and conditions as the FAA
Administrator deternunes necessary.
�
... �
ARTICLE 8- POINTS OF CONTACT
FAA Parties
For tlte FAA regarding this Agreement
Name: Robert Valdes, AJA-46
Contracting Officer
Terminal & En Route Contracts Group
Phone:202-385-6157
Robert.valdes @faa.gov
Address: Federal Aviation Adminis[ration
600 Independence Avenue S.W.
FOB lOB, Fourth Floor # 4W41JS
Washington, DC 20591
Name: David L. Reynolds
Contract Specialist
Phone:202-385-8658
David.L.Reynolds @faa.gov
Address: Federal Aviation Administration
600 Independence Avenue S.W.
FOB10B, Fourth F1oor# 4W41HS
Washington, DC 20591
For the FAA regarding overall project
Name: Malcolm Andrews
Terminal Services Acting Director
Phone:202-385-8615
Malcolm. andrews @ faa.gov
Address: Wilbur WrightBldg. (FOBlOB)
FAA National Headquarters
600 Independence Ave., SW
Washington, DC 20591
7
For [he FAA regarding technical and project implementation
Name: Pamela Maxwell
ASE VSAS Project Lead
Phone:202-385-8717
Pamela.ma7cwe11 @ faa.gov
Address: Wilbur Wright Bldg. (FOB lOB)
FAA National Headquarters
600 Independence Ave., SW
Washington, DC 20591 .
Non-FAA Partv
For die Airport
Name: Jim Elwood
Airport Director
Phone: 970 429-2851
Fax:970-920-5378
Jim.Elwood C� co.pi tkin. co.us
Address: 0233 E. Airport Road
E Concourse, Suite A
Aspen, CO 81611
ARTICLE 9- FUNDING AND PAYMENT
a. The total not to exceed (NTE) cost of this agreement is $320,000.
b. $320,000 will be disbursed to the Aiiport within 30 days after the effective date of this
Agreement for design, specifications, permits, construction, and related work. Please
complete Attachment 3(Vendor/Miscellaneous Payment Information Form) when this
A,greement is signed by the Aiiport.
c. Within 2 months from the execution date of the Agreement, the Airport will submit a
project budget plan to the FAA for review. The plan should address the completion of the
field site construction.
d. The Auport will notify the FAA when the following milestones occur: (1) the Airport
releases the construction solicitarion, and (2) the Airport makes an awaz�d for the
construction contract.
e. In no even[ will the FAA's total contribution exceed the amount stated in Article 9(a).
f. It is understood by the parties that the funds supplied by the FAA through the OTA
will cover the full cost of the project.
�
g. With the funds provided under this Agreement, the Airport will design, construct, equip,
and maintain through CAI the VSAS field site at the Airpor[. All funds provided by the
FAA under this Agreement will be used by the Airport only for the purposes ab eed to in
Article 2.
h. Nothing contained herein will prevent this Agreement from being amended or
modified. Such amendments and/or modifications must be in writing and signed by
the parties.
i. In the event of termination or expiration of this Agreement, any FAA funds which
have not been spent or obligated for allowable expenses prior to the date of
termination, and are not reasonaUly necessary as detennined by the FAA to cover
termination expenses will Ue returned to the FAA. The Airport will not be required
to return funds that were expended on allowable expenses.
j. A formal request for payment should be submitted to the FAA at the billing address
identified Uelow.
Billing Address:
Federal Aviation Administration
Ternunal Services Branch
600Independence Aveime, S.W.
FOB lOB, Fourth Floor
Washington, DC 20591
ARTICLE 10 - LIMITATION OF FUNDS
The Federal Government's liability to the Airport is limited to $320,000.
ARTICLE 11- COMPETITION FOR CONSTRUCTION
The contract for the construction of the aforementioned facility shall be awarded through
compedtive procurement procedures unless the Airport can demonstrate that single-
source contractivg is more advantageous, cost and oflier factors considered.
ARTICLE 12 - AUDITS
The Federal Government has the right to examine and/or audit relevant financial records
relating to this agreement and the design and construction of the field site for a period not
to exceed three years, after expiration of the term of this Agreement. The Airport and
contractors/subcontractors must maintain an accoundng system that complies with
acceptable accounting standards.
In addition to any other existing authority the Department of Transportation Inspector
General or the Comptroller General has, the Inspector General and Comptroller General
are further authorized (a) to examine any records of the Authority or any of its
contractors that pertain to, and involve transac[ions relating to, the contract or
subcontract; and (b) to interview any officer or employee of the Authority or contractor.
ARTICLE 13 - CHANGES, MODIFICATIONS
Changes and/or modifications to this Agreemen[ will be in writing and signed by a FAA
Contracting Officer and the Airport. The modification will cite this Agreement, and will
state the exac[ nature of the modification. No oral statement by any person will be
interpreted as modifying or otherwise affecting the terms of this Agreement.
ARTICLE 14 - TERMINATION
This Agreement will be concluded when (1) the Airport's contractor(s) has completed the
design aud construction of the VSAS field si[e, and (2) the FAA has approved said
facility via CAI. The FAA may [erminate this Agreement with or without cause with a
30-day notice in writing.
ARTICLE 15 - ORDER OF PRECEDENCE
In tlte event of any inconsistency between the terms of the Agreement, the inconsistency
will be resolved by giving preference in the following order:
(a) The Agreement
(b) The Attachments
ARTICLE 16 - CONSTRUCTION OF THE AGREEMENT
This Agreement is an 'bther transaction" issued under 49 U.S.0 106 (1) and (m) and is
not a procurement contrac[, e ant or cooperative agreement. Nothing in this Agreement
will be construed as incorporating by reference or implication any provision of Federal
acquisition law or regula[ion.
Each party acknowledges that all parties hereto participated equally in the negotiation and
drafting of [his Agreement and any amendments thereto, and that, accordingly, this
Agreement will not be cons[rued more stringently against one party than against the
other.
10
ARTICLE 17 — DISPUTES
Where possible, disputes will be resolved by informal discussion between the parties. In
the event the parties are unable to resolve any disagreement through good faith
negotiations, the dispute will be resolved by altemative dispute resolution using a method
to be agreed upon by the parties. The outcome of the al[erna[ive dispute resolution will
be final unless it is timely appealed to the Administrator, whose decision is not subject to
further administrative review and, [o the extent pernutted by law, is final and bindiug (see
49 USC 46110).
ARTICLE 18 - WARRANTIES
The FAA makes no express or implied warranties as to any matter arising under this
Agreement, or as to [he ownership, merchantability, or fitness for a pazticulaz purpose of
any property, including any equipment, device, or software that may be provided under
this Agreement.
ARTICLE 19 - INSURANCE
Airport will arrange Uy insurance or otherwise for the full protection of Airport from and
against all liability to third par[ies arising out of, or related to, its performance of this
Agreement. The FAA assumes no liability under this Agreement for any losses arising
out of any action or inaction by Airport, its employees, or cont��actors, or any third party
acting on its behalf. The Airport agrees to hold [he United States huinless against any
claim by third persons for injury, death or property damage arising out of or in
connection with its performance under this Agreement.
ARTICLE 20 - LINIITATION OF LIABILITY
Claims for damages of any uature whatsoever pursued mider this Agreement will be
limited [o direct damages only up to [he aggregate amount of funding obligated under this
Agreement at the time the dispute arises. In no event will the FAA be liable for claims for
consequential, punitive, special and incidental damages, claims for lost profits, or other
indirect damages.
11
ARTICLE 21 - LOWER TIER AGREEMENTS
The Airport hereby certifies to the FAA [hat it will comply with all applicable Federal
laws, regula[ions, executive orders, policies, guidelines and requirements, and State and
local ordinances and regulations as [hey relate to the application, acceptance and use of
Federal funds for this project. In addi[ion to the General Requiremen[s cited in this
Ar[icle aUove, [he following specific Federal statutes and guidelines will be complied
with by the Airport:
• Davis-Bacon Act — 40 U.S.C. 3141, et. Seq.
• Drug Free Workplace Act of 1988 - 41 U.S.C. 702 through 706
• Buy American Act Clauses 3.6.4-3 and 3.6.4-5 (see a[tachment 3)
ARTICLE 22 - CIVIL RIGHTS ACT
Airport will comply with Title VI of the Civil Rights Act of 1964 relating to
nondiscrimination in Federally-assisted programs and provide a certification to that
effect.
ARTICLE 23 - OFFICIALS NOT TO BENEFIT
FAA Acquisi[ion Management System (AMS) Clause 3.2.5-1, "Officials Not to Benefit"
and Clause 3.2.5-7, "Disclosure Regarding Payments [o Influence Certain Federal
Transactions" are attached hereto and incorporated by reference into this Agreement.
ARTICLE 24 - PROTECTION OF INFORMATION
The par[ies agree that they will take appropriate measures to protect proprietazy,
privileged, or otherwise confidential information that may come into [heir possession as a
result of this Agreement.
AGREED:
Aspen-Pitkin County Airport
-�.: ,��-;� � �.<
Hill Fle[cher
Pitkin County Manager
Date: �` " � � " � d
Feder iation d 'nisU'ation
�
Robert Valdes, AJA-46
Contracting Officer
Date: �(�/�
Witness:
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Attachment 2: Federal Aviation Administrafion
VENDOR / MISCELLANEOUS PAYMENT INFORMATION FORM
This form is used for both Taupayer ldentification Number (TIN) no[ification and Automated Clearing House
(ACH) payments with an addendum record that contains payment-related information processed through the
Vendor Express Program. Recipients of these payments should bring this information to the attention of
their financial institution when presenting this form for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579) and the Debt
Collection Improvement Act of 1996 (P.L. 104-134, Ch. 10). All information collected on this form is required
under the provisions of 31 U.S.C. 3322 and 7701, 31 CFR 210, and Internal Revenue Code 6109. This
informa[ion will be used by the Treasury Department to transmit payment data, by electronic means to
vendor's financial institution. The FAA will use the TIN information for purposes of collecting and reporting
on any delinquent amounts arising out of such person's relationship with the Government. Failure to provide
the information may delay or prevent the receipt of payments through the Automated Clearing House
Payment System.
Federal Aviation Adminlstmtion
AGENCY IDENTIFIER: I AGENCY IOCATION CODE (ALC):
FAA 69-00-1704
ADDRESS:
800lndependence Avenue, SW
Washington, DC 20591
CONTACT PERSON NAME: I
Ralph Nobie, AFM-220
ADDITIONAL INFORMATION (Assigned payee vendor number, etc.):
ACH FORMAT:
[X] CCD+ f ] CTX [ ] CTP
TELEPHONENUMBER:
( 202 ) 267-8986
or
SOLE PROPRIETOR NAME (If different from above):
BUSINESS STATUS: (Check here if previously provtded []j
[ ] Individual/Sole Proprietor [ ] Corporation [ ] Partnership
[ ] Other (please specity)
ADDRE55:
CONTACT PERSON NAME: I TELEPNONE NUMBER:
( �
Are vou sublect to "backuo wlthhoidinq" per Internal Revenue Code Sec. 6041 or 6041A(a�7 Please check one box below:
[ j I am Exempt from Backup withholding [] I have not been notified by IRS that I am subJect to Backup W khholding as a result of
faiWre to report all Interest or dividends � 1 ihe IRS has notifled me that I am no longer subject to backuy withholding.
TIN Certification. Under penalties of perjury, I certify that the number shown above Is my correct TIN (or I arn waiting tor a number
to be issued to me), and the backup withholding status as marked above is correci.
Rinnaturw � Date � . .
ADDRESS:
ACH COORDINATOR NAME:
sita, please check this box f]
NIlVE-DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACGOUNT TITLE:
DEPOSITOR ACCOUNT NUMBER
I TELEPHONE NUMBER:
( )
TYPE OF ACCOUNT:
[] CHECKING J 1 SAVINGS f] LOCKBOX
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: TELEPHONE NUMBER:
(Could be same as ACH Coordinator) I ( )
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Substitute Form 3881 and W-9 Form (Combined) Created by the Federal Aviation Administration (FAA)
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ATTACF3MENT 3: Buy American Act - Construction Materials (July 1996)
(a) The Buy American Act (41 U.S.C. 10) and Executive Order No. 10582, dated
December 17, 1954, as amended, provide that the Govemment give preference to
domestic construction material. The restrictions of the Buy American Act do not apply
when the FAA deternunes use of a pazticular domestic construction material: (i) would
unreasonably increase the cost; (ii) would be impracticable; or (iii) is not mined,
produced, or manufactured in sufficient and reasonably available commercial quantities
of a satisfactory quality.
(b) Definitions:
(1) "Components," as used in this clause, means those articles, materials, and supplies
incorporated directly into construction materials.
(2) "Construction material," as used in this clause, means an article, material, or supply
brought to the construcuon si[e for incorporation into the building or work. ConsWction
material also includes an item brought to the site pre-assembled from articles, materials
or supplies. However, emergency life safety systems, such as emergency lighting, fire
alarm, and audio evacuation systems, which are discrete systems incorporated into a
public building or work and which aze produced as a complete system, shall be evaluated
as a single and distinct construction material regardless of when or how the individual
parts or components of such systems are delivered to the construction site.
(3) "Domestic construction material," as used in this clause, means (i) an unmanufactured
construc[ion material mined or produced in [he United States, or (ii) a construc[ion
material manufactured in the United States, if the cost of its components mined,
produced, or manufactured in the United States exceeds 50 percent of the cost of all its
components. Components of foreign origin of the same class or kind as the consh�uction
materials deternuned to be unavailable shall be treated as domestic.
(c) The Authority agrees that only domestic construction material will be used by the
Authority, the Contractor, subcontractors, material men, and suppliers in [he performance
of this contract, except for foreign construction materials, if any, listed in this contract.
3.6.4-5 Buy American - Steel and Manufactured Products (July 1996)
(a) Section 9129 of the Aviation Safety and Capacity Expansion Act of 1990 (Subtitle B
of Tide IX of Pub. L. 101-508, the Omnibus Budget Reconciliation Act of 1990) requires
the use of steel and manufactured products produced in the United States when a project
such as tha[ covered by this contract receives funding.
(b) The Contractor shall deliver only steel and manufactured products produced in the
United States. This requirement shall not apply where the Secretazy or his or her designee
has found--
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(1) That its application would be inconsistent with the public interest;
(2) That such materials are not produced in [he United States in sufficieut and reasonably
available quantities and of a satisfactory quality;
(3) In the case of the procurement of facili[ies and equipment under the Airport uid
Airway Improvement Act of 1982, (i) the cost of components and subcomponents which
are produced in the United States is more than 60 percent of the cost of all components to
be delivered under this contract, and (ii) final assembly of the facility or equipment to be
delivered under this contract has taken place in die United States; or
(4) That inclusion of domestic material will increase the cost of dte overall contract by
more than 25 percent. _
(c) In calculating components' costs, labor cos[s involved in final assembly shall not be
included in the calculation.
(d) This clause takes precedence over the provisions of clause "Buy American Act--
Supplies" and clause "Buy American Act--Construction Materials" in respect to their
applicabiliry to steel and manufactured products.
(e) The offeror warrants that steel and manufactured products to be used in the project aze
produced in the United States, and that components of unknown origin are considered to
have been produced or manufactured outside the United States. Should any end product
be of foreign origin, the Contractor shall identify, in writing, such products and country
of origin to the Contracting Officer prior [o contract award. Such information is required
in implementation of Section 9129 of the Aviation Safety and Capacity Expansion Act of
1990, (SuUtide B of Title IX of P. L. 101-508, the Omnibus Budget Recouciliation Act of
1990).
3.6.4-18 Certification Regarding Steel and Manufactured Products (April
2009)
In accordance with 49 USC Section 50101, the offeror/contrac[or cer[ifies that:
[Check one]
The steel and manufactured goods, including components and subcomponen[s
provided in accordance with this contract are entirely produced in United States (or
deemed United States produced pursuaz�t to Intemational Agreement)
The cost of components azid subcomponents produced in the United States is more
than 60 percent of the cost of all components of the facility or equipment and final
assembly of the faciliry or equipment has occurred in the United States
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