### U N I Tt ; D S 'l " A ' fES OF AMERICA J lEPARTMENT OF TRA N SPORTA nON 

## OFFICE O F 

## T Im S " ~ CRET ARY OF n c • • ~ 01 ' " A V IATION A l ~ . - \L YSIS TITLE V i 

### ASS U RA l ~CE ( Implemen ting Title VI of tlleChilRigbt5 An

- o f 1964 , 1IS~ ) 

### A SS U RA N C E CO N CERN ING ~O l 'l 4 ])ISCRI~ UN ATIO N O N THE BASIS OJ <' n l S A BI L ITY I N FED E RA J .. - L Y-ASSISTED PROGIL\ , . \
- t S AN D AC T IVIT I ES RECR I V IN G OR BE N EFITI N G F RO M



### :n ·: nl <: RA L F lN A 1~ CIAL ASSIS T A N C E ( Imp le menti n g th e R ehabilitation Act of 1913 , as amended , 

### and the

A i rCarri e r Access Ad 

### of19S6) 49 C F R 

### Parts 2 1 and 21 and 14 CFR Parts 271, and 382 

# tp f ' ,1 · l 

## Jo · ) '

I - ' { l ' e . . 

## rn 

# r

. . . ~'
- . ( the R ec ipi e nt ) H E RE BY AGREES TH AT,


## ~-- (N
- ' a-m - e - di Recipient )
- - ---- I . As a c o nditi on 10 rec e i v in g an y F e deral finan ci al assist an c . . " C f rom the D c partmenr of Tr an s p o rtation . I t win c ompl y: wi tb T itl e VI of the Ci v il Righ ts A~ o f 1 96 4. as s l l1 ende rl .42 

### US ; c . 2000d- - 4 2 us e 2000d -4: all requ irements impos ed 

### b y o r p u rsuan t \ ( ) ; Titl e 49 , Code of F ederal Regulati ons , 

### Part 2 1. N ondisc rimin ation i n Feder ally- A s sisted



### . Pr o g r ams of th e Dep artment of Tmnsportati o n - Effec tuation o f 

### Title V I of the Ci\ · i l Rig h ts Act of 

### I t)(H ~

and o the r p e rtinent d i rec tiv e s s o that no person in th e Un i ted Slates 

### sh an . on th e gr o un ds of race , colo r , or 

### national o ri g in , b e ex c lud ed 

### f n : )nl panic i pati o n i n. be d e ni e d the be n efit s 

### o f, o r be 

### othe rwise subje cte d t o di scriminati on under an y 

### program o r ac thilY f o r which the Rec i p i enr rece i ve s f e der al f i n an c i al a ss i s tanc e f

ro m the Departmem of T r ansportati on . 

### T his as s uran ce i s re qu ired h y T itle 4 9. ewe 

### o f F e deral Regulati ons. s ecti o n 2L7 ( a ) and Ti tl e 1 4. C ode of Feder al R egu lati o n s , sectio n 2 7 1 . 9 ( c ). I I, As a co n di tion t o rece ivi ng any f e d e ral f i nanc i al assi stan c e fr om th e Dep artm e n t of' l' ran s p o rt ati oa, i t wi l l c o mp ly wi th ; s ection 504
- of th e R eh abi Htmi o n A ct o f 1 973, as am e n d ed ( 29 

### U . s.C 794 ) : the Air Carrier Acc e ss A ct of 1986 ( 4 9 U -<: L C . J 37 4 ( c });

. an d aU requ irem ears i mposed 

### b y or pur s u an t (0 Ti tle 49 , C ode o f federal Reg ul ation s , Part T l .l \o n disc riminati on on th e Ba si s 

### o f Handicap i n Programs and A c ti v i ties Rece i ving o r Bene fitting from F ede ral Fi na a c i al Assistance , 

### T il l e 14 , Code 

### of Federal Regulations. P art 3 S 2, N ond is cri mi n ati on o n th e Basis 

### of H an dicap i n Air Travel ; and 

### o ther p e rtin en t d i rectiv e ss o that n o oth e rwis e qual if i ed per s on w i th a d i sabi l i ty. b e excluded fr om p arti ci p atio n i n . b e d e nied 

### thebe n e fit s of. be di s crimin at ed a g ain st 

### b y re as on of s u c h h andi cap i n 

### th e p ro v i si o n o f ai r transp o rt ation , or o therwi se b e s ubje c t e d [ 0 d i s c rimi n ati o n un d e r ~U I ) p rogr am for w h ich th e Re c i p ien t re c e i v e s Fed e r al f inancial a ssis t an ce fro m th e D e p artm ent o f Tran sportati on. T his a s s u ran c e i s re qu ire d 

### b y Till e 49 . Co d e of Federal Re g ulatio ns. se c ti o n 27. 9 an d T itl e 1 4 . C ode of F e deral 

### Rc g u l auon s , s ections 27 1 . 9 ( c ) an d 3 82 . 9 . 

## m , 1 1 w i l l promptl y take an y rne aure s n ece s s ary to e ff ectu ate thi s agree m e n t . T h e Re c ip i e n t further a g rees that it shal l t ake re asonab l e a c tions t o g uar an t ee th at 

### it. its co ntr ac tor s and s ub c ontr a ctor s s ubj ec t t o the Dep artm ent of Tr an s po rt atio n re g u lati on s c i t e d ab o v e, tran sferees , and s uc c e ss ors in in te re s t wi ll c ompl y w ith all re quire me nt s imp o se d o r p u rs u ant t o the s tatutes an d D e partment of Transp ortati o n reg ulati on s c i t e d abov e , oth er p e rti n en t dire c ti v e s . an d th e abo v e assur ance s. IV . T h es e a s suran c e s obl i gate the Re c i p ient f o r [i ll : p e ri o d du rin g w h i c h Fe d er al financ i ala ss ist ance i s e xt e n de d . T h e Re ci p i ent ag re e s th at th e U n i t ed Stat e s ha s a rig h t [ 0 s ee k j u d i cial e nfo rce m e nt wi th regar d to an y matt e r arisi n g u nde r th e statu t e s an d D e p artm e n t of 

### Transp o rtation re g ulations cited ab ov e. 

### othe r pertine n t direc ti v e s , an d th e 

### ab o v e a ssurances . V . Th e s ea ss u r an c e s arc g iv e n f o r the p u rpose o f o bt ai ning f e d e ral s u b si dy under the E ss e nti al A ir Se rvi ce Prog r am and ar e bindin g O J} [he Recipient , co n tra c t or s . s ub co ntr ac t ors . tran sf

erees , succes s ors in int ere st. an d all othe r parti c ip ant s rece i vi n g Fe de r al s ub s idy i n th e E s senti al Air Serv i ce Pr o gr am , Th e p e r so n o r p e r s o n s w ho s e s ig natu re s ap pear below are auth o rized to sign th i s a gre e ment on behal f of th e R e c ipi e nt. V I . I n additi on [ 0 th e s e a ssuran ces. the R e c ipi e n t a g ree s ro f i l e : a s u mm ary of all complai nt s filed agai n s t i t w ith in th e pH S ! ye ar that allege v i o latio m s) b y the Re c ipie n t o f T itl e V I o f th e Ci v il Right'> Act of I %4 , a s ame nd e d , se c tio n 50 4 of the R e habi li t ation A ct o f 1 9 7 3. a s am e nd e d. or th e A ir C arri e r Acce s s A ct o f 19 8 6 ; o r a s t atem e nt [ hat th ere h ave b e e n n o co mp l ai n t s filed a g ain s t i t The s u mmary s hould in c lud e the d at e th e c omp l aint was tiled , the nature of th e co mplai nt. rhe status or outcom e o f the co mp l ai n t 

## < 1 . & : . whe ther 

### i t i s sti l l p e nd i n g o r h ow it wa s re s ol v ed ) .

B y :

### UNITED STATES O F A M ERIC A D EPAR TMENT O F T RA NSPORTAT I ON 

## OJ i ' ) !'ICE OF T H E SECRETA RY O l ,'fleE OF A

V l AT l ON AN AL YS I S · CERTIF I CATION RE(~A R DING D RUG-F REE WO RKP L A CE 

## REQUI REMENTS I N T HE 

### PERFORMANCE OF SU BSI DIZED ESSEl ' {IIAI . . 

### A IR SERVICE A

_ . The subsidized e s sen tial ai r service carri er certifies that it w ill. or will continue , to provi d e a drugfree workplac e b y; ( a ) Publ i shing a stat em e nt no ti f y ing empl o y ees that th e un l aw fu l m anufacture , d i stribu tion , d i spensing . poss e ssion o r us e o f a c ontrolled 

### subs t anc e i s 

### prohibited in 

### the carrier ' sworkplac e, an d 

### sp ec ifyi ng th e ac ti on s that wil l be tuk (:" agains t employees for 

### v i olati on of such pr o hibitio n : ( b ) E s tabl i shing an ongo i ng drug
- f ree awaren e ss program to info rm emp l oyees about- (1) T he dangers o f drug ab use in the wo rkplace; ( 2 ) The grantee ' s po l i cy o f m aintaining a drug-free wo rkplace ; (31 A ny av ai lable drugcounseltng . rehabili t ation . nnd e mployee . assistanceprogram s ; and (4) The penal ti es th at ma ) ' he imposed upon emplo yee s for 

### drug ab u se v iolations occu rri ng i n 

### the workpl ac e; 

### ( c ) Making i t a requireme n t 

### that eac h employ e e 

### t o be engaged 

### in U te 

### performance of 

### work supported 

### b y th e subsidy be gi v en a co p y 

### o f the state ment required by par a gr aph (a ); ( d ) l\ ' o ti fy ing the emplo y ee in th e statem e nt required by paragr aph ( a ) th at , as - a co n ditio n of e mploym e nt supported 

### b y thesubsidy , the emplo y ee wiU
-- 

### ( 1 ) Abide b y 

### the terms of Ihe s tatement ; and ( 2 ) 

### N o tif y the employer i n w riting 

### of hi s or 

### ber con v i c tion for a 

### v i olation of a 

### t . : rinti n al drug statute occurri ng in the workplace no later than 

### fi v e calendar day s after su ch conviction: 

### ( e l N o ti f

y ing 

### the agenc y 

### in w ri ting, w ithi n [e ll calendar days 

### after recei v ing notice onde r paragraph ( d )( 2 ) from an employee or oth e rwise re ce iv i ng actual notice of conv i cno n , Emplo y e rs of convi c ted emplo y ees . mu s t pro vi de 

### notice . inc l uding position title, t o th e 

### Office of A vi ation Anal y sis . Notic e 

### shalt i nclude the ord e r number o f each affected 

### s ubs i dized serv ic e ; ( t) Taking 

### one of th e Io ll owing acti on . ". within 30 day s 

### of receiv i ng noti c e under 

### parag r aph { d ) (2) , wi th respect to any employ ee who i s so con v ict e d
- ( I ) 

### Taking appropriate per s onnel action against such an emplo y ee, up to and inc l u d i n g 

### terminati on , cons i stent w ith 

### th e require ments o f the Rehabilitation Act o f 1 9 73 , . 3 s amended , or (2) Requiring such employee t o p arti cipate satisfactoril y in a drug abuse assistance or 

### rcll i i N lit. . 1tio n program appro ve d for s uch 

### purpo s es b y a Federal , 

### Slate or 

### local health , law en f

orceme nt, or o ther appropriate agenc y;( g ) M al c in g a good f aith effort to c o ntinue (0 m ain tain a drug - fre e w o rkplace through imp l e me n t ation of paragr aphs ( a) , (b ) . ( e ) . ( d ) . ( e ) and ( f ) . B. Th e sub s i d ized e s senti al air se rv i c e c arrier 

### may . but i s n o t requ ire d t o. i n se rt i n th e s p ac e p r o v id e d b elow the s it e for the perform an c e of wo rk d o ne in c o n nection w ith th e 

### spe c ific gr ant . 

### P l a ce s o f Perf

o rmance 

### ( s tree t address , c ity , COU ll I) ' • 

### s t at e. zip code ). F or th e pr o v i sio n o f es s en ti al 

### ai r se rv ice , w orkplaces include o u t st ation s . mai n t enance sites , he a dquart e r s of fi ce l ocation s. training si t es and an y o th er wo rksit e s w he re w ork i s p e rform e d that i s . s u pp o rt e d b y [ he s ubsidy .



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# - ~ - -

### UNITE)) STAI ES OF AM E RICA DRPARTMENT 

### OF TRANSPORTA T IO N OFF ICE OF THE SE C RE T ARY OFFlCE O F A VIATIO N . < \' ~ ALYSIS CERTIFICAT I O N REGARDI_ G I N FLUE NCI NG ACTIV I TIES

Certification 

### for Contracts, 

### Grants , L o ans , an d Cooperati ve Agreements The u nders i gned certifies . [ 0 th e bes t o f h i s or her kno w l ed ge and belie f, th at : ( I ) 

### No F e d e ral ap pr op ri at e d 

### f un d s h av e b ee n p aid or w ill b e p ai d . b ~ Or on b eh al f o f th e u ndersign ed , to any per so n f or i nfluen c ing or au e rnpting t o in f lue n c e an of

f i c er or e mpl oyee of 

### an y ag e nc y. a Member o f Congress . an 

### officer o r emplo yee of Con gres s , o r an emp l oy e e of a Member o f C o n g ress. i n co n ne c tion w ith th e awardin g o f any F e d er al co n tr ac t . {]l C maki ng of an y Federal g ran t. t h e 

### m aki ng o f an y Fe d eral l oan . the en t erin g i n t o o f an y c oopcrati c a g reement . and th e e x t e nsion . c on tinuatio n. rene wal. amen d m e n t . o r mo d ific ati on of an y Fe d e r al c ontr a ct . g r an t , l o an. o r coop e r ati v e a g reement , ( 2 ) If an y f

un ds o th e r th an federal app r opriated f unds 

### have b ee n p aid \ . 11 ' wi ll be paid t o an y per so n for influencin g 

### or atte mpti n g to i nf lu en c e an of

f ice r or empl oyee of any a g e n c y . a Member of Con g ress. an o fficer o r emplo y e e o f C o n g re s s. o r an e mp l o y e e o f a Member of Congress in conne c tion wi th this f eder al co n tract , grant , lo an. or co o pe rativ e ag reem e n t . the un d e r sig n ed shall co mpl e t e an d s ubmil Standard F orm- L LL , " D is clos u re form to Rep o rt 

### I nflu e nc ing Activi ties , " i n acc ord an ce 

### with its i n struc t io n s . ( 3 ) T h e under si gned sh all requ i re that th e langu age o f this certifi c ation b e in c l u d e d i n th e a w ard d o cum e n t s for all s ub award s at all tier s {in c l ud i n g s u bcon tra c ts , s u bgr an t s. 

### emu con trac t " u nder g r ant s . loans and c oo perativ e agreemen ts ) and th at al l s u b reci p ie n t s s h al l certif y 

### (met d i sclos e accordingl y. T his ce rtif

ic ation i s a materi al rep re sentatio n o f f act upo n w h i ch re l ianc e w a s placed w he n this tr ansacti o n was mad e or ent e re d int o . Submi ssi o n of this ce rtif i cation is a p re re qu isi t e f or makin g o r e n t ering into this transaction impo s e d 

### b y s ecti o n 1 3 5 2 . ti tle 3 1 . U ,S. Cod e . A n y per s on w ho fail s t o fi le the requ i red ce rtif i c ati on shall h e s ub

jec t LO a c i v il penal ty o f n ot le s s than S JO . OOO and nul mo re than $ I O OJXX ) f or e ach suc h f

ai l u re ,


### ~

S ignature Title 

# C VN
- 

# '

D F L" ess e n tial A ir Servic e P oi nns ) To Which 

### Certific ation Applies

## - - - - " - - -- -
_ ._- - - - - - - -- - -



## INSTRUCTIONS FOR CERTIFICATION l , By signing and/or submitting this application or grant agreement . the subsidized essential air servic e carri er i s providing the certiflcaiion. 2 . Th e c e rti fication is a material representation of fact 

### upon which reliance is 

### plac e d wh e n (he agency 

### aw ards the subsidy , 

### I f i t 

### i s later determined 

### that the subsidized carrier knowingly 

### rendered a fal se . 

### certification. or otherwise v iolated {he requirements of the Drug Free Workplace Act , th e 

### agenc y . in 

### additio n to an y o ther remedies available
- to 

### the f e deral Government • .

may takeaetlon authorized under t be 

### Drug-Free Workplace Act . 3. Wofkplac~ 

### under grants , 

### for grantees other 

### than individeals, ne e d 

### not be identified on the c e nitication. If known. the } ' may be i dentified in the subsidy application . 

### If the subsidized carrier docs not 

### idemi fy [he workplaces at 

### th e time of application , or upon award if rhere is no application , the . carrier 

### must keep t . h c identity of the 

### workplaces 

### on file 

### i n it s office 

### and make the 

### info . rmationavailab l e f or F ed eral I nspection. Failure 

### to identif) , all known workplaces constitutes
- a violation of the subsidized carrier's drug-free workplace requirements. 4. Workplace identifications must include tbc actual address of buildings (or parts of buildings) o r 

### othersites where work under the grant take!'; place. 

### Categorical descriptions may be used ( c.g .• 

### all counters at the airports served by 

### the carrier ) . 5. Ifthc workplace 

### identified to 

### th~ agenc y changes during the performance 

### of (he subsidized servic e , ti le s ubsidized 

### carrier shall i nform tile 

### agenc y of the Change. if it 

### previously i&:nti1i e d the workplace 

### i n 

### questio n . . 6. . Definitions of terms in the 

### Nonprocuremcnl Suspension and Debarment common rule (4 9 

### CFR Part 29 ) and 

### Drug-Free Workplace 

### common rule 

### (49 Cf
- R 

### Part 29. 

### Subpart F) apply to 

### this certification. 

### Carriers ' auennon is called. in particular. to the following 

### definitions from these rules: ControUed substance means a controll e d substance in Schedules 

### I through 

### V of the Controlled Substances Act (21 

## use 812) and 

### as further defined by regulati on (21 

## eFR 1308 . 1) through 1308 . 15 ) : 

### Conviction means a finding of guilE (including a plea of 

### nolo contenderes 

### or imposition of sentence , or both , 

### by any judicial body charged with the 

### responsibility to dete rmine 

### violations of the Federal or 

### Stal e. criminal drug statutes; 

### Criminal dr~g statute means a Federal or non federal 

### criminal statute in v 

### olving the manufacture. 

### distribution. dispensing. 

### use, or 

### possession of any controlled sub s tance: 

### Employee means the emplo y eeof 

### a subsidized carrierdirectly engaged in the performance 

### of work supporte d b y ~ 

### subsidy. including: 

# en AU direc t charge 

### employees ; (ii) 

### AU indirect charge 

### employees unless their 

### impact or invol v ement is insignificant to theperformance of subsidi7.ed serv i ce; and (i ii) Temporary . personnel and consul t ants who 

### are directly engag e d in 

### the performance 

### of work supported by 

### th e subsidy and who are on the subsidiz e d carrier ' s 

### payroll. This deflnaiondoes not inc l ud e workers 

### not on the pay ron of the subsidized carrier ( e.g •• 

### volunteers , even if used 

### to meet a march i ng requirement; 

### eonsuhanrs or independent 

### conuactcrs not on rhe subsidized carrier's payroll; 

### or cmptoy~es

ofsubrecipients or subcontracto r s in covered workplaces ) .