GRANT OFFER AND AGREEMENT BETWEEN THE

U.S. DEPARTMENT OF TRANSPORTATION

AND SCOTTSBLUFF COUNTY BOARD OF COMMISSIONERS,

ACTING FOR THE COMMUNITY OF SCOTTSBLUFF, NEBRASKA, UNDER THE SMALL
COMMUNITY AIR SERVICE DEVELOPMENT PILOT PROGRAM

WHEREAS, the Scottsbluff County Board of Commissioners, hereinafter
referred to as the Sponsor (or Grant Recipient or Grantee), on behalf of
the communities of Scottsbluff, Nebraska, has applied for a Grant under
the Small Community Air Service Development Pilot Program; now
THEREFORE, the U.S. Department of Transportation, hereinafter referred
to as the DOT, acting for the UNITED STATES, offers the Sponsor a grant
in the amount of \$950,000 to assist in Sponsor's efforts to address the
community's air service needs.

CONDITIONS

THIS OFFER IS MADE ON AND SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS:

## GENERAL CONDITIONS

1.  The maximum obligation of the United States payable under this Offer
    shall be \$950,000.00.

2.  Payment of the United States' share of the agreed project costs will
    be made pursuant to and in accordance with the provisions of such
    regulations and procedures as the DOT may prescribe. Final
    determination of the United States' share will be based upon the
    final audit of the total amount of agreed project costs and
    settlement will be made for any upward or downward adjustments to
    the United States' share of costs.

3.  The Sponsor shall carry out and complete the Projects without undue
    delays and in accordance with the terms hereof, and such regulations
    and procedures as the DOT may prescribe.

4.  The DOT reserves the right to amend or withdraw this offer at any
    time prior to its acceptance by the Sponsor.

5.  This offer shall expire and the United States shall not be obligated
    to pay any part of the costs of the project unless the Sponsor
    accepts this offer on or before September 23, 2002, or such
    subsequent date as may be prescribed in writing by the DOT.

6.  The Sponsor shall take all steps, including litigation, if
    necessary, to recover Federal funds spent fraudulently, wastefully,
    or in violation of Federal antitrust statutes, or misused in any
    manner in any project upon which Federal funds have been expended.
    For the purposes of this agreement, the term "Federal funds" means
    funds however used or disbursed by the Sponsor that were originally
    paid pursuant to this DOT Grant Agreement (hereinafter referred to
    as the Grant Agreement).

7.  The Sponsor shall retain all documents relevant to the grant award
    for a period of seven years from completion of all projects
    undertaken pursuant to the Grant Agreement and receipt of final
    reimbursement from the U.S. Treasury. It shall furnish the DOT, upon
    request, all documents and records pertaining to the determination
    of the amount of the Federal share or to any settlement, litigation,
    negotiation, or other efforts taken to recover such funds. All
    settlements or other final positions of the Sponsor in court or
    otherwise, involving the recovery of such Federal share, shall be
    approved in advance by the DOT.

8.  The United States shall not be responsible or liable for damage to
    property or injury to persons, that may arise from, or be incident
    to, compliance with this Grant Agreement.

9.  The Sponsor shall ensure compliance with Federal regulations
    requiring conduct of a Federally-approved audit of any expenditure
    of funds under this grant award in excess of \$300,000 in any
    twelve-month period.

10. The provisions of 49 U.S.C.§18.36 will apply to the extent that the
    Sponsor procures property and services in carrying out the approved
    grant project(s).

# B. SPECIAL CONDITIONS

1.  Except to the extent otherwise inconsistent with the terms of this
    Grant Agreement, DOT Order 2002-6-14, served June 26, 2002, and the
    Application originally submitted to the DOT on April 22, 2002, in
    Docket OST-2002-11590-168, including any amendments, as well as any
    material submitted in the Docket as Confidential Material, are
    incorporated by reference and made a part hereof.

2.  Subject to terms set forth in this agreement, the DOT reserves the
    right to terminate the Grant Agreement, and the DOT's obligations
    thereunder, on 90 days written notice, unless otherwise agreed
    between the Sponsor and the DOT, if any of the following occurs:

> a\. The Sponsor fails to provide the local contribution, as provided
> in its application.
>
> b\. The Sponsor does not meet the obligations, specified under the
> Proposal Specific Conditions set forth below.
>
> c\. The DOT determines that termination is in the public interest.

3.  Either party may seek to amend or modify this Grant Agreement on 90
    days written notice to the other party. The Grant Agreement will be
    amended or modified only on mutual agreement by both parties.

4.  At any time, on 90 days written notice, the Sponsor may request
    termination of this Grant Agreement.

5.  Subject to the terms set forth in this Grant Agreement, and unless
    otherwise agreed between the Sponsor and the DOT, this Grant
    Agreement will expire two years from the date of execution.

# C. PROPOSAL SPECIFIC CONDITIONS

> [Legal Sponsor]{.underline}: Scotts Bluff County Board of
> Commissioners, designated by the community of Scottsbluff as the legal
> sponsor under the Small Community Air Service Development Pilot
> Program, shall administer the grant according to the following
> conditions set forth in this Grant Agreement.

Sponsor Contact:

Ms. Vera Dulaney

County Clerk

Administration Building

1825 10^th^ Street

Gering, NE 69341-2487

\(308\) 436-6600

2.  [Project Goals and Objectives]{.underline}

> Goal:

-   Secure Federal funding for Westward Airways as a stimulus to achieve
    full capitalization for the airline.

> Objective:

-   Sufficiently capitalize Westward Airways to enable the company to
    commence intrastate Nebraska operations and to achieve
    self-sufficiency.

3\. [Funding]{.underline}

a.  Total Project Costs: \$1,700,000

> Federal Share: \$950,000
>
> Local Share: \$750,000

b.  Payment by DOT shall not exceed \$950,000 for the total project,
    with a maximum of \$867,893 towards pre-operating expenses for
    Westward Airways, and \$82,107 for working capital requirements, as
    provided in the community's application.

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b.  The Sponsor shall submit evidence of all expenditures associated
    with the grant project set forth in paragraph b., above, and
    included in the total project costs set forth in paragraph a., above
    (those to be covered by the local and/or state contribution, as well
    as those covered by the Federal contribution) on a monthly basis.
    The DOT will reimburse the Sponsor on a monthly basis for 100%
    percent of all valid expenditures submitted in accordance with
    Attachment A, List of eligible Reimbursable Items (Federal share of
    total project costs set forth in paragraph a., above), subject to
    the specific limits of Federal funding in paragraph b., above, and
    subject to paragraph d., below. All monthly reimbursement requests
    to the DOT shall include sufficient documentation (*e.g.,* invoices)
    to justify reimbursement of the Sponsor as set forth in this Grant
    Agreement.

c.  Payment of the final 10 percent of the Federal funding for the
    project will be made after receipt by the DOT of the final report
    set forth in Section C.4, below.

d.  Funding will terminate and the Grant Agreement will be deemed
    terminated pursuant to the provisions in Part B.2.b., unless agreed
    between the Sponsor and DOT, if:

> \(i\) Westward Airways has not filed its application for DOT
> certification within three months of the date of execution of this
> Grant Agreement;
>
> \(ii\) either the DOT or the FAA denies Westward Airways
> certification;
>
> \(iii\) contract between Westward Airways and the County is not
> executed; and/or
>
> \(iv\) during the term of this Grant Agreement the contract between
> the Sponsor and Westward Airways is terminated.

f.  If after one year from the date of execution of the Grant Agreement,
    Westward Airways has not received its DOT certification, the DOT and
    the Sponsor will reevaluate whether continued funding is warranted.

g.  The Sponsor shall ensure that the funds provided by the DOT are not
    misappropriated or misdirected to any other account, need, project,
    line-item, or the like.

h.  Any Federal funds not expended in conjunction with the project two
    years after the date of execution of the Grant Agreement will remain
    with the DOT, unless otherwise agreed between the Sponsor and the
    DOT. No further reimbursements to the Sponsor will be made or are to
    be expected.

i.  Should this Grant Agreement be terminated prior to the expiration
    date provided herein, the DOT reserves the right to require that any
    of the funds reimbursed to the Sponsor be returned to the DOT.

> 4\. [Progress Reports]{.underline}

a.  Project reports, including progress on milestones as set forth in
    paragraph c., below, shall be reported to the DOT on a quarterly
    basis.

b.  Project reports shall include the following: (i) the status of
    Westward Airways' certification applications with the DOT and the
    FAA; (ii) the status of completion of the local funding contribution
    to the project; (iii) the status of the lease agreement for the
    Pilatus 12 aircraft, or its equivalent; and (iv) status of
    acquisition of the aircraft maintenance tooling; (v) once service is
    implemented, comparison of enplanement figures separately for the
    regional service and the airport generally on a monthly basis
    beginning with the month of execution of this Grant Agreement with
    the same month in each year of the two previous years (in a format
    provided by the DOT); (vi) number of monthly flights operated and
    cancelled; and (vii) fares charged.

c.  Reporting of project milestones shall include the following: (i)
    Securing the \$950,000 line of credit; (ii) securing the \$200,000
    loan; (iii) completion of \$550,000 stock offering; (iv) signing of
    contract between the Sponsor and Westward Airways; (v) issuance of
    DOT certificate; (vi) issuance of FAA certificate; (vii) leasing of
    Pilatus 12 aircraft, or its equivalent; (viii) commencement of River
    Run service, including cities served, schedule, and frequency;
    and (ix) implementation of service to all points in the proposed
    River Run route.

d.  Final report of the Sponsor's assessment of the success or failure
    of the project shall be made to the DOT within three months after
    expiration of this Grant Agreement or conclusion of the grant
    project, whichever occurs earlier, including the ability of any
    services implemented to be self-sustaining; evaluation of service
    reliability; available one-way and round-trip fares; and other
    indicia regarding the success/failure of the service, *e.g.,*
    enplanements, a summary of customer complaints and/or comments,
    adequacy of service levels, aircraft size, and fare levels; and an
    assessment as to whether the project achieved the goal of
    capitalizing Westward Airways to enable the company to commence
    intrastate Nebraska operations and to achieve self-sufficiency,
    unless otherwise agreed between the Sponsor and the DOT. (Final
    report will be in a format to be provided by the DOT).

5\. [Sponsor Obligations]{.underline}

a.  Immediately upon the date of execution of the DOT Grant Agreement,
    the Sponsor will provide to the DOT, a copy of the signed contract
    or memorandum of agreement between the Sponsor and Westward Airways;
    and notification within 15 calendar days of any termination or
    amendment of that contract or memorandum of agreement.

b.  Immediately upon the date of its execution, the Sponsor shall
    provide to the DOT, a copy of the Pilatus 12 (or equivalent
    aircraft) lease or acquisition agreement; and notification within 15
    calendar days of any termination or amendment of that agreement.

c.  Within three months of execution of the Grant Agreement, the Sponsor
    will provide the DOT:

> \(i\) confirmation from the banking institution verifying that
> conditional approval for a line of credit of \$950,000 has been
> secured, a copy of correspondence attesting such is attached as
> Attachment "B";
>
> \(ii\) confirmation from the banking institution verifying that
> conditional approval for a loan of \$200,000 towards working capital
> has been secured, a copy of correspondence attesting such is attached
> as Attachment "B"; and
>
> \(iii\) certification from Westward Airways that their \$550,000 stock
> offering is on schedule.

d.  Immediately upon completion of Westward Airways' stock offering, the
    Sponsor shall certify that the offering has been completed.

e.  Immediately upon receipt from the DOT and FAA of approval of its
    certification applications, the Sponsor shall submit to the DOT a
    copy of each certificate.

f.  Notification within 15 calendar days if either the DOT or FAA
    certificate application is denied, and a copy of the denial.

g.  Notification of commencement of service by Westward Airways to all
    Nebraska points as identified in the County's application,
    specifically, Scottsbluff, North Platte, Lincoln, and Omaha, within
    18 months of execution of the Grant Agreement, unless otherwise
    agreed between the Sponsor and DOT.

h.  The Sponsor shall ensure that the obligations set forth in Section
    C.4 of this Grant Agreement (Progress Reports) are met.

**D.** **ASSURANCES**

The Sponsor shall execute the attached assurances and certifications in
conjunction with execution of this Grant Agreement and shall ensure
compliance by the grant recipient with those assurances and
certifications. The DOT incorporates by reference, and the Sponsor
agrees to comply with, all applicable provisions of FAA Order 5100-38 B.

#### E. DEFINITIONS {#e.-definitions .unnumbered}

> **Agreement:** Any written or oral contract, obligation, commitment,
> or understanding between the Sponsor and/or all parties identified in
> the community's grant proposal.
>
> **Application or Grant Application:** The complete document submitted
> by the community/sponsor to the DOT in Docket OST-2002-11590, as it
> may be amended.
>
> **Carrier or Air Carrier or Airline:** Entity, including commuter air
> carriers and air taxi operators, providing air services.
>
> **Community:** All parties identified in the grant application as
> participating in the approved grant project, including the designated
> Legal Sponsor.
>
> **DOT:** United States Department of Transportation.
>
> **Execution of Grant Agreement:** Signing of the Grant Agreement by
> the DOT and the Sponsor.
>
> **Federal Share:** Federal funds authorized for use by the grant
> recipient in implementing the approved grant project.
>
> **Grant Agreement:** The agreement between the DOT and the Sponsor for
> the authorized project under the SCASDPP and DOT Order 2002-6-14.
>
> **Local Share:** Public, community, state, or private funds, excluding
> in-kind contributions described in the grant application, committed in
> the grant application for use in implementing the approved grant
> proposal.
>
> **Party:** The Department of Transportation and/or the Sponsor, as the
> context indicates.
>
> **Project or Grant Project:** The authorized use of Federal and/or
> local funds to fulfill the goals and objectives described in the
> community grant application.
>
> **Proposal:** Project defined by the community in its grant
> application.
>
> **Quarter or Quarterly:** Calendar quarter. Reports or other
> information required for submission on a quarterly basis are due no
> later than 15 calendar days after close of the calendar quarter.
>
> **Small Community Air Service Development Pilot Program (SCASDPP):** A
> grant-in-aid financial assistance program established under the
> Wendell H. Ford Aviation Investment and Reform Act for the 21^st^
> Century (AIR-21), P.L. 106-181, and codified in 49 U.S.C. 41743 *et
> seq.*
>
> **Sponsor Obligations:** Responsibilities of the Sponsor under this
> Grant Agreement.
>
> **Sponsor or Legal Sponsor or Grant Recipient or Grantee:** The
> designated representative of the community to administer and oversee
> implementation of the Grant Agreement. The Sponsor shall be
> responsible for ensuring that all participants in the project fulfill
> their obligations.
>
> **Total Project Costs:** Sum of the Federal and local shares
> contributed toward completion of the approved grant project, excluding
> in-kind contributions.

**OFFER**

This offer is made in accordance with Public Law 106-181 and Public law
107-87 according to the above conditions and assurances.

Executed this \_\_\_\_\_\_\_\_ day of \_\_\_\_\_\_\_\_, 2002.

> United States Department of Transportation

(SEAL)

##### Read C. Van de Water

> Assistant Secretary for Aviation
>
> and International Affairs

**ACCEPTANCE**

The sponsor agrees to accomplish each element of the project in
compliance with the terms and conditions contained herein.

Executed this \_\_\_\_\_\_\_\_ day of \_\_\_\_\_\_\_\_, 2002.

> Scotts Bluff County Board of Commissioners
>
> Scottsbluff, Nebraska

(SEAL)

> Signature of Sponsor's Designated Official Representative
>
> Title

Attest:

Title:

# CERTIFICATE OF SPONSOR'S ATTORNEY

I, , acting as Attorney for the Sponsor do hereby certify:

That in my opinion the Sponsor is empowered to enter into the foregoing
Grant Agreement under the laws of the State (or Commonwealth) of
\_\_\_\_\_. Further, I have examined the foregoing Grant Agreement, and
the actions taken by said Sponsor relating thereto, and find that the
acceptance thereof by said Sponsor and Sponsor's official representative
has been duly authorized and that the execution thereof is in all
respects due and proper and in accordance with the laws of the said
State (or Commonwealth) and Title 49 U.S.C. In addition, for grants
involving projects to be carried out on property not owned by the
Sponsor or where Sponsor may make payments to others, there are no legal
impediments that will prevent full performance by the Sponsor. Further,
it is my opinion that the said Grant Agreement, including the
Assurances, constitutes a legal and binding obligation of the Sponsor in
accordance with the terms thereof.

Signature of Sponsor's Attorney Date

Printed or Typed Name Telephone

ATTACHMENT "A"

GRANT OFFER AND AGREEMENT BETWEEN USDOT AND SCOTTS BLUFF COUNTY
COMMISSIONERS

LIST OF ELIGIBLE REIMBURSABLE EXPENSES

  ----------------------------------------------------------- -----------
  Administrative and Flying Ops Wages - First 6 Months        \$227,490

  Administrative and Flying Ops Wages - Pre-Op                \$78,810

  Administrative Capital Equipment                            \$20,000

  Administrative Office Rent - First 6 Months                 \$15,000

  Administrative Office Rent - Pre-Op                         \$10,000

  Advertising - Initial                                       \$35,000

  Aircraft Lease Deposit - Aircraft #1                        \$200,000

  Aircraft Parts Inventory - Aircraft #1                      \$100,000

  Airport Station Capital Equipment                           \$30,800

  Credit Card Security Deposit                                \$50,000

  Leasehold Improvements                                      \$40,000

  Maintenance Tooling                                         \$50,000

  Merchant Account Deposit                                    \$75,000

  Training                                                    \$17,900

                                                              

                                                              \$950,000
  ----------------------------------------------------------- -----------

ATTACHMENT "B"

CONDITIONAL APPROVAL OF LINE OF CREDIT AND DEBT FINANCE

PLATTE VALLEY NATIONAL BANK LETTER DATED AUGUST 13, 2002,

> **Attachments**

**OFFICE OF THE SECRETARY**

**DEPARTMENT OF TRANSPORTATION**

**TITLE VI ASSURANCE**

(Implementing Title VI of the Civil Rights Act of 1964, as amended)

**ASSURANCE CONCERNING NONDISCRIMINATION ON THE**

**BASIS OF DISABILITY IN FEDERALLY-ASSISTED PROGRAMS**

**AND ACTIVITIES RECEIVING OR BENEFITING FROM**

**FEDERAL FINANCIAL ASSISTANCE**

(Implementing the Rehabilitation Act of 1973, as amended, and the

Air Carrier Access Act of 1986)

49 CFR Parts 21 and 27 and 14 CFR Parts 271 and 382

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the Grant Recipient) HEREBY AGREES THAT,

(Name of Grant Recipient)

I. As a condition to receiving any Federal financial assistance from the
Department of Transportation, it will comply: with Title VI of the Civil
Rights Act of 1964, as amended, 42 U.S.C. 2000d\--42 U.S.C. 2000d-4; all
requirements imposed by or pursuant to: Title 49, Code of Federal
Regulations, Part 21, Nondiscrimination in Federally-Assisted Programs
of the Department of Transportation\--Effectuation of Title VI of the
Civil Rights Act of 1964; and other pertinent directives so that no
person in the United States shall, on the grounds of race, color, or
national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under any
program or activity for which the Recipient receives Federal financial
assistance from the Department of Transportation. This assurance is
required by Title 49, Code of Federal Regulations, section 21.7(a) and
Title 14, Code of Federal Regulations, section 271.9(c).

II\. As a condition to receiving any Federal financial assistance from
the Department of Transportation, it will comply with: section 504 of
the Rehabilitation Act of 1973, as amended (29 U.S.C. 794); the Air
Carrier Access Act of 1986 (49 U.S.C. 1374(c)); and all requirements
imposed by or pursuant to Title 49, Code of Federal Regulations,
Part 27, Nondiscrimination on the Basis of Handicap in Programs and
Activities Receiving or Benefiting from Federal Financial Assistance,
Title 14, Code of Federal Regulations, Part 382, Nondiscrimination on
the Basis of Handicap in Air Travel; and other pertinent directives so
that no otherwise qualified person with a disability, be excluded from
participation in, be denied the benefits of, be discriminated against by
reason of such handicap in the provision of air

transportation, or otherwise be subjected to discrimination under any
program for which the Recipient receives Federal financial assistance
from the Department of Transportation. This assurance is required by
Title 49, Code of Federal Regulations, section 27.9 and Title 14, Code
of Federal Regulations, sections 271.9(c) and 382.9.

III\. It will promptly take any measures necessary to effectuate this
agreement. The Recipient further agrees that it shall take reasonable
actions to guarantee that it, its contractors and subcontractors subject
to the Department of Transportation regulations cited above,
transferees, and successors in interest will comply with all
requirements imposed or pursuant to the statutes and Department of
Transportation regulations cited above, other pertinent directives, and
the above assurances.

IV\. These assurances obligate the Recipient for the period during which
Federal financial assistance is extended. The Recipient agrees that the
United States has a right to seek judicial enforcement with regard to
any matter arising under the statutes and Department of Transportation
regulations cited above, other pertinent directives, and the above
assurances.

V. These assurances are given for the purpose of obtaining Federal grant
assistance under the Small Community Air Service Development Pilot
Program and are binding on the Recipient, contractors, subcontractors,
transferees, successors in interest, and all other participants
receiving Federal grant assistance in the Small Community Air Service
Development Pilot Program. The person or persons whose signatures appear
below are authorized to sign this agreement on behalf of the Grant
Recipient.

VI\. In addition to these assurances, the Recipient agrees to file: a
summary of all complaints filed against it within the past year that
allege violation(s) by the Recipient of Title VI of the Civil Rights Act
of 1964, as amended, section 504 of the Rehabilitation Act of 1973, as
amended, or the Air Carrier Access Act of 1986; or a statement that
there have been no complaints filed against it. The summary should
include the date the complaint was filed, the nature of the complaint,
the status or outcome of the complaint (*i.e.*, whether it is still
pending or how it was resolved).

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date Legal Name of Grant Recipient

By:

Signature of Authorized Official

**UNITED STATES OF AMERICA**

**DEPARTMENT OF TRANSPORTATION**

**OFFICE OF THE SECRETARY**

**OFFICE OF AVIATION ANALYSIS**

**CERTIFICATION REGARDING INFLUENCING ACTIVITIES**

Certification for Contracts, Grants, Loans,

and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and
belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, 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 in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.

\(2\) If any funds other than 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 in
connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL,
\"Disclosure Form to Report Influencing Activities,\" in accordance with
its instructions.

\(3\) The undersigned shall require that the language of this
certification be included in the award documents for all subawards at
all tiers (including subcontracts, subgrants, and contracts under
grants, loans and cooperative agreements) and that all subrecipients
shall certify and disclose accordingly.

This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S.
Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than \$10,000 and not more than
\$100,000 for each such failure.

Signature Date

Title

Grant Recipient

**UNITED STATES OF AMERICA**

**DEPARTMENT OF TRANSPORTATION**

**OFFICE OF THE SECRETARY**

**OFFICE OF AVIATION ANALYSIS**

**CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS**

**IN THE PERFORMANCE OF SMALL COMMUNITY AIR SERVICE PURSUANT TO GRANT
AWARD UNDER THE SMALL COMMUNITY AIR SERVICE DEVELOPMENT PILOT PROGRAM**

A. The grant recipient certifies that it will, or will continue, to
provide a drug-free workplace by:

\(a\) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the grant recipient's workplace, and
specifying the actions that will be taken against employees for
violation of such prohibition;

\(b\) Establishing an ongoing drug-free awareness program to inform
employees about\--

\(1\) The dangers of drug abuse in the workplace;

\(2\) The grantee\'s policy of maintaining a drug-free workplace;

\(3\) Any available drug counseling, rehabilitation, and employee
assistance programs; and

\(4\) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;

\(c\) Making it a requirement that each employee to be engaged in the
performance of work supported by the grant award be given a copy of the
statement required by paragraph (a);

\(d\) Notifying the employee in the statement required by paragraph (a)
that, as a condition of employment supported by the grant award, the
employee will\--

\(1\) Abide by the terms of the statement; and

\(2\) Notify the employer in writing of his or her conviction for a
violation of a criminal drug statute occurring in the workplace no later
than five calendar days after such conviction;

\(e\) Notifying the agency in writing, within ten calendar days after
receiving notice under paragraph (d)(2) from an employee or otherwise
receiving actual notice of conviction. Employers of convicted employees
must provide notice, including position title, to the Office of Aviation
Analysis. Notice shall include the order number of the grant award;

\(f\) Taking one of the following actions, within 30 days of receiving
notice under paragraph (d)(2), with respect to any employee who is so
convicted\--

\(1\) Taking appropriate personnel action against such an employee, up
to and including termination, consistent with the requirements of the
Rehabilitation Act of 1973, as amended, or

\(2\) Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such purposes by
a Federal, State or local health, law enforcement, or other appropriate
agency;

\(g\) Making a good faith effort to continue to maintain a drug-free
workplace through implementation of paragraphs (a), (b), (c), (d), (e)
and (f).

B. The grant recipient *may*, but is not required to, insert in the
space provided below the site for the performance of work done in
connection with the specific grant.

Places of Performance (street address, city, county, state, zip code).
For the provision of air service pursuant to the grant award, workplaces
include outstations, maintenance sites, headquarters office locations,
training sites and any other worksites where work is performed that is
supported by the grant award.

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Check \[ \] if there are workplaces on file that are not identified
here.

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Grant Recipient Signature Date

**OFFICE OF THE SECRETARY OF TRANSPORTATION**

**CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS \-- PRIMARY COVERED TRANSACTIONS**

# Instructions for Certification

1\. By signing and submitting this proposal, the prospective primary
participant is providing the certification set out below.

2\. The inability of a person to provide the certification required
below will not necessarily result in denial of participation in this
covered transaction. The prospective participant shall submit an
explanation of why it cannot provide the certification set out below.
The certification or explanation will be considered in connection with
the department or agency\'s determination whether to enter into this
transaction. However, failure of the prospective primary participant to
furnish a certification or an explanation shall disqualify such person
from participation in this transaction.

3\. The certification in this clause is a material representation of
fact upon which reliance was placed when the department or agency
determined to enter into this transaction. If it is later determined
that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

4\. The prospective primary participant shall provide immediate written
notice to the department or agency to which this proposal is submitted
if at any time the prospective primary participant learns that its
certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.

5\. The terms covered transaction, debarred, suspended, ineligible,
lower tier covered transaction, participant, person, primary covered
transaction, principal, proposal, and voluntarily excluded, as used in
this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may
contact the department or agency to which this proposal is being
submitted for assistance in obtaining a copy of those regulations.

6\. The prospective primary participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is proposed for debarment under 48 CFR part 9, subpart
9.4, debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the
department or agency entering into this transaction.

7\. The prospective primary participant further agrees by submitting
this proposal that it will include the clause titled \"Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
\-- Lower Tier Covered Transaction,\" provided by the department or
agency entering into this covered transaction, without modification, in
all lower tier covered transactions and in all solicitations for lower
tier covered transactions.

8\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that it
is not proposed for debarment under 48 CFR part 9, subpart 9.4,
debarred, suspended, ineligible, or voluntarily excluded from the
covered

transaction, unless it knows that the certification is erroneous. A
participant may decide the method and frequency by which it determines
the eligibility of its principals. Each participant may, but is not
required to, check the List of Parties Excluded from Federal Procurement
and Non-procurement Programs.

9\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealings.

10\. Except for transactions authorized under paragraph 6 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is proposed for
debarment under 48 CFR part 9, subpart 9.4, suspended, debarred,
ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

**Certification Regarding Debarment, Suspension, and Other
Responsibility Matters \-- Primary Covered Transactions**

\(1\) The prospective primary participant certifies to the best of its
knowledge and belief, that it and its principals:

\(a\) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded by any Federal department
or agency;

\(b\) Have not within a three-year period preceding this proposal 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 public (Federal, State or local)
transaction or contract under a public transaction; violation of Federal
or State antitrust statutes or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;

\(c\) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State or local) with
commission of any of the offenses enumerated in paragraph (1)(b) of this
certification; and

\(d\) Have not within a three-year period preceding this
application/proposal had one or more public transactions (Federal, State
or local) terminated for cause or default.

\(2\) Where the prospective primary participant is unable to certify to
any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

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Name Affiliation

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Title Date

**OFFICE OF THE SECRETARY OF TRANSPORTATION**

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION \-- LOWER TIER COVERED TRANSACTIONS

# Instructions for Certification

1\. By signing and submitting this proposal, the prospective lower tier
participant is providing the certification set out below.

2\. The certification in this clause is a material representation of
fact upon which reliance was placed when this transaction was entered
into. If it is later determined that the prospective lower tier
participant knowingly rendered an erroneous certification, in addition
to other remedies available to the Federal Government the department or
agency with which this transaction originated may pursue available
remedies, including suspension and/or debarment.

3\. The prospective lower tier participant shall provide immediate
written notice to the person to which this proposal is submitted if at
any time the prospective lower tier participant learns that its
certification was erroneous when submitted or had become erroneous by
reason of changed circumstances.

4\. The terms covered transaction, debarred, suspended, ineligible,
lower tier covered transaction, participant, person, primary covered
transaction, principal, proposal, and voluntarily excluded, as used in
this clause, have the meaning set out in the Definitions and Coverage
sections of rules implementing Executive Order 12549. You may contact
the person to which this proposal is submitted for assistance in
obtaining a copy of those regulations.

5\. The prospective lower tier participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is proposed for debarment under 48 CFR part 9, subpart
9.4, debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the
department or agency with which this transaction originated.

6\. The prospective lower tier participant further agrees by submitting
this proposal that it will include this clause titled \"Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
\-- Lower Tier Covered Transaction,\" without modification, in all lower
tier covered transactions and in all solicitations for lower tier
covered transactions.

7\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that it
is not proposed for debarment under 48 CFR part 9, subpart 9.4,
debarred, suspended, ineligible, or voluntarily excluded from covered
transactions, unless it knows that the certification is erroneous. A
participant may decide the method and frequency by which it determines
the eligibility of its principals. Each participant may, but is not
required to, check the List of Parties Excluded from Federal Procurement
and Non-procurement Programs.

8\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealings.

9\. Except for transactions authorized under paragraph 5 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is proposed for
debarment under 48 CFR part 9, subpart 9.4, suspended, debarred,
ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency with which this transaction
originated may pursue available remedies, including suspension and/or
debarment.

**Certification Regarding Debarment, Suspension, Ineligibility an
Voluntary Exclusion \-- Lower Tier Covered Transactions**

\(1\) The prospective lower tier participant certifies, by submission of
this proposal, that neither it nor its principals is presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal
department or agency.

\(2\) Where the prospective lower tier participant is unable to certify
to any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

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Name

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Title

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Affiliation

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Date