5370-1 Construction Progress and Inspection Report

Period Ending

OMB Control No. 2120-0569
11/30/2007

CONSTRUCTION PROGRESS AND
INSPECTION REPORT
Project Number

AIRPORT GRANT PROGRAM

U.S. Department
of Transportation
Federal Aviation
Administration

Airport Name
Project Description

Contractor's Name

1. Rough Estimate of Percent Completion to Date of Construction Phases (include Items such as clearing, grading, drainage, base, surface, lighting, etc.)

2. Work Completed or in Progress this period

3. Brief Weather Summary This Period Including Approximate Rainfall and Periods of Below Freezing Temperature
(On earthwork jobs include soil conditions)

4. Contract Time

No Days
Charged To
Date

5. Summary of Laboratory and Field Testing This Period (Note failing tests and any retests. Summarize
out-of-tolerance.)

Last Working
Day Charged
(Date)

Material. (Identify material subject to pay reduction.)

6. Describe Anticipated Work by Contractor for Next Period

7. Problem Areas/Other Comments (Revisions to plans and specifications approved or denied, delays, difficulties, etc. and actions taken.)

Date

SPONSOR'S INSPECTOR OR REPRESENTATIVE
Typed or Printed Name and Title
Signature

FAA Form 5370-1 (8-89) Supersedes Previous Edition

INSTRUCTIONS FOR PREPARATION OF FAA FORM 5370-1 (8-89)

CONSTRUCTION PROGRESS AND INSPECTION REPORT
AIRPORT GRANT PROGRAM

This preaddressed form is to be filled out, with ballpoint pen or typewriter by the Sponsors Inspector on the project,
folded with return address out, fastened, and mailed to the address shown below. No postage Is required since the
postage has been prepaid by the Federal Aviation Administration.
Submit one copy for each report. If additional space Is required to complete any of the items, continue on a separate
sheet of plain paper, identifying it with the project number, fold and insert inside the report before mailing.
If additional blank copies of the form are required, submit your request to the address provided below.

U.S. GPO:1989-261-335/03364

1st Fold

TAPE HERE

Paperwork Reduction Act Statement: The information collected on this form documents the progress of construction work on a project funded with a
Federal grant under the AIP in a form prescribed by the Secretary of Transportation.
Title 49, United States Code (U.S.C.), Section 47121, requires cost and progress reporting by the sponsor. The burden associated with sponsor
certification of qualified engineering and construction specifications, compliance with wage regulations, and periodic performance reporting is estimated to
be 1/2 hour. Sponsors benefit by receiving proceeds of the grant based on documented performance. No assurance of confidentiality can be given since
these become public records. Please note that an agency may conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number, which is 2120-0569 for this collection. Comments concerning the accuracy of this burden and
suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ABA-20 .

2nd Fold
U.S. Department
of Transportation
Federal Aviation
Administration

800 Independence Avenue, S.W.
Washington, D.C. 20591

NO POSTAGE

NECESSARY

IF MAILED

IN THE

UNITED

STATES

BUSINESS REPLY MAIL
FIRST CLASS

PERMIT NO. 12438

WASHINGTON D.C.

POSTAGE WILL BE PAID BY THE FEDERAL AVIATION ADMINISTRATION
Official Business
Penalty for Private Use $200