# 40-311

LE AIR

Since 1959 P.O

. BO X 53 9 MIL E 131 3

ALASK A HIGHWA Y TOK , ALASK A 9978 0 907-883-519 1 FAX-907-883-519 4 Fairbank sInt' l Airpor t 645 0 Airpor t Wa y Suit e 2 0 Fairbanks , Alask a 9970 9

907-474-001 8 FA X -907-474-895 4

Proposa i t o Provid eEssentia l Ai r Servic e A t Chisana , Alask aDocke t DOT-OST-1998-457 4 An d Heal y

Lake , Alask aDocke t DOT-GST-1998-354 6 Februar y

6 , 201 4
Rout eTKJ-CZN-TK J Frequency : 2

Roun d Trip s

pe r Wee k Aircraf t Type : Cessn a185( 3 seats) , 20 6

o r 207( 4 seats) Annua l Bloc k

Hour s 1 190. 7
Revenu e Rat e 2 Amt/lbs

. Revenu e Passenge r $97.6 710 0 $ 9,767.0 0 Carg o S .4 2 3,000 $ 1,260.00 Spac eAvailabl eCarg o S .2 1 26,00 0 $ 5,460.0 0 Mai l S 1.00119 5

7,00 0 $ 7.008.3 7 Tota l Operatin g Revenu e $23,495.3 7
Direc tOperatin g Expense s Uni tcos t Expens e Pilo t $103.0 0 pe r B H $19,642.1 0 Fue l & Oi l $102.0 0 perB H $19,451.4 0 Maintenanc e $112.0 0 pe r B H $21,358.4 0 Depreciatio n $22.8 5 pe r B H $ 4,357.4 9 Insuranc e $47.2 5 pe r B H $ 9,010.5 8 Agen t fe e $20.0 0 pe r CZ N dept

. $ 2,080.0 0 Tota l Direc t

Operatin g Expense s $75,899.9 7
Indirec tOperatin g Expense s @ 40 % o f

Direc tNe to f

Depreciatio n $28,616.9 9
Tota l Operatin g Expense s $104,516.9 6 Operatin g Loss $81,021.5 9
Profi tElemen t@5

% o f Tota l Operatin g Expense s $ 5,225.8 5
Subsid y Nee d m0O% $86,247.4 4
IBIoc k hour s = (TK J- CZ N -TKJ , 1.8 3 hours )x 2 flights/wee k

x 5 2 = 190. 7hour s 2.Passenge r

an d Carg o Rate s

Befor eExcis eTa x

AI R SCHEDULED , AI R CHARTE R I N ALASK A & CANADA , WHEELS , SKIIS , FLOATS , PACKAG E HUNTS , FLY-I N FISHING , FLIGHTSEEING , BUL K FUE L HAULIN GRout eFAI-HKB-FA I

Frequency : 2

Roun d Trip s

pe r Wee k Aircraf t Type : Cessn a20 6

o r 207( 5 seats) Annua l Bloc k

Hour s 1 20 8
Revenu e Rat e 2 Amt/lbs

. Revenu e Passenge r $ 65.1 2 5 0 $ 3,256.0 0 Carg o $ .4 75,000 $ 2,350.0 0 Mai l $ 1.1 3 1,20

0 $

1,356.00 Tota l Operatin g Revenu e $ 6962.0 0
Direc tOperatin g Expense s Uni tcos t Expens e Pilo t $103.0 0 pe r B H $21,424.0 0 Fue l & Oi l $102.0 0 pe r B H $21,216.0 0 Maintenanc e $112.0 0 pe r B H $23,296.0 0 Depreciatio n $22.8 5 pe r B H $ 4,752.8 0 Insuranc e $47.2 5 pe r B H $ 9,828.0 0 Agen t fe e $20.0 0 pe r HK B dept

. $

2,080.0 0 Tota l Direc t

Operatin g Expense s $82,596.8 0
Indirec tOperatin g Expense s @ 40 % o f

Direc tNe to f

Depreciatio n $31,137.6 0
Tota l Operatin g Expense s $113,734.4 0 Operatin g Loss $106,772.4 0
Profi tElemen t@5%

o f Tota l Operatin g Expense s $ 5,686.7 2
Subsid v Nee d @100 % $112,459.1 2
l^Block hour s = (FA I - HKB , 1 hour)x 4 flights/wee k

x 5 2 = 20 8 hour s 2_Passenge r

an d Carg o Rate s

befor eExcis eTa xUNITE D STATE S O F AMERIC A DEPARTMEN

T O F TRANSPORTATIO

N OFFIC E O F TH E SECRETAR

Y OFFIC E O F AVIATIO N ANAL\SI S TITL E V I ASSURANC

E (Iitplementii ^

Titl e V I o f th e Civi l Right s Ac t o f 1964 , a s amenled ) ASSURANC

E CONCERNIN

G NONDISCRIMINATIO

N O N TH E BASI S O F DISABILIT

Y I N FEDERALL

Y ASSISTE D PROGRAM

S AN D ACTIVITIE

S RECEIVIN G O R BENEFITIN

G FRO M FEDERA L FINANCIA L ASSISTANC

E (Implenientin

g th e Rehabilitatio

n Ac t o f 1973 , a s amended , an d tl w Air Carrie r Acces s Ac t o f 1986 ) 4 9 CF R Part s 2 1 an d 2 7 an d 1 4 CF R Part s 271 , an d 38 2
(th e Recipient ) HEREB Y AGREE S THAT , I

. A s a ccxiditio n t o receivir g an y Federa l firancial ^sistanc e ffcm th e Departnm t ofTrarBportaticii

, i t willconpfy :wiftiTit k V I ofth e Civ i Rgtt s Ac t o f 1964 , a s airended , 4 2 U.S.C

. 2000d--4 2 U.S.C

. 2000d-4 ; allrequiren^nt

s inpose d b y o r pursuan t to :Titl e 49 , Cod e cfFedera l ReguMions , Par t 21 , Nondiscrininatio

n i n Federal^-Assiste

d Program s ofth e Departmen t ofTransportationr-Eflfectuatio

n o f Tile V I ofth e Civ i R^ht s Ac t of1964 ; an d othe r pertinen t directive s s o tha t n o perso n i n th e Unite d State s shal, o n th e ground s o f race , cobr , o r nationa l origin , b e exclude d ffom parti c ^Htio n ii , b e denie d th e benefit s o f o r b e otherwis e subjecte d t o discrrrrinatio n unde r ar y progra m c r adivil^ ' fer whic h th e Recipien t receive s Federalfirancia

l assistanc e fiomtiK Departmen t c f Transportatio n Thi s assuranc e B require d b y Titl e 49 , Cod e ofFeder ^ R^ulations , sectio n 21.7(a ) an d Titl e 14 , Code ofFedera l Regulations , sectio n 271.9(c)

. II

. A s a conditio n t o receivir^ary'Federa

l financial assistanc e ffom th e Departrrcn t ofTransporCatio

n i t wi l compty ' with :sectio n 50 4 o f th e RehabilitatK n Ac t o f 1973 , a s attende d (2 9 U.S.C

. 794) ; th e .^ r Carrie r Acces s Ac t o f 198 6 (4 9 U.S.C

. 1374(c)) ; an d a l requiremenl s irpose d b y o r pursuan t t o Titl e 49 , Cod e ofFedera l Regidaticais , Par t 27 , Ncoiiscrirninatio

n onth e Basi s o f Handica p i n Program s an d Activitie s Receivir ^ o r Benefittir g ffom Federa l Financia l Assistance , Titl e 14 , Cod e o f Federa l Regulations , Par t 382 , Nondiscriminatio

n o n th e Basi s o f Hardica p i n Ai r Travel ; an d othe r pertinen t drective ss

o Ihatn o olherwis e quaifiedperso

n wift i a disability , b e exclude d ffom paittpatk m in , b e denie d ttie benefit s o f b e discriminate d ^ins t b y reaso n o f suc h handica p i n th e provisio n o f ai r transportation

, o r olherwis e b e subjecte d t o discrirninatio n unde r ar y progra m fcs " whic h th e Recpien t receive s Federa l friancial assistanc e ffom th e Departmer t o f Transportatio n Thi s assuranc e i s require d b y Titl e 49 , Cod e ofFedera l Regubtions , sectio n 27. 9 an d Titl e 14 , Cod e o f Federa l Ri^ubtions , section s 271.9(c ) an d 382.9

. III

. I t wi U pronptt y tak e any meaure s necessar y t o effectuat e thi s agreement
. Th e Rec5)Kn t fiirther ^ee s tha t i t shal l tak e reasonabl e action s t o guarante e tha t it , it s contractor s an d subcontractor

s subjec t t o th e Departrrten t ofTransportatio

n regulation s cite d above , transferees , an d successor s i n interes t wil l compf y wit h al l requirement s impose d o r pursuan t t o th e statute s an d Departmen t ofTransportatio

n regulation s cite d above , othe r pertinen t directives , an d th e abov e assurances . IV

. Thes e assurance s obligat e tite Re c pien t fir th e perio d durir g vibkh Federa

l financial assistanc e i s extended

. Th e Recpien t agree s tha t th e Unite d State s ha s a r%h t t o see k judicia l enforcemen t wit h regar d t o ar y matte r arisin g mde r th e statute s an d Departmen t ofTransportatio

n regulaticti s cite d above , othe r pertinen t directiv'es , an d th e abov e assurances . V

. Thes e assurance s ar e give n fcr th e purpos e o f obtainir g Federa l stibsid y unde r th e Essentia l Ai r Servic e Progra m an d ar e bindi ^ o n th e Recpient , contractors , subcontractors

, transferees , successor s i n interest , an d al l othe r participant s receivir ^ Federa l subsidy ' i n th e Essentia l Ai r Servic e Progra m Th e perso n o r person s whos e s%nature s appea r belo w ar e autiiorizE d t o s% n thi s agreemen t o n behal f o f th e Recpient

. VI

. I n additio n t o thes e assurances , th e Recpien t agree s t o file: a snmiar y o f al l conplaint s filed agaiis t i t withi n ftie p ^ yea r tha t alleg e violation(s ) b y th e Recpien t o f TJtf e V I o f Ih e Civi l Right s Ac t o f 1964 , a s amended , sectio n 50 4 o f Ih e Rehabiliatio n Ac t c f 1973 , a s amended , o r th e Ai r Carrie r Acces s Ac t o f 1986 ; o r a statemen t tha t ther e hav e bee n n o ccaiplaint s filed agains t it

. Th e summar y shoul d includ e Ih e dat e th e conplain t wa s filed, th e natur e ofth e corrplaint , th e statu s o r outccm e ofth e complain t (i.e. , whethe r i t i s sti H pendir g o r how it was resolved)

.

Dat e Lega l Nam e o f Rec5)ien t
S^natur e o f Authorize d Officia lUNITE D STATE S O F AMERIC A DEPARTMEN

T OFTRANSPORTATIO

N OFFIC E O F TH E SECRETAR

Y OFFIC E O F AVIATIO N ANAL\SI S CERTIFICATIO

N REGARDIN

G INFLUENCIN

G ACTIVITIE

S Certificatio n fo r Contracts , Grants , Loans , an d Cooperativ e Agreement s Hi e imders^ne d certifies , t o th e bes t ofhi s o r he r knowledg e an d belie:£ that : (1 ) N o Federa l appropriate d fund s hav e bee n pai d o r wiUb e paid , b y o r o n behal f oftii e unders^ned , t o ar y pers« i fcr influencir g o r atterrptin g t o inflrenc e a n oflSce r o r errptoye e o f an^ ' agency , a Merrbe r o f Cot^ess , a n office r o r emptoye e o f Cor^ess , o r a n ertplpye e o f a Mennbe r o f Congres s i n connectio n wit h th e awardir ^ o f ar y Federa l contract , tl i makin g o f an y Federa l grant , th e makin g o f an^ ^ Federa l loan , th e enterin g int o c f ar y cooperativ e agreement , an d th e extension , continuation , renewal , amendment , o r modificatiD n c f ar ^ Federa l contract , grant , ban , o r cooperativ e agreement
. (2 ) If an y fimds othe r tha n Federa l q)propriate d finds hav e bee n pai d o r wil l b e pai d t o ar y perso n fcr influencin g or atterrptir g t o rfLienc e a n oflBce r o r emplo>'e e c f ar y ^enc>' , a Membe r o f Corgress , a n office r o r emptoye e o f Corgress , o r a n emptoye e o f a Merhbe r o f Ccrgres s i i cormectto n wil h thi s Federa l contrac t grant , toan, o r cooperati/ e agreement , th e undersgne d shal l coiplet e an d submi t Standar d Fonn-LLL , 'Disctosur e For m t o Repea t InfLiencin g Activities, " i n accordanc e wit h it s instructions

. (3 ) Th e underfille d shal l requir e tha t tine lar^u^ e o f thi s certificatto n b e include d i n th e awar d document s fcr al l subaward s a t al l tier s (includir g subcontracts , subgranls , an d contract s unde r grants , ban s an d cooperativ e agreements ) an d tha t a U subrecpient s shal l certif y an d disctos e according^

. Tbk certificatton B aniaterialrepresentatto

n affec t iponwtehreliancew'a

s place d whe n thi s transactio n wa s mad e c r entere d into

. Submissto n o f thi s certificatto n i s a prerequisit e fcr makin g o r enteri g int o thi s transactio n impose d b y sectio n 1352 , titl e 31 , U

. S

. Code

. Ar y perso n wh o fiils t o file th e require d certificatia i shal l b e subjec t t o a civi l jKrah y o f no t les s tha n $ 10,00 0 an d rtcA rrcr e tha n $100,00 0 fi^r eac h suc h feilre.

Essentia l A^ervic e Poiit(s ) T o Wba^ Certificatio n Apple s 

# CIA

### UNITE D STATE S O F AMERIC A DEPARTMEN

T O F TRANSPORTATIO

N OFFIC E O F TH E SECRETAR

Y OFFIC E O F AVIATIO N ANAL\^I S CERTIFICATIO

N REGARDIN

G DRUG-FRE

E WORKPLAC

E REQUIREMENT

S I N TH E PERFORMANC

E O F SUBSIDIZE

D ESSENTIA

L AI R SERVIC E A

. Th e subsidize d essentia l ai r servic e carrie r certifie s tha t i wil l o r wil l continue , t o provid e a dn% ffee workplac e by : (a ) Publishir g a statemer t notifyir ^ emplcyee s tha t th e unlawfu l manufecture , distribution , dispensirg , possessio n o r us e o f a controlle d substanc e i s prcHbie d i n th e carrier' s workplace , an d specifyin g ftie action s lha t wil l b e take n agaiis t enpbyee s fcr violatio n o f suc h proMbftion ; (b ) Establishin g a n ongoig dng-fie e awarenes s progra m t o kifca m enplcyee s about

- (1 ) Th e danger s o f dru g abus e i n th e workplace ; (2 ) Th e grantee' s polic y o f maiitaiiin g a drug-fte e workplace ; j (3 ) Ar y availabl e 

### drug, counseBr ^ rehabiliatksi , an d employe e assBtanc e programs ; an d (4 ) The penaltie s tha t ma y b e impose d upon enployee s fcr dru g abus e violatian s occurrin g i n th e workplace ; (c ) Makin g i t a requiremen t tha t eac h employe e t o b e engage d i n th e performanc e o f wor k sipporte d b y Ih e subsii y b e give n a cop y ofth e statemen t reqviired b y par^^ h (a) ; (d ) Notifyir g th e empbye e i n th e statemen t require d b y paragrap h (a ) that , a s a conditis i o f empbymen t sipporte d b y ttie subsify , th e empb^-e e wilt

- (1 ) Abid e b y th e term s ofth e statement ; an d (2 ) Notif y th e empbye r i n writin g ofhi s o r he r convictixifo r a violatb n o f a crimtia l d n g statut e occurrii g i n th e workplac e n o late r tha n fiv e calenda r day s afte r suc h conviction ; (e ) Notifyin g th e agenc y i n writii g withi i te n calenda r day s afte r rec e iin g notic e unde r paragrap h (d)(2 ) ffom a n errpb^'e e o r olherwis e receivki g actua l notic e o f convictio n Errpbyer s o f convicte d employee s mus t provid e notice , iicludii g postks i title, t o th e Offic e o f Aviatio n Anafysis

. Notic e shal l includ e th e orde r numbe r o f eac h afficte d subsidize d servre ; (f ) Takin g m e cfth e folbwir g actbrs , within3 0 d ^ ofreceivir^notic

e vmde r paragrap h (dX2) , wil h respec t t o ar y empbye e wh o i s s o ccxwicted-

- (1 ) Takin g ^jprqjriat e personne l actio n ^ins t suc h a n enpbyee , i p t o an d ii c Ldin g terminatio n consisten t wihth e requirement s ofth e Rehabifitatio n Ac t o f 1973 , a s amended , o r (2 ) Requirir g suc h enplcye e t o participat e satisfectori^ ' i n a dru g abus e assistanc e o r rehabiEtatia i progra m approve d for suc h prrrpose s b y a Federa l Stat e o r bca l healt h la w enforcement , o r othe r ^)propriat e agerKy ,(g

) Makir g a goo d fait h eflfoi t t o continu e t o maintai n a dng-fie e workpfac e throig h inplementatia n o f paragraph s (a) , (b) , (c) , (d) , (e ) an d (f). B

. Th e subsidize d essertfia l ai r servic e carrie r may, tu t E no t require d to , iiser t i i th e spac e provide d belo w th e sit e fer th e perGamanc e o f wor k den e i n ccgmectio n wit h th e specifi c grant
. Place s c f Performanc e (stree t address , city , county , state , zi p code)

. Fo r th e provBio n o f essentia l ai r senice , workplace s includ e outstatians , maiitenanc e sites , headquarter s oflSc e locations , trainin g site s an d an y othe r worksite s wher e wor k i s performe d tha t B supporte d b y th e subsitfy

.

Chec k [ ] i f ther e ar e workplace s o n file tha t ar e no t identifie d here

. Signature^ ( Dat eINSTRUCTION S FO R CERTIFICATIO

N 1

. B y signin g and/o r submkdr ^ tii s applicatk m o r gran t agreemen t ih e subsidize d essenta l ai r servic e carrie r i s providin g ih e certi&atio n 2

. Th e certfficatio n B a materm l representatio

i affec t ipo n whic h relianc e i s place d whe n th e agenc y award s ttie subsidy

. I f i t i s late r determine d lha t th e subsidize d carrie r knowitg ^ rendere d a filse certification , o r otherwis e violate d th e requirement s cfth e Drug-Fre e Wor]q)lac e Act , th e agency , i n additio n t o ar^ ' othe r remedie s availabl e t o th e Federa l Governmen t ma y tak e actr n authorize d unde r th e Drug-Fre e Worlq)lac e Ac t 3

. Workplace s unde r grants , for grantee s othe r tha n indiviluals , nee d no t b e identifie d e n th e certificati n Ifknown , the y ma y b e iderttfie d iith e subsif y applicatix L I f th e subsilize d carrie r doe s no t identif y th e wor]q)lace s a t th e tim e o f applicatico , o r vpon awar d i f ther e i s n o ^Scatjon , ftie carrie r rrus t kee p th e identit y ofth e workplace s o n file i n it s oflSc e an d mak e Ih e irformatio n availabl e for Federa l inspectio n Faiur e t o identif y a U know n workplace s constitute s a violatio n cfth e subsidize d carrier' s dng-ffe e workplac e requirements

. 4

. Workplac e identification s mus t ixlud e tt e actualaddres s ofbiildirg s (o r part s ofbuiMings ) o r othe r site s wher e wor k unde r th e gran t take s place

. Categorica l descrption s ma y b e use d (e.g. , a l counter s a t th e airport s serve d b y th e carrier)

. 5

. I f th e wor]q)bc e identifie d t o th e agenc y chaise s durin g th e performanc e ofth e subsidi2E d servre , th e subsidne d carrie r shal l itiformth e agency ^ o f flie change , i f i t previou s V identifie d Ih e workplac e i n questio n 6

. Definition s o f term s i n ttie Ncnprocuremen

t Si^pensia n an d Debarmen t commo n rul e (4 9 CF R Par t 29 ) an d Drug-Fre e Woriq)lac e commo n rul e (4 9 CF R Par t 29 , Subpar t F ) appt y t o thi s certificatio n Carriers ' attentio n i s called , i n particular , t o th e folowirg definitiai s ffan thes e rules : Controlled sutstance mean s a controlle d substanc e i i Sch e dule s I throtg h V o f tiie Controlle d Substance s Ac t (2 1 US C 812 ) an d a s fiirther define d b y regulatio n (2 1 CF R 1308.1 1 throijg h 1308.15) ; Conviction mean s a finding c f guil t (inclidin g a ple a o f nolo contendere) irrpositio

n o f sentence , o r bot h b y an y judicia l boct y charge d wit h Ih e responsibilit y t o determin e violation s cfth e Federa l o r Stat e crimina l dru g statutes ; Criminal drug statute mean s a Federa l o r non-Federa l crimina l statu e invol,TM:^th e manufecture , distribution , dispensii g i^e , o r possessio n o f ar y controlle d substance ; Employee rrean s flie enpbye e o f a subsidize d carrie r direct ^ et^age d i n th e performanc e o f wor k supporte d b y th e subsiiy , incliding :(i) A H direct charge enpkyees ; (i ^ A U indirect charge enrpbyee s unles s Ihei:irrpac t o r involvemen t i s insignifican t t o th e performanc e o f siabsidize d senTce ; an d (ii ^ Tercporai y personne l an d consultant s wh o ar e direct ^ eng^e d i n ttie performanc e o f wor k supporte d b y th e subsid y an d wh o ar e o n th e subsidize d carrier' s payro E Th K defrib n doe s no t includ e worker s no t o n ftie payrol l ofth e subsidi^ d carrie r (e.g., volunteers , eve n i f use d t o mee t a matchir g requirement ; consultanl s o r independen t contractor s no t o n th e subsidize d carrier' s p^oU ; o r errpbyee s c f subrecpient s o r subcontractoT

s i n covere d workplaces)

.