APPENDIX C

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### SMALL COMMUNITY AIR SERVICE DEVELOPMENT PROGRAM

DOCKET OST

- 2011

- 0119

SUMMARY INFORMATION

All applicants mus t submit this information with their proposal , along with a completed form SF424 on http://

www.grants.gov.



### A. APPLICANT INF ORMATION: (CHECK ALL THAT APPLY)

 N ot a Consortium ⁭ Interstate Consortium ⁭ Intrastate Consortium

⁭ Community now receives EAS subsidy

 Community (or Consortium member) previously received a Small Community Grant

If previous recipient : Date of Grant:

_ 9/17/2004

_ E xpiration date of gran t:

_ 9/17/2005_



### B. P UBLIC /P RIVATE P ARTNERSHIPS : (L IST ORGANIZATION NAMES )

Public Private

1. _ Air Service Development Committee

___ 1.______________________________________

2.____________________________________ 2.________________________________

______ 3.____________________________________ 3.______________________________________

4.____________________________________ 4.______________________________________

5.____________________________________ 5._____________________

_________________



### C. P ROJECT P ROPOSAL : (CHECK ALL THAT APPLY)

 Marketing

 Upgrade Aircraft ⁭ New Route

⁭ Travel Bank ⁭ Service Restoration ⁭ Subsidy

⁭ Surface Transportation ⁭ Regional Service

 Revenue Guarantee

⁭ Launch New Carrier Start Up Cost Offset First Service

Study ⁭ Secure Additional Carrier Other (explain below)

_________________________________________________________________________________________________

_________________________________________________________________ ________________ ________________APPENDIX C

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⁭



### D. E XISTING L ANDING A IDS AT L OCAL A IRPORT:

 Full ILS ⁭ Outer/Middle Marker ⁭ Published Instrument Approach

⁭ Localizer ⁭ Other (specify )



### E. PROJECT COSTS: DO NOT ENTER TEXT IN SHADED AREA

LINE DESCRIPTION SUB TOTAL TOTAL AMOUNT

1 Federal amount requested $500,000

2 State cash financial contribution

Local cash financial contribution

3a Airport cash funds $30,000

3b No n

- airport cash funds $50,000

3 Total local cash funds ( 3a +3b ) $ 80,000

4 TOTAL CASH FUNDING ( 1+2+3 )

In

- Kind contribution

5a Airport In

- Kind contribution**

5b Other In

- Kind contribution** $20,000

5 TOTAL IN

- KIND CONTRIBUTION

( 5a + 5b ) $20,000

6 TOTAL PROJECT COST (4+8) $600,000



### F. IN

- KIND CONTRIBUTIONS**

For funds in lines 5a (Airport In

- Kind contribution) and 7b (Other In

- Kind contribution), please describe the

source(s) of fund(s) for each.

Marketing funds

– public service announce ment spots donated by local media.APPENDIX C

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### G. IS THIS APPLICATION SUBJECT TO REVIEW BY STATE UNDER EXECUTIVE ORDER 12372 PROCESS?

⁭ a

. This application was made available to the State under the Executive Or der 12372 Process for review on

(date)

___________________.

⁭ b. Program is subject to E.O. 12372, but has not been selected by the State for review.

 c. Program is not covered by E.O. 12372.



### H. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? (IF “YES” , PROVIDE EXPLANATION)

 No ⁭ Yes (explain)

________________________________________________________________________________________________________________

___________________________ _______________________________________________________________