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Revised Per Addendum No. 1 — 2/16/2024
ITEMIZED PROPOSAL
WATERLOO REGIONAL AIRPORT
WATERLOO, IOWA
PROJECT: • MISCELLANEOUS LIGHTING REPLACEMENT
FAA AIP PROJECT NO. 3-19-0094-048
ITEM
UNIT
ESTIMATED
QUANTITY
UNIT QUOTE
PRICE
TOTAL QUOTE
PRICE
NO.
DESCRIPTION
1
SRE LED IIIGII BAYob
REPLACEMENT
LS
1.0
so
$ 102 3,Z,
$ 1 a, 342
2
ARFF
REVISIONS NG AND LIGHT
LS
1.0
$ f Q` 10 '
$ p� �'+<D
3
HANGAR 1& 2 LED LIGHTING
REPLACEMENTi
LS
1.0
e
OD
$ $
$ ,u, $.22
TOTAL
BASE BID
oa
$ 4//,
O l y
ADI) ALTERNATE
NO. 1
4
SRE BRANCH CIRCUIT
LS
444
$ N/A
$ N/A
TOTAL ADD AL
$ N/A
I'ERNATE NO. 1
4. The undersigned understands that the above quantities of work to be done are approximate only and are
intended principally to serve as a guide in evaluating the bids. All quantities are subject to increase or
decrease and are to be performed at the unit prices stipulated herein.
5. It is understood that the schedule of minimum wage rates, as established by the Secretary of Labor and
included in the Specifications, are to govern on this project, and the undersigned certifies that he has examined
this schedule of wage rates and that the prices bid are based on such established wage rates.
6. The bidder shall make good faith efforts, as defined in Appendix A of 49 CFR Part 26, Regulations of the
Office of the Secretary of Transportation, to subcontract zero (0%) percent of the dollar value of the prime
contract to small business concerns owned and controlled by socially and economically disadvantaged
individuals (DBE). Individuals who are rebuttably presumed to be socially and economically disadvantaged
include women, Blacks, Hispanics, Native Amei icans, Asian -Pacific Amei icans, and Asian -Indian Americans.
The apparent successful competitor will be required to submit information concerning the DBE's that will
participate in the contract. The information will include the name and address of each DBE, a description of
the work to be performed by each named firm, and the dollar value of the contract. If the bidder fails to
achieve the contract goal stated herein, it will be required to provide documentation demonstrating that it made
good faith efforts in attempting to do so. In the event that the apparent successful competitor for this
solicitation qualified as a DBE, the contract goal shall be deemed to have been met. A bid that fails to meet
these requirements will be considered nonresponsive.
7. The undersigned certifies that he does not maintain or provide for his employees any segregated facilities at
any of his establishments, and that he does not permit his employees to perform their services at any location,
under his control, where segregated facilities are maintained The undersigned certifies further that he will not
maintain or provide for his employees any segregated facilities at any of his establishments, and that he will
not permit his employees to perform their services at any location, under his control, where segregated
facilities are maintained. The undersigned agrees that a breach of this certification is a violation of the equal
opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any
waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, timeclocks, locker
rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas,
transportation, and housing facilities provided for employees which are segregated by explicit directive or are
in fact segregated on the basis of race, color, religion, or national 01 igin, because of habit, local custom, or any
other reason. The undersigned agrees that (except where he has obtained identical certifications from
proposed subcontractors for specific time periods) he will obtain identical certifications from proposed
subcontractors prior to the award of subconti acts exceeding $10,000 which are not exempt from the provisions
of the equal opportunity clause, and that he will retain such certifications in his files.
FAA AIP 3-19-0094-048
P-2 Miscellaneous Lighting Replacement
AECOM Project ##60675091 Waterloo Regional Airport - 60675091
8. The undersigned understands, award of contract is contingent upon receipt ofproject funding from the Federal
Aviation Administration. If funding is not received, the project will be postponed.
9. The undersigned further agrees that if awarded the Contract, he will commence the work within ten (10)
calendar days after the receipt of a "Notice to Proceed" and that he will substantially complete all work
according to the terms of the entire contract by April 12, 2024. An extension of time may be allowed when
extra or additional work is ordered by the Engineer.
10. The undersigned agrees that within 30 days after award of this contract, the Contractor/Subcontractor shall file
a compliance report (Standard Form 100) if s/he has not submitted a complete compliance report within 12
months proceeding the date of award. This report is required if the Contractor/Subcontractor meets all of the
following conditions:
a. Contractors/Subcontractors are not exempt based on 41 CFR 60-1,5.
b. Has 50 or more employees.
c. Is a prime contractor or first tier subcontractor.
d. There is a contract, subcontract, or purchase order amounting to $50,000 or more.
11. To satisfy Clear Air and Water Pollution Control Requirements on all Construction Contracts and
Subcontr acts exceeding $100,000.00 Contractors and Subcontractors agree:
a. That any facility to be used in the performance of the Contract or to benefit from the Contract is not listed
on the Environmental Protection Agency (EPA) List of Violating Facilities.
b. To comply with all the requirements of Section 306 of the Clean Air Act (42 USC 1857(h)), and Section
508 of the Clean Water Act (33 USC 1368), Executive Order 11738, and Environmental Protection
Regulations (40 CFR Part (15)).
c. That as a condition for award of a Contract he shall notify the awarding official of the receipt of any
communication from EPA indicating that a facility to be utilized for performance of or benefit from the
Contract is under consideration to be listed on the EPA List of Violating Facilities.
d. To include or cause to be included in any Contract or Subcontract which exceeds $100,000.00 the
aforementioned criteria and requirements.
12. The contractor, by submission of this offer and/or execution of a contract, certifies that it:
a. is not owned or controlled by one or more citizens or nationals of a foreign country included in the list of
countries that discriminate against U.S. firms published by the Office of' the United States trade
Representative (USTR).
b. has not knowingly entered into any contract or subcontract for this project with a contractor that is a
citizen or national of a foreign country on said list or is owned or controlled directly or indirectly by one
or more citizens or nationals of a foreign country on said list.
c. has not procured any product nor subcontracted for the supply of any product for use on the project that is
produced in a foreign country on said list.
Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with
49 CFR 30.17, no contract shall be awarded to a contractor or subcontractor who is unable to certify to the
above. If the contractor knowingly procures or subcontracts for the supply of any product or service of a
foreign country on the said list for use on the project, the Federal Aviation Administration may direct, through
the sponsor, cancellation of the contract at no cost to the Government.
FAA AIP 3-19-0094-048 P-3 Miscellaneous Lighting Replacement
AECOM Project #60675091 Waterloo Regional Airport - 60675091
Further, the contractor agrees that, if awarded a contract resulting from this solicitation, it will incorporate this
provision for certification without modification in each contract and in all lower tier subcontracts. The
contractor may rely upon the certification of a prospective subcontractor unless it has knowledge that the
certification is erroneous.
The contractor shall provide immediate written notice to the sponsor if the contractor learns that its
certification or that of a subcontractor was erroneous when submitted or has become erroneous by reason of
changed circumstances. The subcontractor agrees to provide immediate wiitten notice to the contractor, if at
any time it learns that its certification was erroneous by reason of changed circumstances.
This certification is a material representation of fact upon which reliance was placed when making the award.
If it is later determined that the contractor or subcontractor knowingly rendered an erroneous certification, the
Federal Aviation Administration may direct, through the sponsor, cancellation of the contract or subcontract
for default at no cost to the Government.
Nothing contained in the foregoing shall be construed to require establishment of a system of records in order
to lender, in good faith, the certification required by this provision. The knowledge and information of a
contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary
course of business dealings.
This certification concerns a matter within the jurisdiction of an agency of the United States of America and
the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under
Title 18, United States Code, Section 1001.
13. The bidder/offeror certifies, by submission of this proposal or acceptance of this contract, that neither it nor its
principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal department or agency. It further agrees by
submitting this proposal that it will include this clause without modification in all lower tier transactions,
solicitations, proposals, contracts, and subcontracts. Where the bidder/offer/contractor or any lower tier
participant is unable to certify this statement, it shall attach an explanation to this solicitation/proposal.
14. By entering into this contract, the contractor certifies that neither it (nor he or she) nor any person or firm who
has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by
virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1).
15. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government
contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1).
16. The undersigned hereby declares that the only parties interested in this Proposal are named herein, that this
Proposal is made without collusion with any other person, firm, or corporation, that no member of the Council,
Waterloo Regional Airport or agent of the City of Waterloo, Iowa, is directly or indirectly financially
interested in this bid.
17. Contractor certifies that all employees employed by Contractor or any subcontractor working on behalf of the
Contractor are in compliance with the Immigration Reform Control Act of 1986 (IRCA) and indemnifies the
Owner and holds harmless Owner for any violations of IRCA as a result of the Contractor's employees or his
subcontractor's employees working on behalf of the Contractor on the Owner's project.
18. The undersigned certifies, to the best of his or her knowledge and belief, that:
a. No Federal appropriated funds shall be paid, by or on behalf of the Contractor, to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a member of Congress in Congress in connection
with the making of any Federal grant and the amendment os modification of any Federal grant.
b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of Congress, an
FAA A1P 3-19-0094-048 P-4 Miscellaneous Lighting Replacement
AECOM Project #60675091 Waterloo Regional Airport - 60675091
officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal grant, the Contractor shall complete and submit Standard Form-LLL, "Disclosure of Lobby
Activities", in accordance with its instructions.
c. The Undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite foi making or entering into this
transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $200,000 for each
such failure.
19. BUY AMERICAN CERTIFICATE (Title 49 U.S.C. Chapter 501)
As a condition of bid responsiveness, the bidder must how it intend to comply with the Buy American
preferences established under Title 49 U.S.C. Section 50101. Bidder must complete the attached Buy
American certification. If the bidder requests a permissible waiver to the Buy America requirements, the
Bidder identified as with the successful bid must submit a formal waiver request and component cost
calculation within the piescribed time identified on the Buy America certification.
20. Drug Free Workplace, Act of 1988.
a. By submission of this offer, the offeror, if other than an individual, who is making an offer that equals or
exceeds $25,000, certifies and agrees that with respect to all employees of the offeror to be employed
under a contract resulting from this solicitation, it will --no later than 30 calendar days after contract award
(unless a longer period is agreed to in writing, for contracts of 30 calendar days or more performance
duration;) or as soon as possible for contracts of less than 30 calendar days performance duration, but in
any case, by a date prior to when performance is expected to be completed--
(1) Publish a statement notifying such employees that the unlawful manufacturer, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the Contractor's workplace
and specifying the actions that will be taken against employees for violations of such prohibition.
(2) Establish an on -going drug -free awareness program to inform such employees about --
(a) The dangers of drug abuse in the workplace.
(b) The Contractor's policy of maintaining a drug -free workplace.
(c) Any available drug counseling, rehabilitation, and employee assistance programs; and
(d) The penalties that may be imposed upon employees foi drug abuse violations occurring in the
workplace.
(3) Provide all employees engaged in performance of the contract with a copy of the statement required
by subparagraph a. (1) of this provision.
(4) Notify such employees in writing in the statement required by subparagraph a.(1) of this provision
that, as a condition of continued employment on the contract resulting from this solicitation, the
employee will --
(a) Abide by the terms of the statement; and
(b) Notify the employer in writing of the employee's conviction under a criminal drug statute for a
violation occurring in the workplace no later than 5 calendar days after such conviction.
(5) Notify the Contracting Officer 1r] writing within 10 calendar days after receiving notice under
subdivision a. (4) (b) of this provision, from an employee or otherwise receiving actual notice of
such conviction. The notice shall include the position title of the employee; and
(6) Within 30 calendar days after receiving notice under subdivision a (4)(b) of this provision of a
conviction, take one of the following actions with respect to any employee who is convicted of a
drug abuse violation occurring in the workplace.
FAA AIP 3-19-0094-048 P-5 Miscellaneous Lighting Replacement
AECOM Project #60675091 Waterloo Regional Airport - 60675091
(a) Take appropriate personnel action against such employee, up to and including termination; or
(b) Require such employee to satisfactorily participate in a drug abuse assistance or rehabilitation
program approved for such purposes by a Federal, State, or local health, law effot cement, or
other appropriate agency.
(7) Make a good faith effort to maintain a drug -free workplace through implementation of
subparagraphs a. (1) through a. (6) of this provision.
b. By submission of its offer, the offeror, if an individual who is making an offer of any dollar value,
certifies and agrees that other offeror will not engage in the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance in the performance of the contract resulting from
this solicitation.
c. Failure of the offeror to provide the certification required by paragraphs a. or b. of this provision, renders
the offeror unqualified and ineligible for award. [See FAR 9.104-1(g) and 19.602-1a.(2)(a)].
d. In addition to other remedies available to the Government, the certification in paragraphs a. or b. of this
provision concerns a matter within the jurisdiction of an agency of the United States and the making of a
false, fictitious, or fraudulent certification may render the maker subject to prosecution under title 18,
United States Code, Section 1001.
21. Attachment to This Bid. The following documents are attached to and made a part of this Bid:
a. Non -Collusion Affidavit of Prime Bidder.
b. Statement of Intent — Non -Discrimination and Equal Opportunity Statement.
c. Buy American Certification Statement.
d. Synopsis of Experience Record. (IDOT Certification may be substituted.)
e. Completed DBE forms "Utilization Statement" and "Letter of Intent."
22. The Bidder shall indicate whether the bid is submitted by a/an:
❑ Individual, Sole Proprietorship
❑ Partnership
Corporation
❑ Joint -venture: all parties must join -in and execute all documents
❑ Other
Respectfully submitted,
,' Bidder
By ��� fir cw• DeVri eS
Signature
Pres1dt•ti±
Title
1%a? 1.ZheoI". .S"-.
Address
(Include Zip Code)
3V\- 2.77— oy/.5
Telephone No.
FAA A1P 3-19-0094-048 P-6 Miscellaneous Lighting Replacement
AECOM Project #60675091 Waterloo Regional Airport - 60675091
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of
)ss
County of 8 ( . e.1. 1-&w l< )
B r j c&vx De V r eS , being first duly sworn, deposes and says that:
(1) He is
(Owner, Partner , Officer Representative, or Agent) of
K�- tom/ S f ee +-ri c
, the Bidder that has submitted the attached Bid:
(2) He is fully informed respecting the preparation and contents of the attached bid and of all pertinent
circumstances respecting such bid.
(3) Such bid is genuine and is not a collusive or sham bid.
(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties
in interest, including this affiant, has in any way colluded, conspired, connived or agi eed, directly or indirectly, with any
other Bidder, firm or person to submit a collusive of sham bid in connection with the Contract for which the attached bid
has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or
indirectly, sought by agreement or collusion of communication or conference with any other Bidder, firm or person to fix
the price or prices in the attached bid or of any other Bidder, or, to fix any overhead, profit o1 cost element of the bid
price or the bid price of any other Biddei, or to secure through any collusion, conspiracy, connivance, or unlawful
agreement any advantage against the City of Waterloo, Iowa, or any person interested in the proposed Contract; and
(5) The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion,
conspiracy, connivance, or unlawful agreement on the part of the Biddei or any of its agents, representatives, owners,
employees, or parties in interest, including this affiant.
Subscribed and sworn to before me
this y I- day of C=jeAnni e
2QXy
ki vC� ��(I���G•f� L�
Title My Commission xpires alas
1 1
JOANNA E1s9. 21711OWf
Cc :.stis irn!cn C un-i'10r 7C_ S
f
l'cbru2ry GE, 2:0011,_
(Signed) err
Title /fires i d twat-
FAA AIP 3-19-0094-048
P-7 Miscellaneous Lighting Replacement
AECOM Project 1160675091 Waterloo Regional Airport - 60675091
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
(To Be Submitted After Bid But Prior to Award)
State of )
)ss
County of __ )
, being first duly sworn, deposes and says that:
(1) He is
(Owner, Partner, Officer, Representative, or Agent) of
, the Bidder that has submitted the attached Bid:
(2) He is fully informed respecting the preparation and contents of the attached bid and of all pertinent
circumstances respecting such bid.
(3) Such bid is genuine and is not a collusive or sham bid.
(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in
interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any
other Bidder, firm or person to submit a collusive or sham bid in connection with the Contract for which the attached bid
has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or
indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix
the price or prices in the attached bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid
price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful
agreement any advantage against the City of Waterloo, Iowa, or any person interested in the proposed Contract; and
(5) The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion,
conspiracy, connivance, or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners,
employees, or parties in interest, including this affiant.
(Signed)
Title
Subscribed and sworn to before me
this day of , 20.
Title
My Commission Expires , 20.
FAA AIP 3-19-0094-048 P-8 Miscellaneous Lighting Replacement
AECOM Project #60675091 Waterloo Regional Airport - 60675091
STATEMENT OF INTENT
NONDISCRIMINATION
AND
EQUAL OPPORTUNITY STATEMENT
The Contractor does hereby certify to the Waterloo Regional Airport, that no person shall, in any way, be favored or
discriminated against because of his race, political or religious opinions and affiliations, national origins, sex, age, sexual
orientation, gender identity, disability, color, creed, mat ital status, employee union or association membership or office
herein.
If selected as the successful bidder, this contractor hereby agrees to file either a nondiscrimination and equal opportunity
statement and/or an Affirmative Action Program.
Improvements to the Waterloo Regional Airport consisting of
Miscellaneous Lighting Replacement
FAA AIP Project No. 3-19-0094-048
161- iti Ei it t" cr
ise-
COMPANY
EXECUTIVE OFFICER
AFFIRMATIVE ACTION OFFICER
ADDRESS OF THE AFFIRMATIVE ACTION OFFICER
a/ Li t✓• co 1,. St.
Ceot tr. Fia is j C/A 506,13
PHONE NUMBER 3 1 9— .2 7 7— d y/ S
FAA AIP 3-19-0094-048 P-9 Miscellaneous Lighting Replacement
AECOM Project 1160675091 Waterloo Regional Airport - 60675091
SYNOPSIS OF EXPERIENCE RECORD
(This synopsis must accompany Proposal Form.)
Name of Bidder Kit £I eG4 rJ . �t�C
1121 L. to l 3+ • Ceett v- Fa.1(3 ( ¶i4- so 413
Individual ( ) Partnership ( ) Corporation p0 (Check One.)
Construction successfully completed within past five years similar in size, scope, and difficulty of construction to the
work bid upon.
Business Address
Name of Owner
Name of
Proiect
l Wth-tn i to 4i1/poft 14-ate, 0'3 LED
2 /'VCC _ /hc Elroy L E!)
3 Peps ck WA/V.0LS) LED
4 /into (A n %,yly Wn GA. ovsc LED
5 k14r Loy 15 4-it 1404re (•vtitfL LED
1
2
3
4
7
5
Number of Contract Days
Allowed for Above Projects
7
7
7
(Signed)
Location of
Proiect
tuk,44--o,rt oa
1,i/,vie�
£4 h.-owl LVo
WA 41400
Actual Number of Days to
Complete above Project
0 tet.
Amount of
Contract
as 70
4 7`1 370
` q0)7,41 =
,31 Isom
s2
54 250
J
cv
Name of Company
(By) erjec`- b-e Vv-iof
(TITLE) psare r %ier
Date .2 lag/ 24
FAA AIP 3-19-0094-048
AECOM Project 1160675091
P- 10 Miscellaneous Lighting Replacement
Waterloo Regional Airport - 60675091
UTILIZATION STATEMENT
Disadvantage Business Enterprise
The undersigned bidder/offeror has satisfied the requirements of the bid specification in the following manner.
(Please mark the appropriate box)
A The bidder/offeror is committed to a minimum of 0% DBE utilization on this
contract.
❑ The bidder/offeror, while unable to meet the DBE goal of %, hereby commits
to a minimum of % DBE utilization on this contract and also submits
documentation, as an attachment demonstrating good faith efforts (GFE).
The undersigned hereby further assures that the information included herein is true and correct, and that the DBE firm(s) listed herein have agreed to
perform a commercially useful function in the work items noted for each firm. The undersigned further understands that no changes to this statement
may be made without prior approval from the Civil Right Staff of the Federal Aviation Administration.
cRW (earim ItetG.
Bidder's/Offeror's Firm Name
Sc----
Signature
7fazf24
Date
DBE UTILIZATION SUMMARY
Contract Amount
DBE Amount Contract
Percentage
DBE Prime Contractor $ x 1.00 = $ 0 0 %
DBE Subcontractor $ x 1.00 = $ %
DBE Supplier $ x 0.60 = $ _ %
DBE Manufacturer $ x 1.00 = $ %
Total Amount DBE $
DBE Goal $ 0 D %
Note: If the total proposed DBE participation is less than the established DBE goal, Bidder must provide written documentation of the
good faith efforts as required by 49 CFR Part 26.
FAA AIP 3-19-0094-048
AECOM Project #60675091
P-11 Miscellaneous Lighting Replacement
Waterloo Regional Airport - 60675091
LETTER OF INTENT
Disadvantage Business Enterprise
(This page shall be submitted for each DBE firm)
Bidder/Offer Name:
Address:
City: State: Zip:
DBE Firm:
DBE Contact Person:
DBE Firm:
Address:
City: State: Zip:
Name: Phone: (
DBE Certifying Agency: Expiration Date:
Each DBE Firer shall submit evidence (such as a photocopy) of their certification
status.
Classification:
Prime Contractor
Manufacturer
Subcontractor
Supplier
Joint Venture
to
Work
be
performed
DBE
item(s)
by
Description
of Work
l _,
em
1
Quantity
Total
pcy
livi
The bidder/offeror is committed to u
estimated participation is as follows:
DBE contract amount: $
ilizi th - , ove-named DBE firm for the work described above. The
Percent of total contract:
AFFIRMATION:
The above -named DBE firm affirms that it will perform the portion of the contract for the estimated dollar value as
stated above.
By:
(Sigua lire)
Arts ider
(Tilley
Note: In the event the bidder/offer or does not receive award of the prime contract, any and all representations in this
Letter of Intent and Affirmation shall be null and void.
FAA AIP 3-19-0094-048
P-12 Miscellaneous Lighting Replacement
AECOM Project 1160675091 Waterloo Regional Airport - 60675091
BUY AMERICAN CERTIFICATION FORM FOR TOTAL FACILITY
(Building projects such as Terminal, SRE, ARFF, etc.)
As a matter of bid responsiveness, the Bidder or Offeror must complete, sign, date, and submit this
certification statement with their proposal. The Bidder or Offeror must indicate how they intend to comply
with 49 USC § 50101 by selecting one of the following certification statements. These statements are
mutually exclusive. Bidder must select one or the other (i.e. not both) by inserting a checkmark (/) or the
letter "X".
■
The Bidder or Offeror hereby certifies that it will comply with 49 USC. 50101 by:
a) Only installing steel and manufactured products produced in the United States, or;
b) Installing manufactured products for which the FAA has issued a waiver as indicated by
inclusion on the current FAA Nationwide Buy American Waivers Issued listing, or;
c) Installing products listed as an Excepted Article, Material or Supply in Federal Acquisition
Regulation Subpart 25.108.
By selecting this certification statement, the Bidder or Offeror agrees:
1. To provide to the Owner evidence that documents the source and origin of the steel and
manufactured product.
2. To faithfully comply with providing US domestic products.
3. To refrain from seeking a waiver request after establishment of the contract, unless extenuating
circumstances emerge that the FAA determines justified.
The Bidder or Offeror hereby certifies it cannot comply with the 100% Buy American Preferences
of 49 USC § 50101(a) but may qualify for either a Type III or Type IV waiver under 49 USC §
50101(b). By selecting this certification statement, the apparent Bidder or Offeror with the apparent
low bid agrees:
1. To the submit to the Owner within 15 calendar days of the bid opening, a formal waiver request
and required documentation that support the type of waiver being requested.
2. That failure to submit the required documentation within the specified timeframe is cause for a
non -responsive determination may results in rejection of the proposal.
3. To faithfully comply with providing US domestic products at or above the approved US domestic
content percentage as approved by the FAA.
4. To furnish US domestic product for any waiver request that the FAA rejects.
5. To refrain from seeking a waiver request after establishment of the contract, unless extenuating
circumstances emerge that the FAA determines justified.
Required Documentation
Type III Waiver - The cost of components and subcomponents produced in the United States is more
that 60% of the cost of all components and subcomponents of the "facility". The required documentation
for a Type III waiver is:
a) Listing of all manufactured products that are not comprised of 100% US domestic content
(Excludes products listed on the FAA Nationwide Buy American Waivers Issued listing and
products excluded by Federal Acquisition Regulation Subpart 25.108; products of unknown origin
must be considered as non -domestic products in their entirety).
b) Cost of non -domestic components and subcomponents, excluding labor costs associated with
final assembly and installation at project location.
FAA AIP 3-19-0094-048 P-13 Miscellaneous Lighting Replacement
AECOM Project #60675091 Waterloo Regional Airport - 60675091
c) Percentage of non -domestic component and subcomponent cost as compared to total "facility"
component and subcomponent costs, excluding labor costs associated with final assembly and
installation at project location.
Type IV Waiver — Total cost of project using US domestic source product exceeds the total project cost
using non -domestic product by 25%. The required documentation for a Type IV of waiver is:
a) Detailed cost information for total project using US domestic product.
b) Detailed cost information for total project using non -domestic product.
False Statements: Per 49 USC § 47126, this certification concerns a matter within the jurisdiction of the
Federal Aviation Administration and the making of a false, fictitious or fraudulent certification may render
the maker subject to prosecution under Title 18, United States Code.
Date
7/24 vi
Signature
/fires 1"d e r
Company Name Title
FAA All) 3-19-0094-048 P-14 Miscellaneous Lighting Replacement
AECOM Project #60675091 Waterloo Regional Airport - 60675091