##### SUBMITTAL DOCUMENTS-- Solicitation No. 8009-25 -- **Exclusive use helicopter flight services consisting of one helicopter for use by the Bureau of Land Management, designated base, Rifle, Colorado**

[OFFEROR CHECKLIST]{.underline}. Please read the complete solicitation
and then use the following checklist to ensure you have completed and
included [all]{.underline} the items needed when you submit your
proposal. Proposals submitted without reading the complete solicitation
could be at the peril of the offeror. Failure to include the information
specified at Section D (and as identified below) could result in your
offer being determined unacceptable or being adversely evaluated.

+---+------------------------------------------------------------------+
| D | SF 1449 form and SF30 Amendment form, if any are issued          |
| 4 |                                                                  |
| . | obtain by locating solicitation on the National Business Center, |
| 1 | IDEAS-EC site accessed through <http://fedbizopps.gov/> - At the |
|   | IDEAS-EC site, the SF 1449 is found by selecting the printer     |
|   | icon as shown below. The solicitation specifications and clauses |
|   | are found by selecting the "Clauses and Attachments' located in  |
|   | the blue box immediately below the printer icon shown below.     |
|   |                                                                  |
|   | ![](media/image1.wmf){width="0.34444444444444444in"              |
|   | height="0.33055555555555555in"} To print/view the standard form, |
|   | use our [printer                                                 |
|   | friendly](http://ideasec.nbc.gov/j2ee/standardfo                 |
|   | rm.jsp;jsessionid=afa6df7e087840a89fb2e6f65321ae78.ok9xok5yokfzm |
|   | lbzmNCNa30Kcybtah0IbxyIah4IagSQn3fxagTAmN5xmhaKbx4M-wOSa30K8Qjx- |
|   | Azynk5NnkaIpA9x-ArJrwaLbh4RaNmxo6XHngbCpQPz8QfznA5Pp7ftolbGmkTy) |
|   | page.                                                            |
|   |                                                                  |
|   | Complete the following blocks on the SF 1449:                    |
|   |                                                                  |
|   | -block 12 as applicable, if offering a prompt payment discount   |
|   |                                                                  |
|   | -block 17a and b) white-out or cross out statement 'No           |
|   | Contractor Information Available' and insert your company name   |
|   | and complete mailing address                                     |
|   |                                                                  |
|   | -block 30a, b and c                                              |
|   |                                                                  |
|   | *(NOTE: Solicitation documents can also be found at              |
|   | http://amd.nbc.gov/ under Business Opportunities)*               |
+---+------------------------------------------------------------------+
| D | **Schedule A Pricing pages**                                     |
| 4 |                                                                  |
| . | **Identify offeror and aircraft information and insert daily     |
| 2 | availability and flight rate unit prices in the appropriate      |
|   | locations and compute the extended amounts on the pricing        |
|   | pages**                                                          |
|   |                                                                  |
|   | -Use whole dollars only                                          |
+---+------------------------------------------------------------------+
| D | **Section E -- Offerors Representations and Certifications**     |
| 4 | completed in its entirety where indicated OR complete            |
| . | electronically as permitted under Section E1 and complete shaded |
| 3 | paragraph (b)(2) only                                            |
+---+------------------------------------------------------------------+
| D | **Section E - Complete Offeror's Miscellaneous Information       |
| 4 | Sheet**                                                          |
| . |                                                                  |
| 4 |                                                                  |
+---+------------------------------------------------------------------+
| D | **Acknowledgement of solicitation amendments** if any are        |
| 4 | issued; complete and sign blocks 8, 15A, B, and C and return the |
| . | SF 30 form to the office designated for receipt of proposals     |
| 5 | (amendments may be submitted separately from your proposal and   |
|   | may be faxed to 208-433-5030 prior to the closing date and time) |
+---+------------------------------------------------------------------+
| D | **Section E -- Aircraft Questionnaire completed in its entirety  |
| 4 | for EACH AIRCRAFT offered -- also include as applicable, a copy  |
| . | of your**:                                                       |
| 6 |                                                                  |
|   | 1)  \*Latest aircraft weight and balance report                  |
|   |                                                                  |
|   | 2)  \*Aircraft equipment list                                    |
|   |                                                                  |
|   | 3)  \*Aircraft appropriate hover ceiling charts used to arrive   |
|   |     at the HOGE payload included on the aircraft questionnaire   |
|   |                                                                  |
|   | 4)  A completed load calculation form which shows the HIGE, HOGE |
|   |     and HOGE-J payloads (the HOGE payload computed on the load   |
|   |     calculation form should be the same number entered on the    |
|   |     aircraft questionnaire                                       |
|   |                                                                  |
|   | *\*Failure to include the above information that is the most     |
|   | current with the aircraft questionnaire could affect the         |
|   | evaluation of your aircraft and we may not request this          |
|   | information*                                                     |
+---+------------------------------------------------------------------+
| D | **Section E -- Reference Questionnaire** -- each reference       |
| 4 | identified should include all the information requested on the   |
| . | questionnaire form -- see D4.7 and D13                           |
| 7 |                                                                  |
+---+------------------------------------------------------------------+
|   | Mark proposal envelope with **SOLICITATION NO. 8009-25 RIFLE     |
|   | PROPOSAL**                                                       |
+---+------------------------------------------------------------------+
|   | Send proposal by mail, hand carry or express delivery service    |
|   | to:                                                              |
|   |                                                                  |
|   | > **Department of the Interior**                                 |
|   | >                                                                |
|   | > **Aviation Management**                                        |
|   | >                                                                |
|   | > **Acquisition Branch**                                         |
|   | >                                                                |
|   | > **300 E. Mallard Drive, Suite 200**                            |
|   | >                                                                |
|   | > **Boise, Idaho 83706-3991**                                    |
|   |                                                                  |
|   | By facsimile: **208-433-5030**                                   |
|   |                                                                  |
|   | Facsimile proposals may not exceed 20 pages and must arrive in   |
|   | their entirety **prior** to the date and time set for closing.   |
+---+------------------------------------------------------------------+
|   | **THANK YOU FOR:**                                               |
|   |                                                                  |
|   | -Including all of the items requested above in their entirety    |
|   |                                                                  |
|   | -Remembering to register in the CCR database -- Section D7       |
|   |                                                                  |
|   | \-**Not** sending data or materials that are not specifically    |
|   | requested above and at Section D4.                               |
|   |                                                                  |
|   | \-**Not** binding or punching holes in your offer materials      |
|   | (stapling and paper clipping is fine)                            |
|   |                                                                  |
|   | -Your interest and submission of a proposal in response to these |
|   | requirements                                                     |
+---+------------------------------------------------------------------+

## A2 Item 1 Pricing 

Complete shaded areas only.

+-------------------------+-----------------+--------------------------+
| **DESIGNATED BASE**     | **EXCLUSIVE USE | **START DATE: June 1,    |
|                         | PERIOD**        | 2009 (See C18.)**        |
| **Rifle, Colorado**     |                 |                          |
|                         | **90 calendar   | **END DATE: August 29,   |
|                         | days**          | 2009**                   |
+-------------------------+-----------------+--------------------------+

+------------+-------------------------+------------------------------+
| **OFFEROR  |                         |                              |
| NAME**     |                         |                              |
+------------+-------------------------+------------------------------+
| **AIRCRAFT | Make/Model              | FAA Registration \#          |
| FOR THIS** |                         |                              |
|            |                         |                              |
| **PRICING  |                         |                              |
| SCHEDULE** |                         |                              |
+------------+-------------------------+------------------------------+

**\*\*The amounts in these line items shall not be exceeded without
written authorization by the Contracting Officer. Funding for this line
item and miscellaneous additional pay items shall be funded through
Wildland Fire Management Funds as appropriated annually through the
Department of the Interior appropriations legislation. Bureaus will
ensure that appropriate funds are available prior to ordering services
for flight time and other additional pay items under this contract.
Wildland Fire Management funds are available to support the suppression
or emergency prevention of wildland fire on or threatening lands under
the jurisdiction of the Department of the Interior: for emergency
rehabilitation of burned-over lands under its jurisdiction: for
emergency actions related to potential or actual earthquakes, floods,
volcanoes, storms, or other unavoidable causes; for contingency planning
subsequent to actual oil spills; for response and natural resource
damage assessment activities related to actual oil spills; for the
prevention, suppression, and control of actual or potential grasshopper
or mormon cricket outbreaks on lands under the jurisdiction of the
Secretary, pursuant to the authority in Section 1773(b) of Public Law
99-198 (99 Sat. 1658.)**

+---+----------------------+---+------+------+--------+------------+
| * | **DESCRIPTION**      | * | **QU | **UN | **UNIT | **EXTENDED |
| * |                      | * | ANTI | IT** | P      | AMOUNT**   |
| I |                      | P | TY** |      | RICE** |            |
| T |                      | A |      |      |        |            |
| E |                      | Y |      |      |        |            |
| M |                      | * |      |      |        |            |
| * |                      | * |      |      |        |            |
| * |                      |   |      |      |        |            |
|   |                      | * |      |      |        |            |
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|   |                      | T |      |      |        |            |
|   |                      | E |      |      |        |            |
|   |                      | M |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      |   |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | C |      |      |        |            |
|   |                      | O |      |      |        |            |
|   |                      | D |      |      |        |            |
|   |                      | E |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * | **1^st^ YEAR -- 6/1  | A | 90   | DAYS | **\$** | **\$**     |
| * | -- 8/29**            | V |      |      |        |            |
| 2 |                      |   |      |      |        |            |
| 0 | Price per day for    |   |      |      |        |            |
| 0 | availability         |   |      |      |        |            |
| 9 |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
|   |                      |   |      |      |        |            |
| 1 |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
| a |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Price per flight | F | E    | FL   | **\$** | **\$**     |
| . | hour for             | T | STIM | IGHT |        |            |
| b | **estimated** flight |   | ATED |      |        |            |
| . | hours                |   |      | H    |        |            |
|   |                      |   | 220  | OURS |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Additional pay   |   |      | See  |        | **\$       |
| . | items (see schedule  |   |      | Ad   |        | 40,000**   |
| c | following line item  |   |      | diti |        |            |
| . | pricing              |   |      | onal |        |            |
|   |                      |   |      | Pay  |        |            |
|   | The additional pay   |   |      | I    |        |            |
|   | item estimated       |   |      | tems |        |            |
|   | amount is calculated |   |      | Sche |        |            |
|   | by the agency, and   |   |      | dule |        |            |
|   | is for funding       |   |      | for  |        |            |
|   | purposes only. The   |   |      | R    |        |            |
|   | amount implies no    |   |      | ates |        |            |
|   | guarantee and will   |   |      |      |        |            |
|   | not be evaluated for |   |      |      |        |            |
|   | award purposes.      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * |                      |   |      |      |        | **\$**     |
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+---+----------------------+---+------+------+--------+------------+

+---+----------------------+---+------+------+--------+------------+
| * | **DESCRIPTION**      | * | **QU | **UN | **UNIT | **EXTENDED |
| * |                      | * | ANTI | IT** | P      | AMOUNT**   |
| I |                      | P | TY** |      | RICE** |            |
| T |                      | A |      |      |        |            |
| E |                      | Y |      |      |        |            |
| M |                      | * |      |      |        |            |
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|   |                      | E |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * | **2nd YEAR -- 6/1 -- | A | 90   | DAYS | **\$** | **\$**     |
| * | 8/29**               | V |      |      |        |            |
| 2 |                      |   |      |      |        |            |
| 0 | Price per day for    |   |      |      |        |            |
| 1 | availability         |   |      |      |        |            |
| 0 |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
|   |                      |   |      |      |        |            |
| 1 |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
| a |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Price per flight | F | E    | FL   | **\$** | **\$**     |
| . | hour for             | T | STIM | IGHT |        |            |
| b | **estimated** flight |   | ATED |      |        |            |
| . | hours                |   |      | H    |        |            |
|   |                      |   | 220  | OURS |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Additional pay   |   |      | See  |        | **\$       |
| . | items (see schedule  |   |      | Ad   |        | 40,000**   |
| c | following line item  |   |      | diti |        |            |
| . | pricing)             |   |      | onal |        |            |
|   |                      |   |      | Pay  |        |            |
|   | The additional pay   |   |      | I    |        |            |
|   | item estimated       |   |      | tems |        |            |
|   | amount is calculated |   |      | Sche |        |            |
|   | by the agency, and   |   |      | dule |        |            |
|   | is for funding       |   |      | for  |        |            |
|   | purposes only. The   |   |      | R    |        |            |
|   | amount implies no    |   |      | ates |        |            |
|   | guarantee and will   |   |      |      |        |            |
|   | not be evaluated for |   |      |      |        |            |
|   | award purposes.      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * |                      |   |      |      |        | **\$**     |
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+---+----------------------+---+------+------+--------+------------+

+---+----------------------+---+------+------+--------+------------+
| * | **DESCRIPTION**      | * | **QU | **UN | **UNIT | **EXTENDED |
| * |                      | * | ANTI | IT** | P      | AMOUNT**   |
| I |                      | P | TY** |      | RICE** |            |
| T |                      | A |      |      |        |            |
| E |                      | Y |      |      |        |            |
| M |                      | * |      |      |        |            |
| * |                      | * |      |      |        |            |
| * |                      |   |      |      |        |            |
|   |                      | * |      |      |        |            |
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|   |                      | I |      |      |        |            |
|   |                      | T |      |      |        |            |
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|   |                      | M |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      |   |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | C |      |      |        |            |
|   |                      | O |      |      |        |            |
|   |                      | D |      |      |        |            |
|   |                      | E |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * | **3rd YEAR -- 6/1 -- | A | 90   | DAYS | **\$** | **\$**     |
| * | 8/29**               | V |      |      |        |            |
| 2 |                      |   |      |      |        |            |
| 0 | Price per day for    |   |      |      |        |            |
| 1 | availability         |   |      |      |        |            |
| 1 |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
|   |                      |   |      |      |        |            |
| 1 |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
| a |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Price per flight | F | E    | FL   | **\$** | **\$**     |
| . | hour for             | T | STIM | IGHT |        |            |
| b | **estimated** flight |   | ATED |      |        |            |
| . | hours                |   |      | H    |        |            |
|   |                      |   | 220  | OURS |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Additional pay   |   |      | See  |        | **\$       |
| . | items (see schedule  |   |      | Ad   |        | 40,000**   |
| c | following line item  |   |      | diti |        |            |
| . | pricing)             |   |      | onal |        |            |
|   |                      |   |      | Pay  |        |            |
|   | The additional pay   |   |      | I    |        |            |
|   | item estimated       |   |      | tems |        |            |
|   | amount is calculated |   |      | Sche |        |            |
|   | by the agency, and   |   |      | dule |        |            |
|   | is for funding       |   |      | for  |        |            |
|   | purposes only. The   |   |      | R    |        |            |
|   | amount implies no    |   |      | ates |        |            |
|   | guarantee and will   |   |      |      |        |            |
|   | not be evaluated for |   |      |      |        |            |
|   | award purposes.      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * |                      |   |      |      |        | **\$**     |
| * |                      |   |      |      |        |            |
| O |                      |   |      |      |        |            |
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| * |                      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+

+---+----------------------+---+------+------+--------+------------+
| * | **DESCRIPTION**      | * | **QU | **UN | **UNIT | **EXTENDED |
| * |                      | * | ANTI | IT** | P      | AMOUNT**   |
| I |                      | P | TY** |      | RICE** |            |
| T |                      | A |      |      |        |            |
| E |                      | Y |      |      |        |            |
| M |                      | * |      |      |        |            |
| * |                      | * |      |      |        |            |
| * |                      |   |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | I |      |      |        |            |
|   |                      | T |      |      |        |            |
|   |                      | E |      |      |        |            |
|   |                      | M |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      |   |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | C |      |      |        |            |
|   |                      | O |      |      |        |            |
|   |                      | D |      |      |        |            |
|   |                      | E |      |      |        |            |
|   |                      | * |      |      |        |            |
|   |                      | * |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * | **4^th^ YEAR -- 6/1  | A | 90   | DAYS | **\$** | **\$**     |
| * | -- 8/29**            | V |      |      |        |            |
| 2 |                      |   |      |      |        |            |
| 0 | Price per day for    |   |      |      |        |            |
| 1 | availability         |   |      |      |        |            |
| 2 |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
|   |                      |   |      |      |        |            |
| 1 |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
| a |                      |   |      |      |        |            |
| . |                      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Price per flight | F | E    | FL   | **\$** | **\$**     |
| . | hour for             | T | STIM | IGHT |        |            |
| b | **estimated** flight |   | ATED |      |        |            |
| . | hours                |   |      | H    |        |            |
|   |                      |   | 220  | OURS |        |            |
+---+----------------------+---+------+------+--------+------------+
| 1 | \*\*Additional pay   |   |      | See  |        | **\$       |
| . | items (see schedule  |   |      | Ad   |        | 40,000**   |
| c | following line item  |   |      | diti |        |            |
| . | pricing)             |   |      | onal |        |            |
|   |                      |   |      | Pay  |        |            |
|   | The additional pay   |   |      | I    |        |            |
|   | item estimated       |   |      | tems |        |            |
|   | amount is calculated |   |      | Sche |        |            |
|   | by the agency, and   |   |      | dule |        |            |
|   | is for funding       |   |      | for  |        |            |
|   | purposes only. The   |   |      | R    |        |            |
|   | amount implies no    |   |      | ates |        |            |
|   | guarantee and will   |   |      |      |        |            |
|   | not be evaluated for |   |      |      |        |            |
|   | award purposes.      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+
| * |                      |   |      |      |        | **\$**     |
| * |                      |   |      |      |        |            |
| O |                      |   |      |      |        |            |
| P |                      |   |      |      |        |            |
| T |                      |   |      |      |        |            |
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| t |                      |   |      |      |        |            |
| h |                      |   |      |      |        |            |
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| * |                      |   |      |      |        |            |
| * |                      |   |      |      |        |            |
+---+----------------------+---+------+------+--------+------------+

+-------+---------------------+------+--------+------+---------------+
| **    | **ADDITIONAL PAY    | **AM | **QUAN | **UN | **APPLICABLE  |
| SCHED | ITEMS SCHEDULE**    | D-23 | TITY** | IT** | FOR           |
| ULE** |                     | PAY  |        |      | OPERATIONS IN |
|       |                     | ITEM |        |      | CONTERMIMOUS  |
| **    |                     | CO   |        |      | 48 STATES**   |
| SUB-I |                     | DE** |        |      |               |
| TEM** |                     |      |        |      |               |
|       |                     |      |        |      |               |
| **1   |                     |      |        |      |               |
| .d.** |                     |      |        |      |               |
+-------+---------------------+------+--------+------+---------------+
| i     | Extended Standby -- | EP   | INDE   | HOUR | \$ 47.00      |
|       | Pilot               |      | FINITE |      |               |
+-------+---------------------+------+--------+------+---------------+
| ii    | Extended Standby -- | ET   | INDE   | HOUR | \$ 30.00      |
|       | Fuel Vehicle Driver |      | FINITE |      |               |
+-------+---------------------+------+--------+------+---------------+
| iii   | Subsistence         | PD   | INDE   | O    | Per FTR       |
|       | Allowance           |      | FINITE | vern | Schedule      |
|       |                     |      |        | ight |               |
+-------+---------------------+------+--------+------+---------------+
| iv    | Fuel Servicing      | SM   | INDE   | MILE | 350-749       |
|       | Vehicle Mileage     |      | FINITE |      | gallons       |
|       |                     |      |        |      | \$1.83        |
|       |                     |      |        |      |               |
|       |                     |      |        |      | 750-1,499     |
|       |                     |      |        |      | gallons \$    |
|       |                     |      |        |      | 2.45          |
+-------+---------------------+------+--------+------+---------------+
| v     | Contractor          | SC   | INDE   | EACH | Actual Cost   |
|       | Miscellaneous Costs |      | FINITE |      |               |
+-------+---------------------+------+--------+------+---------------+

#  {#section .unnumbered}

# 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS---COMMERCIAL ITEMS (JUN 2008) 

**An offeror shall complete only paragraph (b) of this provision if the
offeror has completed the annual representations and certifications
electronically at [http://orca.bpn.gov](http://orca.bpn.gov/). If an
offeror [has not]{.underline} completed the annual representations and
certifications electronically at the ORCA website, the offeror shall
complete only paragraphs (c) through (m) of this provision.**

\(a\) *Definitions.* As used in this provision-

\"Emerging small business\" means a small business concern whose size is
no greater than 50 percent of the numerical size standard for the NAICS
code des­ignated.

\"Forced or indentured child labor\" means all work or service\--

\(1\) Exacted from any person under the age of 18 under the menace of
any penalty for its nonperformance and for which the worker does not
offer himself voluntarily; or

\(2\) Performed by any person under the age of 18 pursuant to a contract
the enforcement of which can be accomplished by process or penalties.

"Manufactured end product" means any end product in Federal Supply
Classes (FSC) 1000-9999, except-

(1) FSC 5510, Lumber and Related Basic Wood Materials;

(2) Federal Supply Group (FSG) 87, Agricultural Supplies;

(3) FSG 88, Live Animals

(4) FSG 89, Food and Related Consumables;

(5) FSC 9410, Crude Grades of Plant Materials;

(6) FSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) FSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) FSC 9610, Ores;

(9) FSC 9620, Minerals, Natural and Synthetic; and

(10) FSC 9630, Additive Metal Materials.

> "Place of Manufacture" means the place where an end product is
> assembled out of components, or otherwise made or processed from raw
> materials into the finished product that is to be provided to the
> Government. If a product is disassembled and reassembled, the place of
> reassembly is not the place of manufacture.
>
> "Restricted business operations" means business operations in Sudan
> that include power production activities, mineral extraction
> activities, oil-related activities, or the production of military
> equipment, as those terms are defined in the Sudan Accountability and
> Divestment Act of 2007 (Pub. L. 110-174). Restricted business
> operations do not include business operations that the person
> conducting the business can demonstrate---

(1) Are conducted under contract directly and exclusively with the
    regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of
    Foreign Assets Control in the Department of the Treasury, or are
    expressly exempted under Federal law from the requirement to be
    conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations
    of Sudan;

(4) Consist of providing goods or services to an internationally
    recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote
    health or education; or

(6) Have been voluntarily suspended.

"Service-disabled veteran-owned small business concern"-

(1) Means a small business concern-

```{=html}
<!-- -->
```
(i) Not less than 51 percent of which is owned by one or more
    service-disabled veterans or, in the case of any publicly owned
    business, not less than 51 percent of the stock of which is owned by
    one or more service-disabled veterans; and

(ii) The management and daily business operations of which are
     controlled by one or more service-disabled veterans or, in the case
     of a service-disabled veteran with permanent and severe disability,
     the spouse or permanent caregiver of such veteran.

\(2\) Service-disabled veteran means a veteran, as defined in 38 U.S.C.
101(2), with a disability that is service connected as defined in 38
U.S.C. 101(16).

\"Small business concern\" means a concern, including its affiliates,
that is independent­ly owned and operat­ed, not dominant in the field of
operation in which it is bidding on Govern­ment contracts, and qualified
as a small busi­ness under the criteria in 13 CFR Part 121 and size
stan­dards in this solicitation.

"Veteran-owned small business concern" means a small business concern-

(1) Not less than 51 of which is owned by one or more veterans (as
    defined by 38 U.S.C. 101(2)) or, in the case of publicly owned
    business, not less than 51 percent of the stock of which is owned by
    one or more veterans; and

(2) The management and daily business operations of which are controlled
    by one or more veterans.

\"Women-owned business concern\" means a concern which is at least 51
per­cent owned by one or more women; or in the case of any publicly owned
busi­ness, at least 51 percent of its stock is owned by one or more
women; and whose manage­ment and daily business operations are controlled
by one or more women.

\"Women-owned small business concern\" means a small business concern\--

\(1\) That is at least 51 percent owned by one or more women or, in the
case of any publicly owned business, at least 51 percent of the stock of
which is owned by one or more women; and

\(1\) Whose management and daily business operations are controlled by
one or more women.

\(b\) *(1) Annual Representations and Certifications*. Any changes
provided by the offeror in paragraph (b)(2) of this provision do not
automatically change the representations and certifications posted on
the Online Representations and Certifications Application (ORCA)
website.

\(2\) The offeror has completed the annual representations and
certifications electronically via the ORCA website at
[http://orca.bpn.gov](http://orca.bpn.gov/). After reviewing the ORCA
database information, the offeror verifies by submission of this offer
that the representations and certifications currently posted
electronically at FAR 52.212-3, Offeror Representations and
Certifications-Commercial Items, have been entered or updated in the
last 12 months, are current, accurate, complete, and applicable to this
solicitation (including the business size standard applicable to the
NAICS code referenced for this solicitation), as of the date of this
offer and are incorporated in this offer by reference (see FAR
[4.1201]{.underline}), except for
paragraphs\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

OFFEROR NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*\[Offeror to identify the applicable paragraphs at (c) through (m) of
this provision that the offeror has completed for the purposes of this
solicitation only, if any.*

*These amended representation(s) and/or certification(s) are also
incorporated in this offer and are current, accurate, and complete as of
the date of this offer.*

*Any changes provided by the offeror are applicable to this solicitation
only, and do not result in an update to the representations and
certifications posted on ORCA.\]*

\(c\) Offerors must complete the following representa­tions when the
result­ing contract will be performed in the United States or its
outlying areas. Check all that apply.

\(1\) *Small business concern*. The offeror rep­resents as part of its
offer that it **is** **, is not** a small busi­ness concern.

> *(2) Veteran-owned small business concern.\[Complete*

*only if the offeror represents itself as a small business concern in
paragraph (c)(1) of this provision.\]* The offeror represents as part of
its offer that it **is** **, is not** a veteran-owned small business
concern.

(3) *Service-disabled veteran-owned small business*

*concern. \[Complete* *only if the offeror represents itself as a small
business concern in paragraph (c)(2) of this provision.\]* The offeror
represents as part of its offer that it **is** **, is not** a
service-disabled veteran-owned small business concern.

(4) *Small disadvantaged business concern. \[Complete only if the
    offeror represented itself as a small business concern in paragraph
    (c)(1) of this provision.\]* The offeror represents, for general
    statistical purposes, that it **is** **, is not** a small
    disadvan­taged busi­ness concern as defined in 13 CFR 124.1002.

\(5\) *Women-owned small business concern.* *\[Complete only if the
offeror represented itself as a small business concern in paragraph
(c)(1) of this provision.\]* The offeror represents that it **is** **,
is not** a wom­en-owned small busi­ness concern.

> Note: Complete paragraphs (c)(6) and (c)(7) only if this solicitation
> is expected to exceed the simplified acquisition threshold.

\(6\) *Women-owned business concern.* *(other than small business
concern). \[Complete only if the offeror is a women-owned business
concern and did not represent itself as a small business concern in
paragraph (c)(1) of this provision.\]* The offeror represents that it
**is** a women-owned business concern.

\(7\) *Tie bid priority for labor sur­plus area concerns.* (Not
applicable to this solicita­tion.)

\(8\) *Small Business Size for the Small Busi­ness Com­petitiveness
Demon­stration Program and for the Targeted Industry Categories under the
Small Busi­ness Competitiveness Demonstra­tion Pro­gram.* (Not applicable
to this solicita­tion.)

\(9\) *Complete only if the solicitation contains the clause at FAR
52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged
Business Concerns, or FAR 52.219-25, Small Disadvantaged Business
Participation Program-Disadvantaged Status and Reporting, and the
offeror desires a benefit based on its disadvantaged status.\] (*Not
applicable to this solicitation*.)*

\(10\) *HUBZone small business concern*. \[*Complete only if the offeror
represented itself as a small business concern in paragraph (c)(1) of
this provision*.\] The offeror represents as part of its offer that\--

\(i\) it **is** **, is not** a HUBZone small business concern listed, on
the date of this representation, on the List of Qualified HUBZone Small
Business Concerns maintained by the Small Business Administration, and
no material change in ownership and control, principal office, or
HUBZone employee percentage has occurred since it was certified by the
Small Business Administration in accordance with 13 CFR part 126; and

\(ii\) it **is** **, is not** a joint venture that complies with the
requirements of 13 CFR part 126, and the representation in paragraph
(c)(9)(i) of this provision is accurate for the HUBZone small business
concern or concerns that are participating on the joint venture.
**\[*The offeror shall enter the name or names of the HUBZone small
business concern or concerns that are participating in the joint
venture: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*.\]** Each
HUBZone small business concern participating in the joint venture shall
submit a separate signed copy of the HUBZone representation

\(d\) *Representa­tions re­quired to implement provisions of Executive
Order 11246*\--

\(1\) *Previous Contracts and Compli­ance*. The offeror represents
that\--

\(i\) It **has** **, has not** , participat­ed in a previous contract or
subcontract subject to the Equal Opportunity clause of this
solicita­tion, and

\(ii\) It **has** **, has not** , filed all required compliance reports.

\(2\) Affirmative Action Compliance. The of­feror represents that\--

\(i\) It **has developed and has on file** **, has not developed and
does not have on file** , at each estab­lishment, affir­mative action
programs required by rules and regulations of the Secre­tary of Labor (41
CFR Subparts 60-1 and 60-2), or

\(ii\) It **has not** previously had contracts subject to the written
affirmative action pro­grams requirement of the rules and regulations of
the Secre­tary of Labor.

\(e\) *Certification Regarding Pay­ments to Influ­ence Federal
Transactions* *(31 U.S.C. 1352)*. (Applies only if the contract is
expected to exceed \$100,000.) By submission of its offer, the offeror
certifies to the best of its knowledge and belief that no Federal
appropri­ated funds have been paid or will be paid to any per­son for
influencing or attempting to influ­ence an officer or employee of any
agen­cy, a Member of Con­gress, an officer or em­ployee of Congress or an
employee of a Mem­ber of Congress on his or her behalf in connec­tion with
the award of any resul­tant contract. If any registrants under the
Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf
of the offeror with respect to this contract, the offeror shall complete
and submit, with its offer, OMB Standard Form LLL, Disclosure of
Lobbying Activities, to provide the name of the registrants. The offeror
need not report regularly employed officers or employees of the offeror
to whom payments of reasonable compensation were made.

\(f\) *Buy American Act Certificate*. (Not applicable to this
solicita­tion.)

\(g\) *Buy American Act - Free Trade Agreements - Israeli Trade Act
Certificate.* (Not applicable to this solicitation.)

\(h\) *Certification Regarding Debarment, Suspension or Ineligibility
for Award (Executive Order 12689*). (Applies only if the contract value
is expected to exceed the simplified acquisition threshold.) The offeror
certifies, to the best of its knowledge and belief, that the offeror
and/or any of its principals\--

\(1\) **Are** **, are not** presently debarred, suspended, proposed for
debarment, or declared ineligible for the award of contracts by any
Federal agency; and

\(2\) **Have** **, have not** , within a three-year period preceding
this offer, been convicted of or had a civil judgment rendered against
them for: Commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a Federal, state or local
government contract or subcontract; violation of Federal or state
antitrust statutes relating to the submission of offers; or Commission
of embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, tax evasion, or receiving stolen
property; and

\(3\) **Are** **, are not** presently indicted for, or otherwise
criminally or civilly charged by a government entity with, commission of
any of these offenses.

\(4\) **Have** **, have not** presently, within a three-year period
preceding this offer, been notified of any delinquent Federal taxes in
an amount that exceeds \$3,000 for which the liability remains
unsatisfied.

\(i\) Taxes are considered delinquent if both of the following criteria
apply:

\(A\) *The tax liability is finally determined*. The liability is
finally determined if it has been assessed. A liability is not finally
determined if there is a pending administrative or judicial challenge.
In the case of a judicial challenge to the liability, the liability is
not finally determined until all judicial appeal rights have been
exhausted.

\(B\) *The taxpayer is delinquent in making payment*. A taxpayer is
delinquent if the taxpayer has failed to pay the tax liability when full
payment was due and required. A taxpayer is not delinquent in cases
where enforced collection action is precluded.

\(ii\) *Examples*.

\(A\) The taxpayer has received a statutory notice of deficiency, under
I.R.C. §6212, which entitles the taxpayer to seek Tax Court review of a
proposed tax deficiency. This is not a delinquent tax because it is not
a final tax liability. Should the taxpayer seek Tax Court review, this
will not be a final tax liability until the taxpayer has exercised all
judicial appeal rights.

\(B\) The IRS has filed a notice of Federal tax lien with respect to an
assessed tax liability, and the taxpayer has been issued a notice under
I.R.C. §6320 entitling the taxpayer to request a hearing with the IRS
Office of Appeals contesting the lien filing, and to further appeal to
the Tax Court if the IRS determines to sustain the lien filing. In the
course of the hearing, the taxpayer is entitled to contest the
underlying tax liability because the taxpayer has had no prior
opportunity to contest the liability. This is not a delinquent tax
because it is not a final tax liability. Should the taxpayer seek tax
court review, this will not be a final tax liability until the taxpayer
has exercised all judicial appeal rights.

\(C\) The taxpayer has entered into an installment agreement pursuant to
I.R.C. §6159. The taxpayer is making timely payments and is in full
compliance with the agreement terms. The taxpayer is not delinquent
because the taxpayer is not currently required to make full payment.

\(D\) The taxpayer has filed for bankruptcy protection. The taxpayer is
not delinquent because enforced collection action is stayed under 11
U.S.C. §362 (the Bankruptcy Code).

\(i\) *Certification Regarding Knowledge of Child Labor for Listed End
Products (Executive Order 13126*). (Not applicable to this solicitation)

\(j\) *Place of manufacture*. (Does not apply unless the solicitation is
predominantly for the acquisition of manufactured end products.) For
statistical purposes only, the offeror shall indicate whether the place
of manufacture of the end products it expects to provide in response to
this solicitation is predominantly-

\(1\) In the United States (Check this box if the total anticipated
price of offered end products manufactured in the United States exceeds
the total anticipated price of offered end products manufactured outside
the United States); or

\(2\) Outside the United States.

\(k\) *Certificates regarding exemptions from the application of the
Service Contract Act.* (Certification by the offeror as to its
compliance with respect to the contract also constitutes its
certification as to compliance by its subcontractor if it subcontracts
out the exempt services.)

\[ \] (1) Maintenance, calibration, or repair of certain equipment as
described in FAR 22.1003-4(c)(1). The offeror d**oes** **, does not**
certify that --

\(i\) The items of equipment to be serviced under this contract are used
regularly for other than Governmental purposes and are sold or traded by
the offeror in substantial quantities to the general public in the
course of normal business operations;

\(ii\) The services will be furnished at prices which are, or are based
on, established catalog or market prices (see FAR 22.1003-4(c)(2)(ii))
for the maintenance, calibration, or repair of such equipment; and

\(iii\) The compensation (wage and fringe benefits) plan for all service
employees performing work under the contract will be the same as that
used for these employees and equivalent employees servicing the same
equipment of commercial customers.

\[ \] (2) Certain services as described in FAR 22.1003-4(d)(1). The
offeror **does** **, does not** certify that --

\(i\) The services under the contract are offered and sold regularly to
non-Governmental customers, and are provided by the offeror (or
subcontractor in the case of an exempt subcontract) to the general
public in substantial quantities in the course of normal business
operations;

\(ii\) The contract services will be furnished at prices that are, or
are based on, established catalog or market prices (see FAR
22.1003-4(d)(2)(iii));

\(iii\) Each service employee who will perform the services under the
contract will spend only a small portion of his or her time (a monthly
average of less than 20 percent of the available hours on an annualized
basis, or less than 20 percent of available hours during the contract
period if the contract period is less than a month) servicing the
Government contract; and

\(iv\) The compensation (wage and fringe benefits) plan for all service
employees performing work under the contract is the same as that used
for these employees and equivalent employees servicing commercial
customer.

\(3\) If paragraph (k)(1) or (k)(2) of this clause applies-

\(i\) If the offeror does not certify to the conditions in paragraph
(k)(1) or (k)(2) and the Contracting Officer did not attach a Service
Contract Act wage determination to the solicitation, the offeror shall
notify the Contracting Officer as soon as possible; and

\(ii\) The Contracting Officer may not make an award to the offeror if
the offeror fails to execute the certification in paragraph (k)(1) or
(k)(2) of this clause or to contact the Contracting Officer as required
in paragraph (k)(3)(i) of this clause.

\(l\) *Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C.
7701).* (Not applicable if the offeror is required to provide this
information to a central contractor registration database to be eligible
for award.)

\(1\) All offerors must submit the information required in paragraphs
(l)(3) through (l)(5) of this provision to comply with debt collection
requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of
26 U.S.C 6041, 6041A, and 6050M, and implementing regulations issued by
the Internal Revenue Service (IRS).

\(2\) The TIN may be used by the Government to collect and report on any
delinquent amounts arising out of the offeror\'s relationship with the
Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject
to the payment reporting requirements described in FAR 4.904, the TIN
provided hereunder may be matched with IRS records to verify the
accuracy of the offeror\'s TIN.

*(3) Taxpayer Identification Number (TIN)*.

TIN: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

TIN has been applied for.

TIN is not required because:

Offeror is a nonresident alien, foreign corporation, or foreign
part­nership that does not have income effectively connected with the
conduct of a trade or business in the United States and does not have an
office or place of business or a fiscal paying agent in the United
States;

Offeror is an agency or instrumentality of a foreign government;

Offeror is an agency or instrumentality of a Federal Govern­ment.

*(4) Type of Organization*

Sole proprietorship;

Partnership;

Corporate entity (not tax-exempt);

Corporate entity (tax-exempt);

Government entity (Federal, State, or local);

Foreign Government;

International organization per 26 CFR

1.6049-4;

Other \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

(5)Common Parent.

Offeror is not owned or con­trolled by a common parent;

Name and TIN of common par­ent:

Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TIN\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*(m) Restricted business operations in Sudan*. By submission of its
offer, the offeror certifies that it does not conduct any restricted
business operations in Sudan.

#### OFFEROR'S MISCELLANEOUS INFORMATION

#### 

+------------------------+-----------------+------+---+---------------+
| #### Offeror           | ####            |      |   |               |
| 's Legal Business Name |                 |      |   |               |
|                        |                 |      |   |               |
| ####                   |                 |      |   |               |
+------------------------+-----------------+------+---+---------------+
| ####                   | ####            |      |   |               |
|                        |                 |      |   |               |
| ####                   |                 |      |   |               |
|  Offeror's DUNS Number |                 |      |   |               |
+------------------------+-----------------+------+---+---------------+
| ####                   | #### Address    |      |   |               |
|                        |                 |      |   |               |
| **Offeror's Complete   |                 |      |   |               |
| 'Mailing' Address**    |                 |      |   |               |
+------------------------+-----------------+------+---+---------------+
|                        | #### City       | ##   |   | #### Zip Code |
|                        |                 | ## S |   |               |
|                        |                 | tate |   |               |
+------------------------+-----------------+------+---+---------------+
| ####                   | ####            |      |   |               |
|                        |                 |      |   |               |
| #### Offeror's C       |                 |      |   |               |
| omplete E-mail Address |                 |      |   |               |
+------------------------+-----------------+------+---+---------------+
| ####                   | ####            |      |   |               |
|                        |                 |      |   |               |
| #### Offeror's O       |                 |      |   |               |
| ffice Telephone Number |                 |      |   |               |
+------------------------+-----------------+------+---+---------------+
| ####                   | ####            |      |   |               |
|                        |                 |      |   |               |
| #### Offeror's         |                 |      |   |               |
| Facsimile (FAX) Number |                 |      |   |               |
+------------------------+-----------------+------+---+---------------+
| ####                   | #### 1. Name    |      | # |               |
|                        |                 |      | # |               |
| #### Offeror Con       |                 |      | # |               |
| tact Representative(s) |                 |      | # |               |
|                        |                 |      |   |               |
|                        |                 |      | T |               |
|                        |                 |      | e |               |
|                        |                 |      | l |               |
|                        |                 |      | e |               |
|                        |                 |      | p |               |
|                        |                 |      | h |               |
|                        |                 |      | o |               |
|                        |                 |      | n |               |
|                        |                 |      | e |               |
+------------------------+-----------------+------+---+---------------+
|                        | #### 2. Name    |      | # |               |
|                        |                 |      | # |               |
|                        |                 |      | # |               |
|                        |                 |      | # |               |
|                        |                 |      |   |               |
|                        |                 |      | T |               |
|                        |                 |      | e |               |
|                        |                 |      | l |               |
|                        |                 |      | e |               |
|                        |                 |      | p |               |
|                        |                 |      | h |               |
|                        |                 |      | o |               |
|                        |                 |      | n |               |
|                        |                 |      | e |               |
+------------------------+-----------------+------+---+---------------+

#### 

#### 

+---------------------------------------------+------------------------+
| **Offeror confirms that they have verified  | Check the applicable   |
| that their registration in CCR is           | box                    |
| current.**                                  |                        |
|                                             | **YES** **NO**         |
| **Failure to confirm this information and   |                        |
| to check YES will be the same as if NO had  |                        |
| been checked and no award can be made.**    |                        |
+---------------------------------------------+------------------------+

**AIRCRAFT QUESTIONNAIRE**

You may recreate this form but it must include all the information
listed

This Questionnaire completely and accurately completed will be used to
determine your aircraft payload capability.

REPRODUCE AND SUBMIT FOR EACH AIRCRAFT OFFERED - COMPLETE SHADED BLOCKS

+-----------------+--------+------+-----------+------------+---+-------+
| **[Minimum      |        |      |           |            |   |       |
| Helicopter      |        |      |           |            |   |       |
| Requirements:   |        |      |           |            |   |       |
| ]{.underline}** |        |      |           |            |   |       |
|                 |        |      |           |            |   |       |
| > Seating: Five |        |      |           |            |   |       |
| > (5) insured   |        |      |           |            |   |       |
| > passenger     |        |      |           |            |   |       |
| > seats not     |        |      |           |            |   |       |
| > including     |        |      |           |            |   |       |
| > pilot, but    |        |      |           |            |   |       |
| > including     |        |      |           |            |   |       |
| > copilot seat  |        |      |           |            |   |       |
| > in an         |        |      |           |            |   |       |
| > aircraft,     |        |      |           |            |   |       |
| > normally      |        |      |           |            |   |       |
| > single-pilot  |        |      |           |            |   |       |
| > operated.     |        |      |           |            |   |       |
| > (Note:        |        |      |           |            |   |       |
| > **AS350       |        |      |           |            |   |       |
| > series        |        |      |           |            |   |       |
| > aircraft**    |        |      |           |            |   |       |
| > must be       |        |      |           |            |   |       |
| > equipped with |        |      |           |            |   |       |
| > high-back     |        |      |           |            |   |       |
| > front seats.) |        |      |           |            |   |       |
|                 |        |      |           |            |   |       |
| Payload:        |        |      |           |            |   |       |
| N               |        |      |           |            |   |       |
| on-jettisonable |        |      |           |            |   |       |
| payload (HOGE)  |        |      |           |            |   |       |
| of 650 pounds   |        |      |           |            |   |       |
| at 25 degrees C |        |      |           |            |   |       |
| at 7,000 feet   |        |      |           |            |   |       |
| pressure        |        |      |           |            |   |       |
| altitude using  |        |      |           |            |   |       |
| a pilot weight  |        |      |           |            |   |       |
| of 200 pounds,  |        |      |           |            |   |       |
| a 25 pound      |        |      |           |            |   |       |
| survival kit    |        |      |           |            |   |       |
| and fuel for    |        |      |           |            |   |       |
| 1.9 hours. (N3) |        |      |           |            |   |       |
|                 |        |      |           |            |   |       |
| > Performance:  |        |      |           |            |   |       |
| > Rotorcraft    |        |      |           |            |   |       |
| > certified in  |        |      |           |            |   |       |
| > accordance    |        |      |           |            |   |       |
| > with 14 CFR   |        |      |           |            |   |       |
| > 27.143        |        |      |           |            |   |       |
| > paragraph     |        |      |           |            |   |       |
| > (c), which    |        |      |           |            |   |       |
| > states:       |        |      |           |            |   |       |
| >               |        |      |           |            |   |       |
| > A wind        |        |      |           |            |   |       |
| > velocity of   |        |      |           |            |   |       |
| > not less than |        |      |           |            |   |       |
| > 17 knots must |        |      |           |            |   |       |
| > be            |        |      |           |            |   |       |
| > established   |        |      |           |            |   |       |
| > in which the  |        |      |           |            |   |       |
| > rotorcraft    |        |      |           |            |   |       |
| > can be        |        |      |           |            |   |       |
| > operated      |        |      |           |            |   |       |
| > without loss  |        |      |           |            |   |       |
| > of control on |        |      |           |            |   |       |
| > or near the   |        |      |           |            |   |       |
| > ground in any |        |      |           |            |   |       |
| > maneuver      |        |      |           |            |   |       |
| > appropriate   |        |      |           |            |   |       |
| > to the type   |        |      |           |            |   |       |
| > (such as      |        |      |           |            |   |       |
| > crosswind     |        |      |           |            |   |       |
| > takeoffs,     |        |      |           |            |   |       |
| > sideward      |        |      |           |            |   |       |
| > flight, and   |        |      |           |            |   |       |
| > rearward      |        |      |           |            |   |       |
| > flight) with  |        |      |           |            |   |       |
| > (1) critical  |        |      |           |            |   |       |
| > weight, (2)   |        |      |           |            |   |       |
| > critical      |        |      |           |            |   |       |
| > center of     |        |      |           |            |   |       |
| > gravity, (3)  |        |      |           |            |   |       |
| > critical      |        |      |           |            |   |       |
| > rotor r.p.m., |        |      |           |            |   |       |
| > and (4)       |        |      |           |            |   |       |
| > altitude from |        |      |           |            |   |       |
| > standard sea  |        |      |           |            |   |       |
| > level         |        |      |           |            |   |       |
| > conditions to |        |      |           |            |   |       |
| > the maximum   |        |      |           |            |   |       |
| > altitude      |        |      |           |            |   |       |
| > capability of |        |      |           |            |   |       |
| > the           |        |      |           |            |   |       |
| > rotorcraft or |        |      |           |            |   |       |
| > 7,000 feet,   |        |      |           |            |   |       |
| > whichever is  |        |      |           |            |   |       |
| > less.         |        |      |           |            |   |       |
|                 |        |      |           |            |   |       |
| Powerplant:     |        |      |           |            |   |       |
| Turbine engine  |        |      |           |            |   |       |
|                 |        |      |           |            |   |       |
| Cruising        |        |      |           |            |   |       |
| airspeed:       |        |      |           |            |   |       |
| Minimum of 95   |        |      |           |            |   |       |
| knots           |        |      |           |            |   |       |
|                 |        |      |           |            |   |       |
| **[Target       |        |      |           |            |   |       |
| Helicopter      |        |      |           |            |   |       |
| Requirements    |        |      |           |            |   |       |
| ]{.underline}** |        |      |           |            |   |       |
|                 |        |      |           |            |   |       |
| > Payload:      |        |      |           |            |   |       |
| >               |        |      |           |            |   |       |
| Nonjettisonable |        |      |           |            |   |       |
| > payload       |        |      |           |            |   |       |
| > (HOGE) of 970 |        |      |           |            |   |       |
| > pounds at 25  |        |      |           |            |   |       |
| > degrees C at  |        |      |           |            |   |       |
| > 7,000 feet    |        |      |           |            |   |       |
| > pressure      |        |      |           |            |   |       |
| > altitude      |        |      |           |            |   |       |
| > using a pilot |        |      |           |            |   |       |
| > weight of 200 |        |      |           |            |   |       |
| > pounds, a     |        |      |           |            |   |       |
| > 25-pound      |        |      |           |            |   |       |
| > survival kit, |        |      |           |            |   |       |
| > and fuel for  |        |      |           |            |   |       |
| > 1.9 hours.    |        |      |           |            |   |       |
| > (N3)          |        |      |           |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
| **Aircraft Make | **FAA  |      | **Serial  | **\# of    |   |       |
| and Model**     | Regist |      | \#**      | Insured    |   |       |
|                 | ration |      |           | Passenger  |   |       |
|                 | \#**   |      |           | Seats**    |   |       |
|                 |        |      |           | *(excludes |   |       |
|                 |        |      |           | pilot      |   |       |
|                 |        |      |           | seat)*     |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
|                 |        |      |           |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
| **Aircraft      |        |      |           |            |   |       |
| Equipped        |        |      |           |            |   |       |
| Weight** *(Your |        |      |           |            |   |       |
| aircraft weight |        |      |           |            |   |       |
| & balance       |        |      |           |            |   |       |
| report &        |        |      |           |            |   |       |
| equipment list  |        |      |           |            |   |       |
| will be used to |        |      |           |            |   |       |
| substantiate    |        |      |           |            |   |       |
| this weight --  |        |      |           |            |   |       |
| see note 1.     |        |      |           |            |   |       |
| below)*         |        |      |           |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
| **[Currently    |        |      | **[       |            |   |       |
| Installed       |        |      | Equipment |            |   |       |
| Aircraft        |        |      | to be     |            |   |       |
| Equipment to be |        |      | Added to  |            |   |       |
| Remov           |        |      | Meet]{.u  |            |   |       |
| ed]{.underline} |        |      | nderline} |            |   |       |
| to Achieve      |        |      | the       |            |   |       |
| Offered Payload |        |      | Aircraft  |            |   |       |
| Below** *(If    |        |      | Speci     |            |   |       |
| none, indicate  |        |      | fications |            |   |       |
| NONE)*          |        |      | Requi     |            |   |       |
|                 |        |      | rements** |            |   |       |
|                 |        |      | *(If      |            |   |       |
|                 |        |      | none,     |            |   |       |
|                 |        |      | indicate  |            |   |       |
|                 |        |      | NONE)*    |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
| **EQUIPMENT     |        | **   | **        |            |   | **WEI |
| ITEM**          |        | WEIG | EQUIPMENT |            |   | GHT** |
|                 |        | HT** | ITEM**    |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
|                 |        |      |           |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
|                 |        |      |           |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
|                 |        |      |           |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+
| **ENTER YOUR    |        |      |           |            |   |       |
| PROPOSED HOGE   |        |      |           |            |   |       |
| AIRCRAFT        |        |      |           |            |   |       |
| PAYLOAD** (The  |        |      |           |            |   |       |
| aircraft make,  |        |      |           |            |   |       |
| model and HOGE  |        |      |           |            |   |       |
| payload that we |        |      |           |            |   |       |
| confirm with    |        |      |           |            |   |       |
| you will be     |        |      |           |            |   |       |
| made a part of  |        |      |           |            |   |       |
| your offer and  |        |      |           |            |   |       |
| will be binding |        |      |           |            |   |       |
| if your offer   |        |      |           |            |   |       |
| is accepted for |        |      |           |            |   |       |
| award           |        |      |           |            |   |       |
+-----------------+--------+------+-----------+------------+---+-------+

[NOTE]{.underline}

> **1. By signing below, I acknowledge that I have included the items
> below:**

(1) Aircraft's latest aircraft weight and balance report,

(2) Aircraft equipment list,

(3) Aircraft appropriate hover ceiling charts used to arrive at the
    above payload.

(4) Interagency Helicopter Load Calculation Form completed in its
    entirety indicating HIGE, HOGE and HOGE-J payloads for the aircraft
    identified above

***Failure to include the above information, will effect the evaluation
you receive for your aircraft.***

**2. Identify water/retardant bucket sizes appropriate for this
contract.** *(See B6, Equipment Requirements)*

*(appropriate capacities will be identified in the conformed contract)*

  ---------------------------------- ----------- -------------- ----------- --------------
  **WATER/RETARDANT BUCKET CAPACITY  ***1ST***                  ***2ND***   
  REQUIRED**                                                                

  ---------------------------------- ----------- -------------- ----------- --------------

  ---------------------------------- ------------------------------------
  **3. Identify capacity of fuel     
  servicing vehicle to be used.**    

  ---------------------------------- ------------------------------------

**4. By signing below, I certify to the best of my knowledge that the
above information is accurate.**

  ------------------------------------------------ ----------------------
  Name and Signature of Representative Completing  Date
  this Form                                        

                                                   

  OFFEROR'S NAME                                   

                                                   
  ------------------------------------------------ ----------------------

**REFERENCE QUESTIONNAIRE**

You may recreate this form but it must include all the information
listed

**[If you fail to include all requested information or we are unable to
contact your references based on the information you provide, you may
not receive consideration for the work done. Include recent (not more
than 3 years old) experience of the kind described in paragraph B1.1 of
the specifications.]{.underline}**

+------------------+------------+---+-------+---+-----+----------------+
| OFFEROR NAME:    |            |   |       |   | D   |                |
|                  |            |   |       |   | ATE |                |
+------------------+------------+---+-------+---+-----+----------------+
| Primary Type of  |            |   |       |   |     |                |
| Work Done:       |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
|                  |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Location of Work |            |   |       | A |     |                |
| Done:            |            |   |       | / |     |                |
|                  |            |   |       | C |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | a |     |                |
|                  |            |   |       | k |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | / |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | o |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | l |     |                |
|                  |            |   |       | U |     |                |
|                  |            |   |       | s |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | : |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Contract #:      | Exclusive  | U |       |   |     | > CHECK ALL    |
|                  | Use        | s |       |   |     | > THAT APPLY   |
| None             |            | e |       |   |     |                |
|                  | Call When  | D |       |   |     | 2008 2007 2006 |
|                  | Needed     | a |       |   |     |                |
|                  |            | t |       |   |     |                |
|                  |            | e |       |   |     |                |
|                  |            | s |       |   |     |                |
|                  |            | : |       |   |     |                |
|                  |            | T |       |   |     |                |
|                  |            | O |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Est. Annual      | Estimated  |   | C     |   |     |                |
|                  | Annual     |   | lient |   |     |                |
| Value of Work:   |            |   | Name/ |   |     |                |
|                  | Flight     |   |       |   |     |                |
|                  | Hours:     |   | Point |   |     |                |
|                  |            |   | of    |   |     |                |
|                  |            |   | Con   |   |     |                |
|                  |            |   | tact: |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Client Telephone |            |   | C     |   |     |                |
| #:               |            |   | lient |   |     |                |
|                  |            |   | Facs  |   |     |                |
|                  |            |   | imile |   |     |                |
|                  |            |   | #:    |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Primary Type of  |            |   |       |   |     |                |
| Work Done:       |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
|                  |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Location of Work |            |   |       | A |     |                |
| Done:            |            |   |       | / |     |                |
|                  |            |   |       | C |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | a |     |                |
|                  |            |   |       | k |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | / |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | o |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | l |     |                |
|                  |            |   |       | U |     |                |
|                  |            |   |       | s |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | : |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Contract #:      | Exclusive  | U |       |   |     | > CHECK ALL    |
|                  | Use        | s |       |   |     | > THAT APPLY   |
| None             |            | e |       |   |     |                |
|                  | Call When  | D |       |   |     | 2008 2007 2006 |
|                  | Needed     | a |       |   |     |                |
|                  |            | t |       |   |     |                |
|                  |            | e |       |   |     |                |
|                  |            | s |       |   |     |                |
|                  |            | : |       |   |     |                |
|                  |            | T |       |   |     |                |
|                  |            | O |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Est. Annual      | Estimated  |   | C     |   |     |                |
|                  | Annual     |   | lient |   |     |                |
| Value of Work:   |            |   | Name/ |   |     |                |
|                  | Flight     |   |       |   |     |                |
|                  | Hours:     |   | Point |   |     |                |
|                  |            |   | of    |   |     |                |
|                  |            |   | Con   |   |     |                |
|                  |            |   | tact: |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Client Telephone |            |   | C     |   |     |                |
| #:               |            |   | lient |   |     |                |
|                  |            |   | Facs  |   |     |                |
|                  |            |   | imile |   |     |                |
|                  |            |   | #:    |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Primary Type of  |            |   |       |   |     |                |
| Work Done:       |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
|                  |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Location of Work |            |   |       | A |     |                |
| Done:            |            |   |       | / |     |                |
|                  |            |   |       | C |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | a |     |                |
|                  |            |   |       | k |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | / |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | o |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | l |     |                |
|                  |            |   |       | U |     |                |
|                  |            |   |       | s |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | : |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Contract #:      | Exclusive  | U |       |   |     | > CHECK ALL    |
|                  | Use        | s |       |   |     | > THAT APPLY   |
| None             |            | e |       |   |     |                |
|                  | Call When  | D |       |   |     | 2008 2007 2006 |
|                  | Needed     | a |       |   |     |                |
|                  |            | t |       |   |     |                |
|                  |            | e |       |   |     |                |
|                  |            | s |       |   |     |                |
|                  |            | : |       |   |     |                |
|                  |            | T |       |   |     |                |
|                  |            | O |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Est. Annual      | Estimated  |   | C     |   |     |                |
|                  | Annual     |   | lient |   |     |                |
| Value of Work:   |            |   | Name/ |   |     |                |
|                  | Flight     |   |       |   |     |                |
|                  | Hours:     |   | Point |   |     |                |
|                  |            |   | of    |   |     |                |
|                  |            |   | Con   |   |     |                |
|                  |            |   | tact: |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Client Telephone |            |   | C     |   |     |                |
| #:               |            |   | lient |   |     |                |
|                  |            |   | Facs  |   |     |                |
|                  |            |   | imile |   |     |                |
|                  |            |   | #:    |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Primary Type of  |            |   |       |   |     |                |
| Work Done:       |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
|                  |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Location of Work |            |   |       | A |     |                |
| Done:            |            |   |       | / |     |                |
|                  |            |   |       | C |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | a |     |                |
|                  |            |   |       | k |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | / |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | o |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | l |     |                |
|                  |            |   |       | U |     |                |
|                  |            |   |       | s |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | : |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Contract #:      | Exclusive  | U |       |   |     | > CHECK ALL    |
|                  | Use        | s |       |   |     | > THAT APPLY   |
| None             |            | e |       |   |     |                |
|                  | Call When  | D |       |   |     | 2008 2007 2006 |
|                  | Needed     | a |       |   |     |                |
|                  |            | t |       |   |     |                |
|                  |            | e |       |   |     |                |
|                  |            | s |       |   |     |                |
|                  |            | : |       |   |     |                |
|                  |            | T |       |   |     |                |
|                  |            | O |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Est. Annual      | Estimated  |   | C     |   |     |                |
|                  | Annual     |   | lient |   |     |                |
| Value of Work:   |            |   | Name/ |   |     |                |
|                  | Flight     |   |       |   |     |                |
|                  | Hours:     |   | Point |   |     |                |
|                  |            |   | of    |   |     |                |
|                  |            |   | Con   |   |     |                |
|                  |            |   | tact: |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Client Telephone |            |   | C     |   |     |                |
| #:               |            |   | lient |   |     |                |
|                  |            |   | Facs  |   |     |                |
|                  |            |   | imile |   |     |                |
|                  |            |   | #:    |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Primary Type of  |            |   |       |   |     |                |
| Work Done:       |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
|                  |            |   |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Location of Work |            |   |       | A |     |                |
| Done:            |            |   |       | / |     |                |
|                  |            |   |       | C |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | a |     |                |
|                  |            |   |       | k |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | / |     |                |
|                  |            |   |       | M |     |                |
|                  |            |   |       | o |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | l |     |                |
|                  |            |   |       | U |     |                |
|                  |            |   |       | s |     |                |
|                  |            |   |       | e |     |                |
|                  |            |   |       | d |     |                |
|                  |            |   |       | : |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Contract #:      | Exclusive  | U |       |   |     | > CHECK ALL    |
|                  | Use        | s |       |   |     | > THAT APPLY   |
| None             |            | e |       |   |     |                |
|                  | Call When  | D |       |   |     | 2008 2007 2006 |
|                  | Needed     | a |       |   |     |                |
|                  |            | t |       |   |     |                |
|                  |            | e |       |   |     |                |
|                  |            | s |       |   |     |                |
|                  |            | : |       |   |     |                |
|                  |            | T |       |   |     |                |
|                  |            | O |       |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Est. Annual      | Estimated  |   | C     |   |     |                |
|                  | Annual     |   | lient |   |     |                |
| Value of Work:   |            |   | Name/ |   |     |                |
|                  | Flight     |   |       |   |     |                |
|                  | Hours:     |   | Point |   |     |                |
|                  |            |   | of    |   |     |                |
|                  |            |   | Con   |   |     |                |
|                  |            |   | tact: |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+
| Client Telephone |            |   | C     |   |     |                |
| #:               |            |   | lient |   |     |                |
|                  |            |   | Facs  |   |     |                |
|                  |            |   | imile |   |     |                |
|                  |            |   | #:    |   |     |                |
+------------------+------------+---+-------+---+-----+----------------+

**STANDARD INTERAGENCY LOAD CALCULATION METHOD AND FORM**

+----------+---------------+-------------+----+-------+----------+---+
| **INT    |               |             |    | **MO  |          |   |
| ERAGENCY |               |             |    | DEL** |          |   |
| HELI     |               |             |    |       |          |   |
| COPTER** |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| **LOAD   |               |             |    |       |          |   |
| CALCU    |               |             |    |       |          |   |
| LATION** |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| A        |               |             |    |       |          |   |
| MD-67/FS |               |             |    |       |          |   |
| 5700     |               |             |    |       |          |   |
| (10/06)  |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               |             |    | *     |          |   |
|          |               |             |    | *N#** |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| **PI     |               |             |    | **D   |          |   |
| LOT(S)** |               |             |    | ATE** |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| **M      |               |             |    | **T   |          |   |
| ISSION** |               |             |    | IME** |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 1        |               |             |    |       |          |   |
| **D      |               |             |    |       |          |   |
| EPARTURE |               |             |    |       |          |   |
| PA OAT** |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 2        |               |             |    |       |          |   |
| **DES    |               |             |    |       |          |   |
| TINATION |               |             |    |       |          |   |
| PA OAT** |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 3        |               |             |    |       |          |   |
| **HE     |               |             |    |       |          |   |
| LICOPTER |               |             |    |       |          |   |
| EQUIPPED |               |             |    |       |          |   |
| WEIGHT** |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 4        |               |             |    |       |          |   |
| **FLIGHT |               |             |    |       |          |   |
| CREW     |               |             |    |       |          |   |
| WEIGHT** |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 5 **FUEL |               |             |    |       |          |   |
| WT**     |               |             |    |       |          |   |
| (\_\_\   |               |             |    |       |          |   |
| _\_\_\_\ |               |             |    |       |          |   |
| _gallons |               |             |    |       |          |   |
| **X**    |               |             |    |       |          |   |
| \_\_\_   |               |             |    |       |          |   |
| \_\_\_\_ |               |             |    |       |          |   |
| lb per   |               |             |    |       |          |   |
| gal)     |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 6        |               |             |    |       |          |   |
| **O      |               |             |    |       |          |   |
| PERATING |               |             |    |       |          |   |
| WEIGHT** |               |             |    |       |          |   |
| (3 + 4 + |               |             |    |       |          |   |
| 5)       |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               | Non-J       |    |       | Jett     |   |
|          |               | ettisonable |    |       | isonable |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               | **HIGE**    | ** |       | **       |   |
|          |               |             | HO |       | HOGE-J** |   |
|          |               |             | GE |       |          |   |
|          |               |             | ** |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 7a       |               |             |    |       |          |   |
| **PER    |               |             |    |       |          |   |
| FORMANCE |               |             |    |       |          |   |
| REF**    |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| (List    |               |             |    |       |          |   |
| pa       |               |             |    |       |          |   |
| ge/chart |               |             |    |       |          |   |
| from FM) |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 7b       |               |             |    |       |          |   |
| **COMP   |               |             |    |       |          |   |
| GROSS    |               |             |    |       |          |   |
| WT**     |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| (FM      |               |             |    |       |          |   |
| per      |               |             |    |       |          |   |
| formance |               |             |    |       |          |   |
| section) |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 8 **WT   |               |             |    |       |          |   |
| RED      |               |             |    |       |          |   |
| UCTION** |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| > (Req   |               |             |    |       |          |   |
| > for    |               |             |    |       |          |   |
| > all    |               |             |    |       |          |   |
| > n      |               |             |    |       |          |   |
| on-jetti |               |             |    |       |          |   |
| sonable) |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 9        |               |             |    |       |          |   |
| **       |               |             |    |       |          |   |
| ADJUSTED |               |             |    |       |          |   |
| WEIGHT** |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| > (7b    |               |             |    |       |          |   |
| > minus  |               |             |    |       |          |   |
| > 8)     |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 10       |               |             |    |       |          |   |
| **GROSS  |               |             |    |       |          |   |
| WT       |               |             |    |       |          |   |
| LIMIT**  |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| > (FM    |               |             |    |       |          |   |
| > lim    |               |             |    |       |          |   |
| itations |               |             |    |       |          |   |
| >        |               |             |    |       |          |   |
| section) |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 11       |               |             |    |       |          |   |
| **       |               |             |    |       |          |   |
| SELECTED |               |             |    |       |          |   |
| WEIGHT** |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| ([Low    |               |             |    |       |          |   |
| est]{.un |               |             |    |       |          |   |
| derline} |               |             |    |       |          |   |
| of 9 or  |               |             |    |       |          |   |
| 10)      |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 12       |               |             |    |       |          |   |
| **O      |               |             |    |       |          |   |
| PERATING |               |             |    |       |          |   |
| WEIGHT** |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| (From    |               |             |    |       |          |   |
| line 6)  |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 13       |               |             |    |       |          |   |
| **ALL    |               |             |    |       |          |   |
| OWABLE** |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| **P      |               |             |    |       |          |   |
| AYLOAD** |               |             |    |       |          |   |
| (11      |               |             |    |       |          |   |
| minus    |               |             |    |       |          |   |
| 12)      |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 14       |               |             |    |       |          |   |
| **       |               |             |    |       |          |   |
| PASSENGE |               |             |    |       |          |   |
| RS/CARGO |               |             |    |       |          |   |
| MA       |               |             |    |       |          |   |
| NIFEST** |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
|          |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| 15       |               |             |    |       |          |   |
| **ACTUAL |               |             |    |       |          |   |
| P        |               |             |    |       |          |   |
| AYLOAD** |               |             |    |       |          |   |
| (Total   |               |             |    |       |          |   |
| of all   |               |             |    |       |          |   |
| weights  |               |             |    |       |          |   |
| listed   |               |             |    |       |          |   |
| in Item  |               |             |    |       |          |   |
| 14)      |               |             |    |       |          |   |
|          |               |             |    |       |          |   |
| **Line   |               |             |    |       |          |   |
| 15 must  |               |             |    |       |          |   |
| not      |               |             |    |       |          |   |
| exceed   |               |             |    |       |          |   |
| line 13  |               |             |    |       |          |   |
| for the  |               |             |    |       |          |   |
| intended |               |             |    |       |          |   |
| mi       |               |             |    |       |          |   |
| ssion.** |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| PILOT    |               |             |    |       |          |   |
| S        |               |             |    |       |          |   |
| IGNATURE |               |             |    |       |          |   |
+----------+---------------+-------------+----+-------+----------+---+
| MGR      |               |             |    |       | Hazmat   |   |
| S        |               |             |    |       |          |   |
| IGNATURE |               |             |    |       | Yes      |   |
|          |               |             |    |       | \_\_\_   |   |
|          |               |             |    |       | No       |   |
|          |               |             |    |       | \_\_\_   |   |
+----------+---------------+-------------+----+-------+----------+---+