07/11/11 FAA/Application for Payment 3_= Federal Aviation
Administration
Memorandum
Date: July 11, 2011
From: Gary Gates, HLN-610
2725 Skyway Dr; Ste 2, Helena, MT 59602
(406) 449-5230
To: Accounts Payable Branch, AMZ-110
Subject: ACTION: Application for Payment Number: 3 Partial
Kalispell City Airport
Kalispell, MT
Al Project No. 3-30-0043-003-2010
Grant Contract Number: DOT-FA10NM-2032
A scanned copy of FAA Form 5100-60 is submitted for payment. Based on the
representation and certification contained in the payment request, I find the amount of
$15,200 (shown on line 'b') to be an allowable project cost, not previously paid, and
approved for payment.
a. Accumulated previous payments......... $30,233.00
4. Amount approvedthis payment.......... F $15,200.00
c. Total accumulative payments .............. $45,433.00
d. Maximum grant amount .....................
e. Remaining balance ...........................
Gary s, HLN-610
3 Enclosures
cc: ANM-613
City of Kalispell
Stelling Engineers, Jeff Walla
$92,910.00
$47,477.00
OUTLAY REPORT AND REQUEST FOR REIMBURSEMENT
FOR CONSTRUCTION PROGRAMS
(see invmctions on back)
OMB APPROVAL NO. 0348-0002
PAGE OF
I 1 1 PAGES
1. TYPE OF REQUEST
[ ] FINAL X ] PARTIAL
2. BASIS OF REQUEST
[ X ] CASH ACCRUAL
FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO
WHICH THIS REPORT IS SUBMITTED
DOT -FAA
4, FEDERAL GRANT OR OTHER
IDENTIFYING NUMBER
ASSIGNED BY FEDERAL AGENCY
DOT-FAIONM-2032
5. PARTIAL PAYMENT REQUEST NO.
Three (3)
EMPLOYER IDENTIFICATION
NUMBER
81-6001281
7. RECIPIENT'S ACCOUNT NUMBS F
OR IDENTIFYING NUMBER
3-30-0043-003-2010
PERIOD COVERED BY THIS REQUEST
FROM (Month, day, year)
111812011
TO (Month, day, year)
612912011
RECIPIENT ORGANIZATION
Una: City of Kalispell
a. and Street: 201 1st Avenue East
ty, State and Kalispell, MT 69901
P coda:
10. PAYEE (Where checlik is to be sent ff different than Item 9)
Name,
No. and Street:
City, State and
ZIP Code
11. STATUS OF FUNDS
CLASSIFICATION
TOTAL
No. 1
N0.2
No, 3
Administrative expense
$0.00
Preliminary expense
$0.00
Land, structures, right-of-way
$0.00
Architectural engineering basic fees
512,100.00
$19,725,00
$16,000.00
547,825.00
Other architectural engineering fee
$Oko
Project inspection fees
$0.00
Land development
WOO
Relocation expense
$0.00
Relocation payments to individuals and businesses
$0.00
Demolition and removal
$0.00
Construction and project improvement cost
SO.00
Equipment
SO.00
Miscellaneous cost
$0,00
Total cumulative to data (sum offines a thru m)
$12,100.00
519,725.00
516,000.00
$47,825.00
Deductions for program income
SO.00
Nei cumulative to date (line n minus line p)
$12,100.00
519,725.00
S16,000.00
$47,825,00
Federal share to date
$45,433.00
Rehabilitation grants (100% reimbursement)
$0.00
Total Federal share (sum of lines q and r)
$45,433.00
Federal payments previously requested
$30,233.00
Amount requested for reimbursement
$15,200.00
Percentage of physical completion of project (Grant Amount $92,910.00)
48.9%