5100-134 Selection of Consultants - Airport Improvement Program S

U.S. Department
of Transportation
Federal Aviation
Administration

FAA Form 5100-134, Selection of Consultants – Airport
Improvement Program Sponsor Certification
Paperwork Reduction Act 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 5100-134

U.S. Department of Transportation
Federal Aviation Administration

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

Selection of Consultants
Airport Improvement Program 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 requirements for selection of consultant services within federal grant programs
are described in 2 CFR §§ 200.317-200.326. Sponsors may use other qualifications-based procedures
provided they are equivalent to standards of Title 40 chapter 11 and FAA Advisory Circular 150/5100-14,
Architectural, Engineering, and Planning Consultant Services for Airport Grant Projects.
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.
1. Sponsor acknowledges their responsibility for the settlement of all contractual and administrative
issues arising out of their procurement actions (2 CFR § 200.318(k)).
Yes

No

N/A

2. Sponsor procurement actions ensure or will ensure full and open competition that does not
unduly limit competition (2 CFR § 200.319).
Yes

No

N/A

3. Sponsor has excluded or will exclude any entity that develops or drafts specifications,
requirements, or statements of work associated with the development of a request-forqualifications (RFQ) from competing for the advertised services (2 CFR § 200.319).
Yes

No

N/A

FAA Form 5100-134 (2/17) SUPERSEDES PREVIOUS EDITION

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4. The advertisement describes or will describe specific project statements-of-work that provide
clear detail of required services without unduly restricting competition (2 CFR § 200.319).
Yes

No

N/A

5. Sponsor has publicized or will publicize a RFQ that:
a. Solicits an adequate number of qualified sources (2 CFR § 200.320(d)); and
b. Identifies all evaluation criteria and relative importance (2 CFR § 200.320(d)).
Yes

No

N/A

6. Sponsor has based or will base selection on qualifications, experience, and disadvantaged
business enterprise participation with price not being a selection factor (2 CFR § 200.320(d)).
Yes

No

N/A

7. Sponsor has verified or will verify that agreements exceeding $25,000 are not awarded to
individuals or firms suspended, debarred or otherwise excluded from participating in federally
assisted projects (2 CFR §180.300).
Yes

No

N/A

8. A/E services covering multiple projects: Sponsor has agreed to or will agree to:
a. Refrain from initiating work covered by this procurement beyond five years from the date
of selection (AC 150/5100-14); and
b. Retain the right to conduct new procurement actions for projects identified or not
identified in the RFQ (AC 150/5100-14).
Yes

No

N/A

9. Sponsor has negotiated or will negotiate a fair and reasonable fee with the firm they select as
most qualified for the services identified in the RFQ (2 CFR § 200.323).
Yes

No

N/A

10. The Sponsor’s contract identifies or will identify costs associated with ineligible work separately
from costs associated with eligible work (2 CFR § 200.302).
Yes

No

N/A

11. Sponsor has prepared or will prepare a record of negotiations detailing the history of the
procurement action, rationale for contract type and basis for contract fees (2 CFR §200.318(i)).
Yes

No

N/A

12. Sponsor has incorporated or will incorporate mandatory contact provisions in the consultant
contract for AIP-assisted work (49 U.S.C. Chapter 471 and 2 CFR part 200 Appendix II)
Yes

No

N/A

FAA Form 5100-134 (2/17) SUPERSEDES PREVIOUS EDITION

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13. For contracts that apply a time-and-material payment provision (also known as hourly rates,
specific rates of compensation, and labor rates), the Sponsor has established or will establish:
a. Justification that there is no other suitable contract method for the services (2 CFR
§200.318(j));
b. A ceiling price that the consultant exceeds at their risk (2 CFR §200.318(j)); and
c.

A high degree of oversight that assures consultant is performing work in an efficient
manner with effective cost controls in place 2 CFR §200.318(j)).

Yes

No

N/A

14. Sponsor is not using or will not use the prohibited cost-plus-percentage-of-cost (CPPC) contract
method. (2 CFR § 200.323(d)).
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.
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.
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 5100-134 (2/17) SUPERSEDES PREVIOUS EDITION

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