Attachment E Seismic Compliance Documentation.docx

OMB CONTROL NO. 2120-0595

Department of Transportation Federal Aviation Administration Life Safety Compliance/Seismic Certification In response to Announcement/ Lease Contract #:

690EG4-23-L-00006

Honolulu, Hawaii

Date: MM/DD/YYYY

Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0595. Public reporting for this collection of information is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

Instructions: Building owner must have a licensed structural engineer evaluate the building and fill out the below certification.

Date: ____________ Building Address: _______________________________________________________________ City, State, and Zip code: _________________________________________________________ I certify that the building above (check one):

☐ is a New Building or Major Renovations are planned to the existing building where renovation costs exceed 50% of replacement cost of building and the building meets appropriate seismic provisions of _____________________________ (IBC or local seismic building code, if more stringent than IBC) edition of ___________________. (Attach documentation confirming compliance).

The below apply only to Existing Buildings not undergoing Major Renovations:

☐was designed, built and maintained to the requirements of seismic standards RP-8 as specified in Section 2.2 of Standards of Seismic Safety for Existing Federally Owned or Leased Buildings and Commentary issued by the Interagency Committee on Seismic Safety in Construction as ICSSC RP-8, Seismic Standards for Existing Federally Owned and Leased Buildings, Dec 2011. (Attach documentation confirming compliance.)

☐meets the minimum acceptable performance seismic standard of ‘Life Safety’ using the American Society for Civil Engineers (ASCE) 31-03, Seismic Evaluation of Existing Buildings. (Attach documentation confirming compliance.)

☐is a benchmark building according to RP-8 Section 1.3.1. (Attach documentation confirming compliance.)

Structural Engineer completing certificate:

(Print name)

(Signature)

License No. _____________________________________ Field of Practice _________________________________ SEAL: Expiration Date ________________________

Federal Aviation Administration Page 2 of 2 Life Safety Compliance/Seismic Certification, 10/2022 FAA Form 4400-90