5100-129 Construction Project Final Acceptance - Airport Improvem

U.S. Department
of Transportation
Federal Aviation
Administration

FAA Form 5100-129, Construction Project Final Acceptance –
Airport Improvement Program 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 the Federal Aviation
Administration at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection
Clearance Officer, ASP-110.

FAA Form 5100-129

U.S. Department of Transportation
Federal Aviation Administration

OMB CONTROL NUMBER: 2120-0569
EXPIRATION DATE: 8/31/2019

Construction Project Final Acceptance
Airport Improvement Program Sponsor Certification
Sponsor:
Airport:
Project Number:
Description of Work:

Application
49 USC § 47105(d), authorizes the Secretary to require me certification from the sponsor that it will
comply with the statutory and administrative requirements in carrying out a project under the Airport
Improvement Program. General standards for final acceptance and close out of federally funded
construction projects are in 2 CFR § 200.343 – Closeout and supplemented by FAA Order 5100.38. The
sponsor must determine that project costs are accurate and proper in accordance with specific
requirements of the grant agreement and contract documents.
Certification Statements
Except for certification statements below marked not applicable (N/A), this list includes major
requirements of the construction project. Selecting “Yes” represents sponsor acknowledgment 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.
1. The personnel engaged in project administration, engineering supervision, project inspection, and
acceptance testing were or will be determined to be qualified and competent to perform the work
(Grant Assurance).
Yes

No

N/A

2. Construction records, including daily logs, were or will be kept by the resident
engineer/construction inspector that fully document contractor’s performance in complying with:
a. Technical standards (Advisory Circular (AC) 150/5370-12);
b. Contract requirements (2 CFR part 200 and FAA Order 5100.38); and
c.

Construction safety and phasing plan measures (AC 150/5370-2).
Yes

No

N/A

3. All acceptance tests specified in the project specifications were or will be performed and
documented. (AC 150/5370-12).
Yes

No

N/A

FAA Form 5100-129 (1/17) SUPERSEDES PREVIOUS EDITION

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4. Sponsor has taken or will take appropriate corrective action for any test result outside of
allowable tolerances (AC 150/5370-12).
Yes

No

N/A

5. Pay reduction factors required by the specifications were applied or will be applied in computing
final payments with a summary made available to the FAA (AC 150/5370-10).
Yes

No

N/A

6. Sponsor has notified, or will promptly notify the Federal Aviation Administration (FAA) of the
following occurrences:
a. Violations of any federal requirements set forth or included by reference in the contract
documents (2 CFR part 200);
b. Disputes or complaints concerning federal labor standards (29 CFR part 5); and
c.

Violations of or complaints addressing conformance with Equal Employment Opportunity or
Disadvantaged Business Enterprise requirements (41 CFR Chapter 60 and 49 CFR part 26).
Yes

No

N/A

7. Weekly payroll records and statements of compliance were or will be submitted by the prime
contractor and reviewed by the sponsor for conformance with federal labor and civil rights
requirements as required by FAA and U.S. Department of Labor (29 CFR Part 5).
Yes

No

N/A

8. Payments to the contractor were or will be made in conformance with federal requirements and
contract provisions using sponsor internal controls that include:
a. Retaining source documentation of payments and verifying contractor billing statements
against actual performance (2 CFR § 200.302 and FAA Order 5100.38);
b. Prompt payment of subcontractors for satisfactory performance of work (49 CFR § 26.29);
c.

Release of applicable retainage upon satisfactory performance of work (49 CFR § 26.29);
and

d. Verification that payments to DBEs represent work the DBE performed by carrying out a
commercially useful function (49 CFR §26.55).
Yes

No

N/A

9. A final project inspection was or will be conducted with representatives of the sponsor and the
contractor present that ensure:
a. Physical completion of project work in conformance with approved plans and specifications
(Order 5100.38);
b. Necessary actions to correct punch list items identified during final inspection are complete
(Order 5100.38); and
c.

Preparation of a record of final inspection and distribution to parties to the contract
(Order 5100.38);
Yes

No

N/A

10. The project was or will be accomplished without material deviations, changes, or modifications
from approved plans and specifications, except as approved by the FAA (Order 5100.38).
Yes

No

N/A

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11. The construction of all buildings have complied or will comply with the seismic construction
requirements of 49 CFR § 41.120.
Yes

No

N/A

12. For development projects, sponsor has taken or will take the following close-out actions:
a. Submit to the FAA a final test and quality assurance report summarizing acceptance test
results, as applicable (Grant Condition);
b. Complete all environmental requirements as established within the project environmental
determination (Oder 5100.38); and
c.

Prepare and retain as-built plans (Order 5100.38).
Yes

No

N/A

13. Sponsor has revised or will revise their airport layout plan (ALP) that reflects improvements made
and has submitted or will submit an updated ALP to the FAA no later than 90 days from the
period of performance end date. (49 USC § 47107 and Order 5100.38).
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.

FAA Form 5100-129 (1/17) SUPERSEDES PREVIOUS EDITION

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