• 4 M P,0 , BO X 53 9 MIL E 131 3 ALASK A HIGHWAY TOK , ALASK A 9978 0 907-883-519 1 FAX-907-883-519 4 -•'^^^r' '
f'airbank s Int' l Airpor t 645 0 Airpor t Way Suit e 2 0 Fairbanks , A!asl< a 9970 9

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

# 4

,v ^

' m m 'A ' Proposa l t o Provid e Essentia l Ai rServic e A t Heal y Lake , Alask a Docket OS T 1998-354 6 Februar y 17 , 201 2 Rout e FAI-HKB-FA I Frequency : 2 Roun d Trip s pe rWee k -r-.'-^:z ^ 

## V Aircraf t Type : Cessn a 20 6 o r207( 5 seats ) Annua l Bloc k

Hour s 1 20 8 Revenu e Passenge r Carg o Mai l Tota l Operatin g Revenu e Direc t Ooeratin e Expense s Pilo t & Copilo t Fue l & Oi l Maintenanc e Depreciatio n Insuranc e Agen t fe e Tota l Direc t Operatin g Expense s Rat e 2 $ 65.1 2 $ ,4 7 $ ,95838 2 Uni t cos t $96.0 0 pe rB H $102.0 0 pe rB H $93.0 0 pe rB H $22.8 5 pe rB H $47.2 5 pe rB H Amt/lbs .

5 0 5,00 0 1,20 0

$20.0 0 pe rHKBdep t Indirec t Operatin g Expense s @ 40 % o f Direc t Ne t o f Depreciatio n Tota l ODeratin a Expense s Operatin g Los s Profi t Elemen t ^5 % o f Tota l Operatin g Expense s Subsid y Nee d #100 % f r Revenu e $ 3,256.0 0 $ 2,350.0 0 S 1.162.0 6 $6,768.0 6 Expens e $19,968.0 0 $21,216.0 0 $19,344.0 0 $ 4,752.8 0 $ 9,828.0 0 $ 2,080,0 0 $77,188.8 0 $28,974.4 0 $106,163.2 0 $99,395.1 4 $ 5,308.1 6 $104,703.3 0 IBIoc k hour s ^

{FA I - HKB , 1 hour ) x 4 flights/wee k x 5 2 = 20 8 hour s 2_Passenge ran d Carg o Rate s befor e Excis e Ta x

AI R SCHEDULED , AI R CHARTE R I N ALASKA & CANADA . WHEELS , SKNS , FLOATS , PACKAG E HUNTS . FLY-I N FLSHSNG , FLIGHTSEEING . BUL KFUE L HAULIN G/ UMTKl ) ST A IK S O FAMERIC A DRPARTMKN T O FfRANSPO RT A TIO N OFFIC RO FTM FSK ( R E TAR Y OFFI C E O FAVIAHO N ANALYSI S H I L E V I .VSS l RANC E (Implementin g Titl e V I o f th e Civi l Right s Ac t

o f 1964 , a s amended ) ASSURANC E CONCERNINt i NONDISCRIMINATIO N O N HI E BASI S O F DISABILIT Y I N FEDERALLY-ASSISTE D PROGRAM S AN D ACTIVITIE S RECEIVINC ; O RBENEFITIN G FRO M

FEDERA L FINANCIA L ASSISTANC E (Implementin g th e Rehabilitatio n .Ac t o f 1973 , a. s amended , an dth e Ai r Carrie r .\eces s .Act

o f 1986 ) 4 9 CF RPart s 2 1 an d2 7 an d1 4 CF RPart s 271 , an d38 2

/C'-'^^^''^

- - V /^ . - ( ,^^^

- ^ ^- t . . laHh c Recipient ) lIHRhB Y ACIRKK S IIT A I . (Nam e o f Recipient ) I . A. S aconditio n t o receivin g any I'ederal linancial a.ssistaric e fro mih e rX'partment

o f Transportation , i

t wil l comply : wit

h riti e V T o f th e Civi l Right s Ac t

o f 1964 , a s amended , 4 2 U.S.C . 20(K)d~4 2 IJ.S.C . 20()<)d-4 ; al l requirement s impose db y or pursuan t to : Titl e 49 . Cod e o f

Federa l Regulations , Par

t 21 . Nondiscriminatio n i

n Federdlly-Assiste d Program s ot'th e Departmen t o t Transportation—htTecluatio n o f Titl e V I o f th e Civi l Right s Ac t o f 1964 ; an dothe r

pertinen t directive s s o tha

t n o perso n i

n th e Unite dStale s shall , on th e ground s o f

race , color , o r

nationa l origin , b e exclude dfro

mparticipatio n in . b e denie dth e benefit s of

, o r b e otherwis e subjecte dto discriminatio n under any progra

mor activit y fo r whic h th e Recipien t

receive s Federal linancia l a.ssistanc e fro mth e Departmen t

ol ' fransptirtation . Thi s a.ssuranc e i s require dby Titl e 49 . Cod e o f

Federal Regulations , sectio n 21.7(a ) an dTitl e 14 . Cod e o f Federa l Regulations , seclit

m271.9(c) . II . ,\ s aconditi() n t o receivin g an v federa l linancial a.ssislanc e irt)n i th e Departmen t

o f IVansportation . i

t will comply with : sectio n 50 4 o f th e Rehabilitati(u i Ac

t o f 1973 . a s amende d(2 9 IJ.S.C . 794) : th e Ai r Carrie r Acces s Ac t

o t 198 6 (4 9 li.S.C . 137-Mc)) : an dall requirement s im(X)sc db y o r pursuant t o 1 iti e 19 . (.'(xle o f

federa l Regulations . Par

t 27 . Nondiscriminatio n o n th e Basi s ()f Handica p i n Program s an dActivitie s Receivin g o r Benefittin g fro

mFedera l financia l A.ssistance . litl e 14 . Cod e o f federa l Regulations , Par t ,'^82 , Nondiscriminatio n o n th e Basi s o f

I landica p i n Ai r I ravel : andothe r

pertinen t directive ss o tha t n o otherwis e qualille df)crso n wit h adi.siibility . b e exclude dI'ro mparticipatio n in . b e denie dth e benefit s of

. b e discriminate dagains t b y reaso n o f

such handica

p i n th e provisio n o f ai r tnin.sportation . o r

otherwis e b e subiecte dto discriminatio n under any progra

mfo r whic h th e Recipien t

receive s Federal linancia l a.ssi,slanc c fro mth e Depamnen t

o f Transportation , fhi s assuranc e i s require db y I iti c 4^) . Cod e o f

federa l Regulations , sectio n 27. 9 an dTitle T4 . Cod e o f Federa l Regulations , section s 271,9(c ) and382.9 . IH . I t wil l promptl y tak e an y mcaure s necessary - to clTectual e thi s agreement . I h e Recipien t furthe r agree s tha

t i t shal l take reasonabl e action s t o guarante e tha t it . it s contractor s an dsubcontractor s subjec t t o th e Departmen t

ot ~ Transportatio n regulation s cite d above , transferees , an dsuccessor s i n interes t wil l compl y wit

h al l requirement s impose do r pursuan t t o th e statute s an dDepartmen t o t lransp<iriatio n regulation s cite dabove , othe r pertinen t directives , an dth e abov e assurances , IV . I hes e assurance s obligat e th e Recipien t lo r th e perio ddurin g whic h federa l linancia l assistanc e i s extended . Th e Recipien t agree s tha

t th e Unite dState s ha s arigh t to see k judicia l enlbrcemen t

wit h regardt o any matte r

arisin g unde r

th e statute s an dDepartmen t o f Transportatio n regulation s cite dabove , othe r pertinen t directives , an dth e afov e assurances . V . Thes e a,ssurdnce s ar e give n fo r th e purpos e oTobtainin g federa l subsldv unde r th e Fsseniia l Air

Servic e Progra

m;in dar e l)ifidin

g on th e Recipient , contractors , subcontractors , transferees , succes.sor s i n interest , an dal l othe r

participant s receivin g Federal subsid y i n th e Essentia l Ai r

Servic e Program . I he perst) n o r person s whos e signature s appear belo w ar e authorize dto sig n thi s agreemen t o n behal f o f th e Recipient . VI . i n additio n t o thes e assurances , th e Recipien t agree s t o file : asummitr y o f al l complaint s filedagains t

i t withi n th e pa.s

t yeii r tha t alleg e violation(s ) b

y th e Recipient

o f Titl e V I o f th e Civi l Right s Ac t

o f 1964 . a s amended , .sectio n 504 o f th e Rehabilitatio n Ac

t o f 1973 , a s amended , o r

th e Ai r Carrie r Acces s ,\c t

of 1986 ; or astatemen t

tha t ther e hav e bee n n o complaint s tile dagain.s t it . Th e summar y shoul dinclude th e dat e th e complain t wa s tiled , th e natur e o f

th e complaint , th e statu s or outcom e o f

th e complain t

(fe. . uliethe r

i t i s stil l pendin g o r

ho w i t wa s resolved) .

•^al e Lega l Name oi'Recipien t IK : Simiatur

e o f ,AuthorizedOfficia

lI NITFJ ) STATE S O F AMERIC A DEPARTMEN T O FIRANSPOR[ATIO N OFFIC E O FTH E SECRETAR Y OFFIC E O FAVI A HO N ANALYSI S CERTIFICATIO N RE<;ARI)1N( ; INFL l EN(IN( ; A ( riVIHE S

Certificatio n fo r

Contracts , (Jrants , Loans , an dCooperativ e .A«»reenient s Ih e undersigne dcertifies , to th e bes t o f hi s o r he r knowledg e an dbelie f

that : (1 ) N o F^edera

l appropriate dfund s hav e Ix-e n pai dor will Ix ; paid , b

y o r o n behal f ot'th e undersigned , to any perso n to r intliiencin g o r

attemptin g t

o inlluenc e a

n olllce r o r employe e o f an y agency , aMember

o f Congress , a

n olllce r or employe e o f

Congress , o r

a n employe e o f aMembe r

o f Congres s i

n connectio n wit

h th e awardin g o f

any Federal contract , th e makin g o f

any Federa

l gran t th e makin g o f

an y Federa l lo;m . th e enterin g int

o o f an y cooperativ e agreement , an dth e extension , continuation , renewal , amendment , o r modificatio n o f

any Federa

l contract , grant , loan , or

coo|x;raiiv e agreement . (2 ) If any fund s othe r

tha n Federa l appropriate dfund s hav e been pai do r wil l b e pai dt o an

v perso n fo r influencin g o r

attemptin g to inlluenc e a n olllce r o r employe e o f

any agencv , a Membe r o f Congress , a

n officer o r emplove e o f

Congress , o r

a n emplove e o f

a.Vlembe

r o f Congres s i

n connectio n wit

h thi s Federa

l cotUrac L gran L loan , or cooperativ e agreemen c th e undersigne d.shal

l complet e an dsubmi t

StandardForin-l.l.F . "Disclosure fOr mt o Repor t Influencin g Activities, " i

n accordanc e wit

h it s instructions . (3 ) fh c undersigne dshal l requir e tha t th e huiguag e o f

thi s certificatio n b e include di n th e awar ddocuments fo

r al l subaward s a

t al l tier s (includin g subcontracts , subgrants , an d contract s under

grants , loan s an dccx^perative agreements ) an dtha t al l subrecipient s shal l certify ' an ddisclos e accordingly . Thi s certificatio n i s amaterial representatio n o f fac t upo n whic h relianc e wa s place dwhe n thi s transiictio n wa s mad e o r entere dinto . Submissio n o f thi s certificatio n i s aprerequisit e fo r makin g o r

enterin g into thi s tran.saction impose db y sectio n 1352 . titl e 31 . l.LS . (ode . An y perso n wh o fail s t o file th e require dcertificatio n shall b e subjec t l o acivi l penalt

y ot'no t les s tha n SI0.00 0 an dtiot

more tha n .SIOO.OO O fo r eac h such lailure .
Siynatur e ,' ' Dal e

• - f ) Title \; r Carrie r Essential Ai

f Servic e l'oint(s ) l o Which ( crtificalio n Applie sUNITE D S r VIE S O FAMER K

A DEPARIMEN FO FIRANSPO RIVriO N OFFIC E O FTH E SE ( R E lAR V OFF K E O FAVIAITO N ANALYSI S CERTIFICATIO N RE(;ARDIN( ; DRIJ(;-FRE E \V()RKPLA ( E REQLIREMEM S I N TH E PERFORMANC E O F SLBSIDIZE D ESSENTIA L AI RSERVIC E .A . Th e subsidize dessentia l ai r

servic e carrier

certifie s tha

t i t will , or wil l continu e to provid e adrug

free workplac e by : (a ) Publfshin g astatemen t notifyin g employee s tha

t th e unlawful maniilacturc . distribution , dispensing , pos.sessio n o r u.s e o f acontrolle dsubstanc e i s prohibite di n th e carrier' s wi^rkplace . an d specifyin g th e action s tha

t will h) C taken agains t

employee s fo

r violatio n o f

such prohibition : (b ) Fstablishin g a

n ongoin g drug-fre e awarenes s programt o infor memployee s about

- (1 ) Th e danger s o f

dru g abu.s e i

n th e workplace ; (2 ) Th e grantee' s polic y o f

maintainin g u drug-iVee workplace ; (3 ) ,\n y availabl e dru g counseling , rehabilitation . ;uidemploye e assistanc e programs ; an d (4 ) Th e penaltie s tha

t ma y b e impt)se dupo n employee s fo r drii g abus e violation s (.x;currin g i n th e workplace ; (c ) Makin g i

t arequiremen t

tha t eac h employe e t

o b e engage di

n th e pertbnn;inc e o f

wor k supporte db

y th e subsidy b e give n acop y o f th e statemen t

reqifire db

y paragrap h (a) ; (d ) Notifyin g th e employe e i n th e statemen t

require db

y paragrap h (a ) that , a s aconditio n o f employmen t

supporte db

y th e subsidy , th e employe e will — (1 ) Abid e by th e lenn s o f th e statement ; an d (2 ) Notif y th e emplove r

i n writin ao f

hi s o r he r convictio n fo

r aviolatio n o f

acriminal dru g statut e occurrin g i

n th e workplac e n o late

r tha n Cw x calendar

tia y s alte r suc h conviction ; (e) Notifyin g th e agenc y i n writing , withi n ten calenda r day s atie r

receivin g notic e under paragrap h (d)(2 ) fro

ma n employe e o r

otherwis e receivin g actual notic e o f conviction . Ijnployer s i>

f convicte demployee s mus t provid e notice , includin g positio n litle . t o th e Offic e o f Aviatio n Analysis . Notic e shal l includ e th e (»rdc r numbe r o f eac h affecte d subsidize dsei"vice : ( 0 Takin g on e o f th e fi>IIowin

g actions , withi n .)(

) day s ol'ieceivin g notic e under paragrap h (d)(2) . wit

h respec t t o an y employe e wh o i s s o convicicti-

- (1 ) fakin g appropriat e fxjrsonne l actio n agains t

such a n employee , u

p to andincludin g tennination . consistent

wit h th e requirement s olTh c Rehabilitatio n .Ac t vi ' 1973 . ;i. s amended , or (2 ) Requirin g >uc

h employe e l o participate satisfactoril y i n adru g abus e assistanc e or rehabilit;tlio n progra

mapprove dfo

r suc h purpose s b

y afederal . State or

loca l health , la w cntbrcemcn L o

r other appn^priate agency :(g ) Makin g agoo dfait h elTor t t o continu e t o maintai n adnig-fre e workplac e throug h implementatio n o f

paragraph s (a) , (b) , (c) , (d) , (e ) an d(f) . B . The subsidize dessentia l ai r servic e carrie r

may . but i s no t require dto , inser

t in th e spac e provide d belo w th e sit e fo

r th e performanc e o f

wor k don e i n connectio n wit

h th e specifi c grant . Place s o f Perfonnanc e (stree t

addres.s , city , county , state , zi p code) . Fo r th e provisio n o f

essentia l ai r service , woricplace s includ e outstations , maintenanc e sites , headquarter s offic e locations , trainin g site s an dan y othe r

worksite s wher e work

i s performe dtha

t i s supporte dby th e subsidy . 

# Toy C / M ^'9^'.^ O I T

Chec k [ I i f ther e ar e workplace s o n file that ar c no t identifie dhere .

^ . - Signatur e ' ' Dat e 

# ">r^K:990/:X .

### INSTRUCTION S FO RCERTIHCATIO N

1 . B y signin g and/o r

submittin g thi s applicatio n o r gran t agreemen t

th e subsidize dessential ai r servic e carrie r i s providin g th e certification . 2 . ITi e certificatio n i s amateria l representatio n o f fac t upo n whic h relianc e i s place dwhe n th e agenc y award s th e subsidy . I f

i t i s later determine dthat

th e subsidize dcarrie r

knowingl y rendere dafals e certification , o r

otherwis e violate dth e requirement s o f th e Drug-Fre e Workplac e Act , th e agency , i n additio n t o any othe r

remedie s availabl e t o th e Federal Government , ma y take actio n authorize dunde r th e Drug-Fre e Workplac e Act . 3 . Workplace s unde r

grants , to r

grantee s othe r

tha n individuals , nee dno t b e identifie do n th e certification . If

known , the y ma

y b e identifie din th e subsid y application . If th e subsidize dcarrie r

doe s no t identif y th e workplace s at

th e tim e o f

application , o r

upo n awar di f

ther e i s n o application , th e carrie r mus t kee p th e identit

y o f th e workplace s o n file i

n it s offic e an dmake th e informatio n availabl e fo r Federal inspection . Failure t o identif y all know n workplace s con.stitute s aviolatio n o f th e subsidize dcarrier' s drug-fre e workplac e requirements . 4 . Workplac e identification s mu.s t includ e th e actual addres s o f building s (o r

part s o f buildings ) o r othe r site s wher e work

unde r th e gran t take s place . Categorica l description s ma y b e use d{e.g.,<i\

\ counter s a t

th e airport s serve db y th e carrier) . 5 . I f th e workplac e identifie dt o th e agenc y change s durin g th e perlbrmanc e o f th e subsidize dservice , th e subsidize dcarrie r

shal l Infor

mth e agenc y o f

th e change , i f

i t previousl y identifie dth e workplac e i n question . 6 . Definition s o f

term s i n th e Nonprocuremen t

Suspensio n an dDebarmen t commo n rul e (4 9 CF RPar t 29 ) an dDrug-Fre e Workplac e commo n rul e (4 9 CF RPar t 29 , Subpar

t F ) appl y t o thi s certification . Ciuriers ' attentio n i s called , i n particular , t o th e followin g definition s fro mthes e rules : Controlle dsubstanc e mean s acontrolle dsubstanc e i n Schedule s I throug h V o f th e Controlle d Substance s Ac t

(2 1 US C 812 ) an da s ftirther define db y regulatio n (2 1 CFR1308.1 1 throug h 1308.15) ; Convictio n mean s afinding o f guil t (includin g aple ao f

nol o contendere ) o r

impositio n o f

sentence , o r both , b y any judicia l body charge dwit h th e responsibilit

y t o determin e violation s o f th e Federa

l o r Stat e crimina l dru g statutes ; Crimina l dru g statut e mean s aFederal o r non-Federa l criminal statut e involvin g th e manufacture , distribution , dispensing , use , o r possessio n o f

an y controlle dsubstance ; Employe e mean s th e employe e o f asubsidize dcarrie r

directl y engage di

n th e performanc e o f

wor k supporte db

y th e subsidy , including : (i ) Al l direc t char^^ e employees ; (ii ) All indirec t charg e employee s unles s thei r

impac t o r involvemen t

i s insignificant

t o th e performanc e o f

subsidize dservice ; an d(iii ) Temporary personne l an dconsultant s wh o ar e directl y engage di n th e performanc e o f

wor k supporte dby th e subsidy an dwh o ar e o n th e subsidize dcarrier' s payroll , fhi s definitio n doe s no t includ e worker s no t

o n th e payrol l o f

th e subsidize dcarrie r

{e.g. , volunteers , eve n i f u.se dt o mee t a matchin g requirement ; consultant s o r independen t

contractor s no t

on th e subsidize dcarrier' s payroll ; o r employee s o f

subrecipient s o r

subcontractor s i

n covere dworkplaces) .