PROJECT CLOSURE SUMMARY I GENERAL INFORMATION AIRPORT NAME LOCATION

Airport Name: Location:

AIP Project No.: Contract No.: FA-NE-

Project description: __________________________________________

2. FISCAL SUMMARY (ELIGIBLE costs only)

3. MISCELLANEOUS

Grant Amendment Request: Letter attached  Request Amount $________________

Special Conditions, if applicable, met? ______ Yes ______ No (if no, explain)

ALP revisions showing project As-Built conditions: ________________ (date)

Airport Master Record (FAA Form 5010-1) update submitted to FAA: ________ (date)

4. ENGINEERING

Consultant/Engineer: _______________________________________________________

Contract: __________________ Eligible: ___________ FAA Approval Date: _____________

Engineering Amendment(s) Amount: __________________________________ (eligible only)

5. CONSTRUCTION

Contractor: _______________________

Total Amount: __________________________ Eligible Amount: _______________________

Notice to Proceed (effective date): _______________ Work Completion Date: ______________

Liquidating Damage Assessment: __________________________________________________

Final Inspection Date: ________________________

6. SUBMISSIONS/CERTIFICATIONS

Date As-Built drawings Submitted: __________________

Date Electronic As-Built Submitted: _________________

Date Certifications of Final Acceptance (attachment 5) signed and submitted: _______________

*******************************EQUIPMENT ONLY******************************

Date Equipment (ARFF/SRE) has been received and inspected by Sponsor: __________________

Equipment meets specification(s) ____________ Yes ____________ No (if no, explain)

FAA USE ONLY

Reported Accepted: ___________ as submitted OR ______________ as annotated

Project Manager: _______________________________ Date: __________________