FY 11 AIGPW orksheet

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New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Type of Grant being Requested State Match (95% FAA; 2.5% Applicant; 2.5% State)

Part I – Applicant Information

Name of Applicant (Company or Governmental Entity): Date of Application:
Applicant
Applicant’s Vendor ID Number
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip

Name and Title of the Person Authorized to apply for State Funding on behalf of the Applicant:
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Website
Email

Person to whom Correspondence regarding the Application should be sent:
( Check here if this individual is the same as the Authorized Person listed above.)
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Website
Email

The Applicant is a:
Federal Agency
Fiscal Year 2011 State Airport Aid Grant Worksheet Page 1 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

The relationship of the person entering the form data to the property is:
Owner
If you are not the registered property owner, please attach a letter from the owner authorizing you to advance this application for this
project on their property/properties and/or alignment(s).

The deed of record is filed as owned by the following corporation/partnership/individual:

For non-governmental agencies or entities, a legal deed or instrument verifying property ownerships including a narrative legal description
of the metes and bounds of the property certified as accurate by a New Jersey registered Land Surveyor or Professional Engineer must be
attached to this application.
Organizational Manager
Organization/Firm:
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Website
Email

( Check here if this individual is the same as the Authorized Person listed above.)
Registered Agent
ONLY FOR USE IN APPLICATIONS BY OUT OF STATE APPLICANTS
Organization/Firm:
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Website
Email

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 2 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Project Manager
Organization/Firm:
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Project Website
Email

Consultant
( Check here if the Consultant is authorized to act on behalf of the Authorized Person listed above.)
Organization/Firm:
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Website
Email

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 3 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Construction Engineer
Organization/Firm:
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Website
Email

Other
Organization/Firm:
Prefix First Middle Last Suffix
Name
Title
Physical Address
City State NJ Zip
P.O. Box
P.O. Box City P.O. Box State NJ P.O. Box Zip
Telephone ( ) - Ext.
Mobile Phone ( ) -
Fax ( ) -
Website
Email

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 4 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Part II – Proposed Project Information
(Provide as much Detail as Possible)
Name of the Proposed Project:

Brief Summary of Project (Narrative description of why this project is necessary and how it relates to the long term development of the
airport and/or air safety – 650 characters max.):

Project Need & Justification (4000 characters max.):

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 5 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Specific Locations on the Property (300 characters max. – attach any sketches):

Background/History (4000 characters max.):

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 6 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Detailed Scope of Work (4000 characters max.):

Construction Duration in Calendar Days:

Application Priority:
If you will be submitting more than one application for this program for the current fiscal year, please indicate the priority of the current
application, with 1 being the highest and 2 being the lowest:
1

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 7 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Part III – Property / Facility Information
Facility Name:

Property Description (3000 characters max.):

Number of based aircraft at the airport, as of date of application:

Number of annual operations:
Total gallons of fuel (by type) dispensed at the airport in the past twelve (12) months.
 Jet: Gallons

 Avgas Gallons

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 8 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Project Location
Check here if the Project is statewide.
County or Counties where the Project is located:

Municipality or Municipalities where the Project is located:

Airport Reference Point
Latitude (North is positive; South is negative): Longitude (East is positive; West is negative):
Congressional District(s):
Name(s) of Congressional Representative(s):
New Jersey State Legislative Districts(s):

Municipality:
Block Number Lot Number(s)

Additional Site Locations
Site name
Physical Address
City State NJ Zip
Telephone ( ) -
Latitude (North is positive; South is negative): Longitude (East is positive; West is negative):

Site name
Physical Address
City State NJ Zip
Telephone ( ) -
Latitude (North is positive; South is negative): Longitude (East is positive; West is negative):
Site name
Physical Address
City State NJ Zip
Telephone ( ) -
Latitude (North is positive; South is negative): Longitude (East is positive; West is negative):
Fiscal Year 2011 State Airport Aid Grant Worksheet Page 9 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Total Estimated Cost of Project

Type of Grant being Requested State Match (95% FAA; 2.5% Applicant; 2.5% State)
If you are requesting a State Match to a Federal Grant, you MUST attach a copy of your application to FAA.
If you have ALREADY received a Federal Grant, you MUST attach a copy of your Federal Grant Agreement.

Requested Participating Costs:
Construction Cost Estimate: $
Sum of Construction Engineering, Construction Inspection, and Materials Testing Estimate if requesting (may be up
to 15% of the final allowable construction cost maximum):
$
Other Requested Participating Cost Estimate: $
Total Requested Participating Cost Estimate: $

Non-Construction Costs:
Design Cost: $
Utility Relocation Cost: $
Permitting Fees Cost: $
ROW Acquisition Cost: $
Total Non-Construction Cost: $

Total Cost Estimate: $

Total Amount Eligible for Reimbursement by the State: $
(95% of the Total Requested Participating Cost Estimate for a State Airport Improvement Safety Program
Grant, OR 2½% of the Total Requested Participating Cost Estimate for a State Matching Grant)

Total Requested Amount: $

Please attach a detailed Cost Estimate for the items cited above.

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 10 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Miscellaneous Attachments
Provide descriptions of any additional documentation attached in support of this application.
Attachment No.
Description:

Attachment No.
Description:

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 11 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Required Exhibits
A complete application requires the following submissions unless specifically waived by the Bureau of Multimodal
Grants and Programs:
1. Attach a list of airport Fixed Based Operators (FBO) including; company name, type of services offered by that
company, and the name and mailing address of the company manager or owner.
2. If the Applicant is a Corporation or a Partnership, attach a list of the names and addresses of persons having at least a
10 Percent Interest in the Corporation or partnership.
3. Corporate grantees shall attach a duly adopted Corporate Resolution designating the person(s) authorized to execute
this Agreement and bind the corporation. The corporate Secretary shall affirm that such resolution is in full force and
effect as of the date executed and shall attest to the execution of and affix the corporate seal to this Agreement.
Partnership grantees shall have all partners sign the Agreement or have the Agreement signed by one partner,
provided documents are attached which authorize that one partner to bind all partners; all signatures shall be
witnessed. For Sole Proprietorship grantees, the sole proprietor shall execute this Agreement with the execution
notarized, notarization to be attached. Joint Venture grantees shall follow the execution procedure applicable to each
of the joint ventures.
4. A current Certificate of Liability Insurance.
5. A Design Certification signed by a professional engineer licensed to practice engineering in New Jersey.
6. A package containing complete contract documents, comprised of:
 Final Plans, Specifications, and (Detailed) Cost Estimates (PS&E) Package signed by a professional engineer
licensed to practice engineering in New Jersey.
 A “Critical Path Method” Schedule for the complete construction and close-out of the project.

Airport Aid Assurances
For airport development projects, these shall remain in full force and effect throughout the useful life of the facility
developed under this project.
The Applicant shall comply with the following:
1. License and Permit Requirements - It shall comply with the current laws, regulations, permit and license
requirements applicable to the development of the project and operation of the associated aviation facility.
2. Applicant Fund Availability - It shall have sufficient funds, and, if requested by the State, shall demonstrate the
availability of such funds for that portion of the project costs which are not paid by the State of New Jersey and has
sufficient funds to assure operation and maintenance of the project/facility for the purposes constructed.
3. Authority of Applicant - It has proper legal authority to apply for State aid and to finance and construct the proposed
project.
4. Good Title to Airport - It holds good title to the airport or project facility.
5. Public Use - It shall maintain and operate as a public use facility and shall not establish hours of operation, use
restrictions, or pricing of services which would affect or the change the airport's status as a public use facility.
6. Airport Operation and Maintenance - It shall suitably operate and maintain the airport and all facilities thereon or
connected therewith. It shall also maintain the project, as constructed, in a usable condition for the project's useful life
as defined in the grant agreements.

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 12 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

7. Hazard Removal and Mitigation - It shall adequately clear and protect the aerial approaches to the airport by
removing, lowering, relocating, marking, or lighting or otherwise mitigating existing airport hazards and prevent the
establishment or creation of future airport hazards in those areas under the Applicant's control.
8. Consultation with Airport Tenants and Users - In making a decision to undertake any airport development project,
it shall provide prior notification of the project to affected parties using the airport at which the project is proposed.
9. Project Inspection and Approval - It shall subject all work on any project funded by the State for airport
development to review, inspection and approval by the NJDOT, Bureau of Multimodal Grants and Programs.
10. Preserving Airport Rights and Powers - It shall not enter into any transaction which might serve to deprive it of any
of the rights and powers necessary to perform any or all of the airport Applicant's obligations herein without prior
written approval of the State.
11. Supervision of Work - It shall assure performance of the work associated with the project in accordance with plans,
specifications, work scope and schedules as approved by the State, or with modifications similarly approved. It shall
provide and maintain competent technical supervision of the project to assure that completed work conforms to State
approved plans and specifications.
General Information
1. Any offer of state airport aid shall be subject to the availability of funds and the execution
of a State Airport Aid Grant Agreement by the Commissioner or designee.
2. Construction project specifications shall require:
 That the contractor supply a performance bond payment bond and liability insurance acceptable to the State.
 As applicable, bid documents shall state that the contract will be awarded to the lowest responsible bidder.
3. It is recommended that the Applicant utilize professional services in the preparation of the Design Certification; the
Final Plans, Specifications, and (Detailed) Cost Estimates (PS&E) Package; and the “Critical Path Method” Schedule
cited above under Required Exhibits.
4. The Authorized Person signing this Application certifies that they have reviewed and verified that all the information
cited therein is correct.

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 13 of 14
New Jersey Department of Transportation
Bureau of Multimodal Grants and Programs
Fiscal Year 2011 State Airport Aid Grant Worksheet
FOR REFERENCE ONLY. NOT FOR USE AS A GRANT APPLICATION

Part VI – Certification

I, hereby certify that I am legally authorized to submit this
Title:
Application on behalf of . I further certify

that the information contained in this Application is true to the best of my knowledge as of ;

and that I agree to the provisions of this Application’s Airport Aid Assurances. I am aware that if any of the

information is willingly false, I am subject to punishment.

Date

Fiscal Year 2011 State Airport Aid Grant Worksheet Page 14 of 14