HomeMy WebLinkAbout126-11 RESOLUTIONRESOLUTION NO. 126-11
A RESOLUTION TO APPROVE TASK ORDER NO. 6 FOR ENGINEERING
WORK BY MCCLELLAND ENGINEERING, INC. RELATED TO THE
AIRFIELD PAVEMENT REHABILITATION AND RE -STRIPING PROJECT
IN THE APPROXIMATE AMOUNT OF $22,830.00, AND APPROVING A
BUDGET ADJUSTMENT
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1: That the City Council of the City of Fayetteville, Arkansas hereby approves
Task Order No. 6 for engineering work by McClelland Engineering, Inc. related to the Airfield
Pavement Rehabilitation and Re -Striping Project in the approximate amount of $22,830.00, and
authorizes Mayor Jordan to sign Task Order No. 6 (attached).
Section 2: That the City Council of the City of Fayetteville, Arkansas hereby approves a
budget adjustment, a copy of which is attached as Exhibit "A".
PASSED and APPROVED this 19th day of July, 2011.
APPROVED:
By:
ATTEST:
0414-sid K,1/114,0aL
SONDRA E. SMITH, CiClerk/Treasurer
1Zrrn
j •
•.G�ZY 0,c•.<./ ,vccv•-:-
: FAYETTEVILLE:
L. r
City of Fayetteville, Arkansas
Budget Adjustment Form
V11.0415
Budget Year
2011
Division: Aviation
Department: Transportation Services
Request Date
7/19/2011
Adjustment Number
BUDGET ADJUSTMENT DESCRIPTION / JUSTIFICATION
To provide funds for a design and engineering Task Order for the Airport Pavement Rehab & Re -marking project.
The project is eligible for 100% funding through grants from the FAA/DOT and the AR Department of Aeronautics,
contingent upon approval of the City Council and the funding agencies. Bid results are required for the submission of
the grant application to the FAA. Upon receipt of the grant, a separate BA will be issued to recognize the grant
revenue and restore the Use of Prior Fund Balance portion.
Division Head
dget Director
Departm - nf�Direc'or
Fin
ce Director
Prepared By: James Nicholson
jnicholson
Reference:
�-s- z1/?,
Date Budget & Research Use Only
Type: A BCD E P
Date
7-5- X.6 1 j General Ledger Date
Date
1- V- t Posted to General Ledger
ff Date
s
yor
Account Name
Initial Date
Checked / Verified
ate Initial Date
TOTAL BUDGET ADJUSTMENT 22,830 22,830
Increase / (Decrease) Project.Sub
Account Number Expense Revenue Number
Professional services 5550.3960.5314.00 22,830 11023 . 1
Use of Fund Balance
R
5550.0955.4999.W'
22,830 . u .�
J:1James120111Budget1BA2011_11023_Airport Pavement_Rehab AIP40 Revised 070511
1 of 1
Ray M. Boudreaux
Submitted By
City of Fayetteville Staff Review Form
City Council Agenda !tams
and
Contracts, Leases or Agreements
7/19/2011
City Council Meeting Date
Agenda Items Only
Aviation
Division
Action Required:
Transportation
Department
Action Required:
a) Approve Task Order #6, McClelland Consulting Engineers Inc., Contact R. Wayne Jones, P.E., 443-2377; 443-
9241 FAX; wjones@mcclelland-engrs_com
22,830.00
Cost of this request
5550.3960.7820.40
Account Number
11023 1
Project Number
$
Category /Project Budget
Funds Used to Date
$
Remaining Balance
ted , 1 1 Budget Adjustment Attached
City Atto
Airport Pavement Rehab & Re -mark
Program Category/ Project Name
Airport Capital Exp
Program / Project Category Name
Airport
Fund Name
7 1 Previous Ordinance or Resolution #
-te
Original Contract Date:
f % /
L t k Original Contract Number:
Date
Finance and Internal Services Director
7- 5-20111
Date
ReceiClerkved
' s Offiin ceCiiy 07-01-1 1 P 0 2 :: 4 5 R C Y I
Received in
Mayor's Office
Comments: Project to be 100% funded with grants from the DOT/FAA and Arkansas Department of Aeronautics.
Revised January 15, 2009
aye
City Council Meeting of: July 19, 2011
Agenda Item Number:
•
ev1 e AVIATION DIVISION
ARKANSAS FAYETTEVILLE EXECUTIVE AIRPORT • DRAKE FIELD
CITY COUNCIL AGENDA MEMO/STAFF CONTRACT REVIEW MEMO
TO: Mayor Jordan
THRU Chief of Staff
TBRU: Staff'Contract Review Committee
THRU: Terry Gulley, Transportation Dir
FROM Ray M. Boudreaux, Aviation
DATE: June 20, 2011
SUBJECT: Approval of Task Order Na 6 with McClelland Consulting Engineers for
the Airfield Pavement Rehab and Re -striping Project. Signature of the
Mayor
• RECOMMENDATION: Approve Task Order No. 6 with McClelland Consulting Engineers for
the Airfield Pavement Rehab and Re -Striping Project. Signature of the Mayor.
$ACKGROUND: This project applies rejuvenation compound to the runway following removal
of rubber and deteriorating paint marling and then re -stripes the surface with approved
markings and adds newly required runway intersection markings to all taxiway and runway
intersections. We submitted application for FAA grant funds, but the FAA has requested an
amended application using bid amounts and not engineering estimates. This Task Order
engages MCE to prepare bid documents and evaluate the bids and provide construction
oversight should the project receive FAA approval.
BUDGET ACT: This project will be funded with Grant proceeds from FAA and State
Aeronautics if the grant is approved.
Attachments: Staff Review
Task Order No. 6
4500 SOUTH SCHOOL AVENUE, SUITE F • AIRPORT TERMINAL BUILDING • FAYETTEVILLE AR 72701
• 4(4. /18.164V -479:718:7846 -FAX • www.aoceseiayenevil e. m:. ra• *.T
- -. ' .• . airport economic development@ai.fayetteviife.ar.us
RESOLUTION NO.
A RESOLUTION TO APPROVE TASK ORDER NO. 6 FOR ENGINEERING
WORK BY MCCLELLAND ENGINEERING, INC. RELATED TO THE
AIRFIELD PAVEMENT REHABILITATION AND RE -STRIPING PROJECT
IN THE APPROXIMATE AMOUNT OF $22,830.00, AND APPROVING A
BUDGET ADJUSTMENT
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1: That the City Council of the City of Fayetteville, Arkansas hereby approves
Task Order No. 6 for engineering work by McClelland Engineering, Inc. related to the Airfield
Pavement Rehabilitation and Re -Striping Project in the approximate amount of $22,830.00, and
authorizes Mayor Jordan to sign Task Order No. 6 (attached).
Section 2: That the City Council of the City of Fayetteville, Arkansas hereby approves a
budget adjustment, a copy of which is attached as Exhibit "A".
PASSED and APPROVED this 19th day of July, 2011.
APPROVED: ATTEST:
By: By:
LIONELD JORDAN, Mayor SONDRA E. SMITH, City Clerk/Treasurer
MCCLE
CONsuLroNGLLAND
ENGINEERS, INC.
June 29, 2011
DESIGNED TO SERVE
Mr. Ray Boudreaux
Airport Director,
Fayetteville Executive Airport
4500 S. School Suite F
Fayetteville, AR 72701
1810 N. College Avenue
P.OBox 1229
Fayetteville, AR 72703/72702-1229
479-443-2377 • FAX 479-443-9241
www.mcclelland-engrs.com
Re: Task Order No 6
Airfield Pavement Rehab & Striping
Fayetteville Executive Airport
Dear Mr. Boudreaux:
RECEIVED
JUN 2 9 2011
AIRPORT
In response to your request, please find three (3) copies of Task Order No 6 for the
Airfield Pavement Rehab & Striping Project.
Please advise if you need further information regarding this Task Order.
Sincerely,
McC LLAND CJNSULTING ENGINEERS, INC.
Vice Pr
Enclosure:
nes, P.E.
ent
Task Order No 6 (3 copies)
J:IDRAKE F I ELDICONTRACTS12009-201 31BOUDREAUX-062911-TO 6. DOC
.4tcelelland '(.onoulti cg Engineexo, .7nc. - "`.deet Engineering
Minnow 2uoineaa 2009 d 2010 (lwa'4 5tecipient
RECEIVED
JUN 2 9 2011
AIRPORT
TASK ORDER NO. 6
AIRFIELD PAVEMENT REHABILITATION & RE -STRIPING
STATE OF ARKANSAS
COUNTY OF WASHINGTON
This Task Order is written pursuant to the basic agreement entitled CITY OF
FAYETTEVILLE, AGREEMENT FOR ENGINEERING SERVICES, executed on May 5,
2009. The referenced basic agreement pertains to proposed improvements to Drake
Field, Fayetteville Executive Airport. This Task Order entered into and executed on the
date indicated below the signature block, by and between the City of Fayetteville and
McClelland Consulting Engineers (MCE), sets forth the project description, project
schedule, and engineering fees related to the preparation of an Airfield Runway &
Taxiway Pavement Rehabilitation & Re -Stripping at Drake Field.
SECTION 1- PROJECT DESCRIPTION
The overall project is to consist of the rehabilitation and re -striping of the Airfield
Pavement including, Rubber Removal, Airfield Striping Removal, Asphalt Pavement
Rejuvenation and re -striping of the Runway and Taxiways. The services to be
performed include: Detailed Plans and Specifications, Bidding Services and
Construction Administration/Construction Observation Services.
SECTION II - PROJECT SCHEDULE
From the time the City of Fayetteville issues the Notice To Proceed (NTP), McClelland
Consulting Engineers, Inc. will endeavor to execute the project within the following time
periods:
J:IDRAKE FIELDICONTRACTS12009-20131Task Order 6.doc 1
Task Completion After NTP
A. Prepare Airfield Pavement Striping Plan
and Specifications 20 calendar days
SECTION III - SCOPE OF SERVICES
McClelland Consulting Engineers, Inc. shall, generally, provide those services listed in
the basic agreement which are applicable to this specific Task Order. Specifically, the
project is likely to include:
A. Prepare the Airfield Striping Plan, specifications, and Bid Documents.
B. Prepare Bidding Document and recommendations for award of construction
contract.
C. Construction Administration and Inspection.
D. Providing three sets of "Record Drawings".
SECTION IV - FEES AND PAYMENTS
The following fees are to be paid to McClelland Consulting Engineers, Inc. as
compensation for his services:
A. Detailed Airfield Striping Plans and
Specifications lump sum of $ 9,830.00
B. Bidding Service lump sum of $ 2,500.00
C. Construction, Administration & Inspection hourly rates
estimated to be $10,500.00
Appendix A presents hourly rates for personnel anticipated to be assigned to this
project by McClelland Consulting Engineers, Inc.
J:IDRAKE FIELD\CONTRACTS12009-20131Task Order 6.doc 2
SECTON V - BASIC AGREEMENT IN EFFECT:
Except as amended specifically herein, the basic AGREEMENT FOR ENGINEERING
SERVICES shall remain in full force as originally approved and executed.
IN WITNESS WHEREOF, the parties hereto have caused this AGREEMENT to be duly
executed as of the date and year first herein written.
FOR THE CITY OF FAYETTEVILLE:
Attest: tai it,v . q9�
FOR McCLELLAND CONSULTING ENGINEERS, INC.:
By:
Date:
President
&%zy/r/
J:IDRAKE FIELDICONTRACTS12009-20131Task Order 6.doc
Attest:
APPENDIX A
TASK ORDER NO, 6
Hourly Rates for Personnel
Fayetteville Executive Airport
CATEGORY BILLABLE
HOURLY RATE RANGE
Principal Engineer $ 155
Sr. Project Manager $ 143
Project Engineer $ 135
Project Engineer IV $ 127
Project Engineer III $ 115
Project Engineer II $105
Project Engineer I $ 85
Registered Land Surveyor $ 104
Survey (2 man or 1 -man Robotic) Crew $ 143
Survey Technician $ 80
Engineering Technician/Observer IV $ 90
Engineering Technician/Observer III $ 84
Engineering Technician/Observer II $ 65
Engineering Technician/Observer I $ 55
Survey (2 man or 1 -man Robotic) Crew $ 143
Chief Draftsman $ 73
Draftsman 11 $ 60
Draftsman I $ 50
Soils Lab Supervisor $ 60
Soils Technician II $ 45
Soils Technician I $ 42
Clerical Support $ 50
Mileage $ 0.50
J:IDRAKE F[ELDICONTRACTS12009-20131Appendix A TO 6.doc
RESOLUTION NO.
A RESOLUTIO 0 APPROVE TASK ORDER NO. 6 FONGINEERING
WORK BY MC ELLAND ENGINEERING, INC. RE ` ATED TO THE
AIRFIELD PAVE T REHABILITATION AND RE -S , RIPING PROJECT
IN THE APPROXIMA . AMOUNT OF $22,830.00
BE IT RESOLVED B THE CITY COU CIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1: That the City Counci of
approves Task Order No. 6 for engineering wo
Airfield Pavement Rehabilitation and Re -Stn
$22,830.00, and authorizes Mayor Jordan to sign
PASSED and APPROVED this 19th day
APPROVED:
By:
By:
LIONELD JORDAN, Mayor r SONDRA E. SMITH, ity Clerk/Treasurer
the Ci i of Fayetteville, Arkansas hereby
by M lelland Engineering, Inc. related to the
roject in the approximate amount of
Order No. 6 (attached).
f July, 011.
ATTEST:
Ray M. Boudreaux
Submitted By
City of Fayetteville Staff Review Form
City Council Agenda Items
and
Contracts, Leases or Agreements
City Council Meeting Date
Agenda Items Only
Aviation
Division
Action Required:
Transportation
Department
Action Required:
a) Approve authority to accept a Grant Offer from DOT/FAA (95% of project cost) & an Arkansas Department of
Aeronautics grant (5% match).
239,497.00
GRANT REVENUE
5550.3960.7820.40
Account Number
11023 1
Project Number
Budgeted Item
REVENUE BUDGET
Category / Project Budget
Airport Pavement Rehab & Re -mark
Program Category I Project Name
Airport Capital Exp
Funds Used to Date Program / Project Category Name
Airport
Remaining Balance Fund Name
Budget Adjustment Attached
9-a- 1 Previous Ordinance or Resolution # 126-11
Date
Original Contract Date: 19 -Jul
51Z"- (/ Original Contract Number:
Date
`Tout k. ' - 12-2c 11
Finance and Internal Services Director
Date
08-12_11P02.42 KL,vu
Received in City
Clerk's Office
Comments: Project to be 100% funded with grants from the DOT/FAA and Arkansas Department of Aeronautics.
The Item is on the 8/16/11 Council Agenda. The Grant dollar amount is revised per FAA request.
Revised January 15, 2009
•
aye evi
ARKANSAS
City Council Meeting of: N/A
Agenda Item Number:
1 e AVIATION DIVISION
FAYETTEVILLE EXECUTIVE AIRPORT • DRAKE FIELD
CITY COUNCIL AGENDA MEMO/STAFF CONTRACT REVIEW MEMO
TO:
THRU:
THRU:
THRU:
Mayor Jordan
Chief of Staff
Staff/Contract Review Committee
Terry Gulley, Transportation Director
FROM: Ray M. Boudreaux, Aviation Dir
DATE: August 10, 2011
SUBJECT: Approve Amended Grant Application for the Runway Rejuvenation
Project at the airport reducing the amount of the grant request to
$239,497 per request of the FAA program manager, Paul Burns.
Signature of the Mayor and City Clerk.
RECOMMENDATION: Signature of the Mayor and City Clerk on amended FAA/AIP grant
application in the amount of $239,497 for the Runway Rejuvenation Project at Drake Field.
BACKGROUND: FAA does not have the funds to approve grant funding for an amount more
than the already approved entitlement funds assigned to Drake Field for the Rejuvenation
Project. McClelland Consulting Engineers has reduced the scope of the project to include the
runway and taxiway "A" only leaving Taxiway "B" for a later date. The new scope falls within
the available funding and has been agreed to by the Contractor, Time Striping. The amended
application is due to the FAA by August 18, 2011 signed.
BUDGET IMPACT: This project is 95% funded through FAA/AIP grant funds and 5% through
State Aeronautics Commission.
Attachments: Staff Review
Amended Grant Application
Original Grant Application
4500 SOUTH SCHOOL AVENUE, SUITE F • AIRPORT TERMINAL BUILDING • FAYETTEVILLE AR 72701
479.718.7642 • 479.718.7646 FAX • uw w.accessfayetteville.org/governmenUaviation
airport_economic_development@ci.fayetteville.ar.us
a'F'Cve .eville
THE CITY OF FAYETTEVILLE, ARKANSAS
AVIATION DIVISION
4500 S School Ave, Ste F
Fayetteville, AR 72701
P (479) 718-7642
ARKANSAS
www.accessfayetteville.org
TO: Mayor Lioneld Jordan
THRU: Jason Kelly, Assistant City Attorney
FROM: Ray M. Boudreaux, Aviation Director
RE: Grant Certifications and Assurances
DATE: 8/12/11
Regarding the Mayor's personal legal liability as signatory for the City on the DOT/FAA grant application for AIP40,
Pavement Rehab project, 1, Ray M. Boudreaux, Director, Aviation Division, hereby certify to the best of my knowledge
and without exception that:
1. the assurances and certifications required by the Grant Agreement can be made as to the project under
consideration;
2. all certifications and assurances required by the Grant Agreement can be legally made
Telecommunications Device for the Deaf TDD (479) 521-1316 113 West Mountain - Fayetteville, AR 72701
Page 1 of 2
James Nicholson - Drake Field Grant Application - Pavement Rehab Project
From: James Nicholson
Date: 6/23/2011
Due: 7/28/2011
Subject: Drake Field Grant Application - Pavement Rehab Project
Thanks Paul, we will get right on it!
Regards, Ray
Ray M. Boudreaux, Col. USAF (ret)
Director of Aviation
Fayetteville Executive Airport, Drake Field
4500 S. School Ave., Suite F
Fayetteville, AR 72701
ph. 479.718.7642
fax. 479.718.7696
email: rboudreaux@d.fayetteville.ar.us
TDD (Telecommunications Device for the Deaf) 479-521-1316
»> <Paul.Burns@faa.gov> 6/23/2011 10:01 AM »>
Ray - I enjoyed visiting with you today on the phone and hopefully your request (summarized in the attachment below) will result
in an AIP-funded project this fiscal year (FY -2011). I just wanted to review a few of our requirements needed for this project to
successfully come about. First, we need the sponsor's grant application package (paper copies, no pdfs please) by July 29,
2011. As always, the grant application should be "based on bids". The application package should include:
-Bid Tabulation
-Copy of Engineering Services Agreement
- All required Sponsor Certifications
-Evidence that the Construction Safety Plan has been e -filed
- Any required requests for Modifications to Standards (seal -coat projects generally require an MOS)
- Updated Capital Improvement Plan
-Evidence that the sponsor's CCR registration is up to date
Be aware, too, the SF -424 (what used to be the first page of a grant application) has been updated. The new SF -424
(comprised of 3 pages) is dated 3/31/2012 and is available on the intemet. Also, please be aware that FYV can only count on
having about $240,000 in non -primary entitlement funds available for an AIP project this year. Thanks.
Paul Burns ASW -630H (817) 222-5648
From: 'James Nicholson"<inicholson@ci.tayetteville.ar.us>
To: Paul Bums/ASW/FAA@FAA
CC 'Ray Boudreaux"<rboudreaux@ci.rayetteville.ar.us>
Date: 06/21/2011 03:24 PM
about:blank
lel �A .. . 4.
7/27/2011
a�fve .evi�le
THE CITY OF FAYETTEVILLE, ARKANSAS
AVIATION DIVISION
4500 S school Ave, Ste F
Fayetteville, AR 72701
P (4791718-7642
ARKANSAS
www.accessfayetteville.org
August 12, 2011
Paul Bums ASW630H
Project Manager
Federal Aviation Administration
Southwest Region, Airports Division
Arkansas/Oklahoma Airports Development Office
Fort worth, Texas 76193-0630
Dear Mr. Burns,
Please accept this letter as our intent to apply for support under the AIP program for our Runway Rejuvenation
Project at Fayetteville Executive Airport, Drake Field. We have reduced the project scope and request support
within the entitlement funds available. Total project cost for the runway portion of the project is $252,102 with
the Entitlement request of $239,497 under the $240,000 available. Attached please find the new contract signed
by the contractor, the revised five year CIP and the engineers estimate as requested.
Thank you for your support of Drake Field.
Sincerely,
Ray M. Boudreaux, Colonel USAF (ret)
Director of Aviation
Atch: Revised CIP
Bid Tab with Engineering Estimate
Change Order Reflecting new scope
Contract for the work signed by contractor and engineer
Task Order w/ MCE for this project
Telecommunications Device for the Deaf TDD (479) 521-1316 113 West Mountain - Fayetteville, AR 72701
OMS Number. 4040-0004
Expiration Date: 03/31/2012
Application for Federal Assistance SF -424
• 1. Type of Submission:
0 Proapplication
E Application
D Changed/Corrected Application
• 2. Type
M New
7 Continuation
71 Revision
of Application: ' If Revision, select appropriate letter(s):
___]
' Other (Specify)
' 3. Date Received: 4. Applicant Identifier.
5a. Federal Entity Identifier:
• 5b. Federal Award Identifier:
AR/OK ADO, ASW -630
3-05-0020-40-2011
State Use Only:
6. Date Received by State:
7. State Application Identifier.
8. APPLICANT INFORMATION:
' a. Legal Name: City of Fayetteville
" b. Employer/Taxpayer Identification Number (EIN/TIN):
716018462
' c. Organizational DUNS:
[134398903
d. Address:
' Street!:
S treet2:
• City:
County:
' State:
Province:
'Country:
• Zip I Postal Code:
4500 S School Ave , Ste F
Fayetteville
Washington
Arkansas
USA: UNITED STATES
72701
e. Organizational Unit:
Department Name:
Division Name:
Transportation
Aviation
t. Name and contact information of person to be contacted on matters involving this application:
Prefix: COI. (USAF ret.)
• First Name:
Ray
Middle Name: M
' Last Name: Soudreatrx
Suffer
Title: Aviation Director
Organizational Affiliation:
Airport Manager, Drake Field, KFYV
• Telephone Number:
479-718-7642 Fax Number: 479-718-7646
• Email: rboudreaux@ci.fayetteville.ar.us
Application for Federal Assistance SF-424
9. Type of Applicant 1: Select Applicant Type:
(C) City Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
• Other (specify):
* 10. Name of Federal Agency:
Federal Aviation Administration
11. Catalog of Federal Domestic Assistance Number:
20.106
CFDA Title:
Airport Improvement Program (AIP) .
* 12. Funding Opportunity Number:
• Tdle:
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
City of Fayetteville, Washington County, Arkansas
` 15. Descriptive Title of Applicants Project:
Pavement Rehabilitation & Re-marking
Attach supporting documents as specified in agency instructions.
Application for Federal Assistance SF-424
16. Congressional
• a, Applicant
Districts Of:
AR District 3 " b. Program/Project 1AR District 3
Attach an additional list of Program/Proiecl Congressional Districts if needed.
1
17. Proposed
' a. Star! Gale:
Project:
October 2011 ' b. End Date: [November 2011
16. Estimated Funding (t):
• a. Federal 239.497
• b. Applicant
' c. State 12,605
' d. Local
' e. Other
• 1, Program income
• g, TOTAL 252.102
' 19. Is Application
ix: a. This application
f< b. Program
c. Program
Subject to Review By State Linder Executive Order 12372 Process?
was made available to the State under the Executive Order 12372 Process for review on
is subject to E.O. 12372 but has not been selected by the State for review.
is not covered by E.O. 12372.
' 20. Is the Applicant Delinquent On Any Federal Debt? (11 "Yes", provide explanation.) Applicant Federal Debt Delinquency Explanation
rYes r No
21, By signing this application, I certify (1) to the statements contained in the list of certifications" and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to
comply with any resulting terms N I accept an award.1 am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218. Section 1001)
Jj'•IAGREE
" The list of certifications and assurances. or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Profs:
Middle Name:
' Last Name:
Suffix:
,The Honorable 1 • First Name: Liotleld
'
Jordan
• Title; 'Mayor, City of Fayetteville
]
' Telephone Number:
F479_575_8330 Fax Number: 479.575-8257
J
' Email: tiordan@ci.fayettetigo.ar.us
• Signature of Authorized
Representative:
, • Date Signed: [ 77:4/,,
Application for Federal Assistance SF -424
Applicant Federal Debt Delinquency Explanation
The following field should contain an explanation if the Applicant organization is delinquent on any Federal Debt. Maximum number of
characters that can be entered is 4,000. Try and avoid extra spaces and carriage retums to maximize the availability of space.
N/A