Period Ending OMB Control No. 2120-0569 11/30/2007 CONSTRUCTION PROGRESS AND INSPECTION REPORT Project Number AIRPORT GRANT PROGRAM U.S. Department of Transportation Federal Aviation Administration Airport Name Project Description Contractor's Name 1. Rough Estimate of Percent Completion to Date of Construction Phases (include Items such as clearing, grading, drainage, base, surface, lighting, etc.) 2. Work Completed or in Progress this period 3. Brief Weather Summary This Period Including Approximate Rainfall and Periods of Below Freezing Temperature (On earthwork jobs include soil conditions) 4. Contract Time No Days Charged To Date 5. Summary of Laboratory and Field Testing This Period (Note failing tests and any retests. Summarize out-of-tolerance.) Last Working Day Charged (Date) Material. (Identify material subject to pay reduction.) 6. Describe Anticipated Work by Contractor for Next Period 7. Problem Areas/Other Comments (Revisions to plans and specifications approved or denied, delays, difficulties, etc. and actions taken.) Date SPONSOR'S INSPECTOR OR REPRESENTATIVE Typed or Printed Name and Title Signature FAA Form 5370-1 (8-89) Supersedes Previous Edition American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR PREPARATION OF FAA FORM 5370-1 (8-89) CONSTRUCTION PROGRESS AND INSPECTION REPORT AIRPORT GRANT PROGRAM This preaddressed form is to be filled out, with ballpoint pen or typewriter by the Sponsors Inspector on the project, folded with return address out, fastened, and mailed to the address shown below. No postage Is required since the postage has been prepaid by the Federal Aviation Administration. Submit one copy for each report. If additional space Is required to complete any of the items, continue on a separate sheet of plain paper, identifying it with the project number, fold and insert inside the report before mailing. If additional blank copies of the form are required, submit your request to the address provided below. U.S. GPO:1989-261-335/03364 1st Fold TAPE HERE Paperwork Reduction Act Statement: The information collected on this form documents the progress of construction work on a project funded with a Federal grant under the AIP in a form prescribed by the Secretary of Transportation. Title 49, United States Code (U.S.C.), Section 47121, requires cost and progress reporting by the sponsor. The burden associated with sponsor certification of qualified engineering and construction specifications, compliance with wage regulations, and periodic performance reporting is estimated to be 1/2 hour. Sponsors benefit by receiving proceeds of the grant based on documented performance. No assurance of confidentiality can be given since these become public records. Please note that an agency may conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number, which is 2120-0569 for this collection. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20 . 2nd Fold U.S. Department of Transportation Federal Aviation Administration 800 Independence Avenue, S.W. Washington, D.C. 20591 NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY MAIL FIRST CLASS PERMIT NO. 12438 WASHINGTON D.C. POSTAGE WILL BE PAID BY THE FEDERAL AVIATION ADMINISTRATION Official Business Penalty for Private Use $200 American LegalNet, Inc. www.FormsWorkflow.com