• 4M 

P,0, BOX 539 

MILE 1313 ALASKA HIGHWAY 

TOK, ALASKA 99780 

907-883-5191 

FAX-907-883-5194 

-•'^^^r' ' 

f'airbanks Int'l Airport 

6450 Airport Way Suite 20 

Fairbanks, A!asl<a 99709 

907-474-0018 

FAX - 907-474-8954 

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Proposal to Provide Essential Air Service 

At Healy Lake, Alaska 

Docket OST 1998-3546 

February 17, 2012 

Route FAI-HKB-FAI 

Frequency: 2 Round Trips per Week 

-r-.'-^:z^ 

V 

Aircraft Type: Cessna 206 or 207(5 seats) 

Annual Block Hours 1 208 

Revenue 

Passenger 

Cargo 

Mail 

Total Operating Revenue 

Direct Ooeratine Expenses 

Pilot & Copilot 

Fuel & Oil 

Maintenance 

Depreciation 

Insurance 

Agent fee 

Total Direct Operating Expenses 

Rate 2 

$ 65.12 

$ ,47 

$ ,958382 

Unit cost 

$96.00 per BH 

$102.00 per BH 

$93.00 per BH 

$22.85 per BH 

$47.25 per BH 

Amt/lbs. 

50 

5,000 

1,200 

$20.00 per HKBdept 

Indirect Operating Expenses @ 40% of Direct Net of Depreciation 

Total ODeratina Expenses 

Operating Loss 

Profit Element ^5 % of Total Operating Expenses 

Subsidy Need #100% 

f r 

Revenue 

$ 3,256.00 

$ 2,350.00 

S 1.162.06 

$6,768.06 

Expense 

$19,968.00 

$21,216.00 

$19,344.00 

$ 4,752.80 

$ 9,828.00 

$ 2,080,00 

$77,188.80 

$28,974.40 

$106,163.20 

$99,395.14 

$ 5,308.16 

$104,703.30 

IBIoc k hours ^ {FAI - HKB, 1 hour) x 4 flights/week x 52 = 208 hours 

2_Passenger and Cargo Rates before Excise Tax 

AIR SCHEDULED, AIR CHARTER IN ALASKA & CANADA. WHEELS, SKNS, FLOATS, 

PACKAGE HUNTS. FLY-IN FLSHSNG, FLIGHTSEEING. BULK FUEL HAULING 
/ 

UMTKl) STA IKS OF AMERICA 

DRPARTMKNT OF fRANSPOR TA TION 

OFFICR OF TMF SK( RE TARY 

OFFIC E OF AVIAHON ANALYSIS 

H I LE VI .VSSl RANCE 

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

ASSURANCE CONCERNINti NONDISCRIMINATION ON HI E 

BASIS OF DISABILITY IN FEDERALLY-ASSISTED PROGRAMS 

AND ACTIVITIES RECEIVINC; OR BENEFITING FROM 

FEDERAL FINANCIAL ASSISTANCE 

(Implementing the Rehabilitation .Act of 1973, a.s amended, and the 

Air Carrier .\ecess .Act of 1986) 

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

/C'-'^^^''^- -V /^ . - ( ,^^^ - ^ ^- t .. laHh c Recipient) lIHRhBY ACIRKKS IITA I. 

(Name of Recipient) 

I. A.S a condition to receiving any I'ederal linancial a.ssistarice from ihe 

rX'partment of Transportation, it will comply: with ritie VT of the Civil Rights Act of 1964, 

as amended, 42 U.S.C. 20(K)d~42 IJ.S.C. 20()<)d-4; all requirements imposed by or pursuant 

to: Title 49. Code of Federal Regulations, Part 21. Nondiscrimination in Federdlly-Assisted 

Programs ot'the Department ot Transportation—htTecluation of Title VI of the Civil Rights 

Act of 1964; and other pertinent directives so that no person in the United Stales 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 linancial a.ssistance from the Department ol' 

fransptirtation. This a.ssurance is required by Title 49. Code of Federal Regulations, section 

21.7(a) and Title 14. Code of Federal Regulations, seclitm 271.9(c). 

II. ,\s a conditi()n to receiving anv federal linancial a.ssislance irt)ni the 

Department of IVansportation. it will comply with: section 504 of the Rehabilitati(ui Act of 

1973. as amended (29 IJ.S.C. 794): the Air Carrier Access Act ot 1986 (49 li.S.C. 137-Mc)): 

and all requirements im(X)scd by or pursuant to 1 itie 19. (.'(xle of federal Regulations. Part 

27. Nondiscrimination on the Basis ()f Handicap in Programs and Activities Receiving or 

Benefitting from Federal financial A.ssistance. litle 14. Code of federal Regulations, Part 

,'^82, Nondiscrimination on the Basis of I landicap in Air I ravel: and other pertinent directives 
so that no otherwise qualilled f)crson with a di.siibility. be excluded I'rom participation in. be 

denied the benefits of. be discriminated against by reason of such handicap in the provision 

of air tnin.sportation. or otherwise be subiected to discrimination under any program for 

which the Recipient receives Federal linancial a.ssi,slancc from the Depamnent of 

Transportation, fhis assurance is required by I itic 4^). Code of federal Regulations, section 

27.9 and Title T4. Code of Federal Regulations, sections 271,9(c) and 382.9. 

IH. It will promptly take any mcaures necessary- to clTectuale this agreement. I he 

Recipient further agrees that it shall take reasonable actions to guarantee that it. its 

contractors and subcontractors subject to the Department ot~ Transportation regulations cited 

above, transferees, and successors in interest will comply with all requirements imposed or 

pursuant to the statutes and Department ot lransp<iriation regulations cited above, other 

pertinent directives, and the above assurances, 

IV. I hese assurances obligate the Recipient lor the period during which federal 

linancial assistance is extended. The Recipient agrees that the United States has a right to 

seek judicial enlbrcement with regard to any matter arising under the statutes and Department 

of Transportation regulations cited above, other pertinent directives, and the afove 

assurances. 

V. These a,ssurdnces are given for the purpose oTobtaining federal subsldv 

under the Fsseniial Air Service Program ;ind are l)ifiding on the Recipient, contractors, 

subcontractors, transferees, succes.sors in interest, and all other participants receiving Federal 

subsidy in the Essential Air Service Program. I he perst)n or persons whose signatures 

appear below are authorized to sign this agreement on behalf of the Recipient. 

VI. in addition to these assurances, the Recipient agrees to file: a summitry of all 

complaints filed against it within the pa.st yeiir 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 ,\ct of 1986; or a statement that there have been 

no complaints tiled again.st it. The summary should include the date the complaint was tiled, 

the nature of the complaint, the status or outcome of the complaint (fe.. uliether it is still 

pending or how it was resolved). 

•^ale Legal Name oi'Recipient 

IK: 

Simiature of ,Authorized Official 
I NITFJ) STATES OF AMERICA 

DEPARTMENT OF IRANSPOR[ATION 

OFFICE OF THE SECRETARY 

OFFICE OF AVIA HON ANALYSIS 

CERTIFICATION RE<;ARI)1N( ; INFLl EN(IN( ; A ( riVIHES 

Certification for Contracts, (Jrants, Loans, 

and Cooperative .A«»reenients 

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

(1) No F^ederal appropriated funds have Ix-en paid or will Ix; paid, by or on behalf ot'the 

undersigned, to any person tor intliiencing or attempting to inlluence an olllcer or employee 

of any agency, a Member of Congress, an olllcer 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 lo;m. the entering into of any 

cooperative agreement, and the extension, continuation, renewal, amendment, or 

modification of any Federal contract, grant, loan, or coo|x;raiive agreement. 

(2) If any funds other than Federal appropriated funds have been paid or will be paid to anv 

person for influencing or attempting to inlluence an olllcer or employee of any agencv, a 

Member of Congress, an officer or emplovee of Congress, or an emplovee of a .Vlember of 

Congress in connection with this Federal cotUracL granL loan, or cooperative agreemenc the 

undersigned .shall complete and submit Standard Forin-l.l.F. "Disclosure fOrm to Report 

Influencing Activities," in accordance with its instructions. 

(3) fhc undersigned shall require that the huiguage of this certification be included in the 

award documents for all subawards at all tiers (including subcontracts, subgrants, and 

contracts under grants, loans and ccx^perative 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 transiiction was made or entered into. Submission of this certification is a prerequisite 

for making or entering into this tran.saction imposed by section 1352. title 31. l.LS. (ode. 

Any person who fails to file the required certification shall be subject lo a civil penalty ot'not 

less than SI0.000 and tiot more than .SIOO.OOO for each such lailure. 

Siynature ,'' Dale 

• - f ) 

Title \;r Carrier 

Essential Aif Service l'oint(s) lo Which ( crtificalion Applies 
UNITED S r VIES OF AMERK A 

DEPARIMENF OF IRANSPOR IVriON 

OFFICE OF THE SE( RE lARV 

OFFK E OF AVIAITON ANALYSIS 

CERTIFICATION RE(;ARDIN( ; DRIJ(;-FREE \V()RKPLA( E REQLIREMEMS 

IN THE PERFORMANCE OF SLBSIDIZED ESSENTIAL AIR SERVICE 

.A. The subsidized essential air service carrier certifies that it will, or will continue to provide a drugfree workplace by: 

(a) Publfshing a statement notifying employees that the unlawful maniilacturc. distribution, 

dispensing, pos.session or u.se of a controlled substance is prohibited in the carrier's wi^rkplace. and 

specifying the actions that will h)C taken against employees for violation of such prohibition: 

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

(1) The dangers of drug abu.se in the workplace; 

(2) The grantee's policy of maintaining u drug-iVee workplace; 

(3) ,\ny available drug counseling, rehabilitation. ;uid employee assistance programs; and 

(4) The penalties that may be impt)sed upon employees for driig abuse violations 

(.x;curring in the workplace; 

(c) Making it a requirement that each employee to be engaged in the pertbnn;ince of work 

supported by the subsidy be given a copy of the statement reqifired by paragraph (a); 

(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of 

employment supported by the subsidy, the employee will— 

(1) Abide by the lenns of the statement; and 

(2) Notify the emplover in writina of his or her conviction for a violation of a criminal 

drug statute occurring in the workplace no later than Cwx calendar tiay s alter such 

conviction; 

(e) Notifying the agency in writing, within ten calendar days atier receiving notice under 

paragraph (d)(2) from an employee or otherwise receiving actual notice of conviction. 

Ijnployers i>f convicted employees must provide notice, including position litle. to the 

Office of Aviation Analysis. Notice shall include the (»rdcr number of each affected 

subsidized sei"vice: 

(0 Taking one of the fi>IIowing actions, within .)() days ol'ieceiving notice under paragraph 

(d)(2). with respect to any employee who is so convicicti--

(1) faking appropriate fxjrsonnel action against such an employee, up to and including 

tennination. consistent with the requirements olThc Rehabilitation .Act vi' 1973. ;i.s 

amended, or 

(2) Requiring >uch employee lo participate satisfactorily in a drug abuse assistance or 

rehabilit;tlion program approved for such purposes by a federal. State or local 

health, law cntbrcemcnL or other appn^priate agency: 
(g) Making a good faith elTort to continue to maintain a dnig-free workplace through 

implementation of paragraphs (a), (b), (c), (d), (e) and (f). 

B. The subsidized essential air service carrier 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 Perfonnance (street addres.s, city, county, state, zip code). For the provision of essential air 

service, woricplaces include outstations, maintenance sites, headquarters office locations, training sites 

and any other worksites where work is performed that is supported by the subsidy. 

ToyC /M ^'9^'.^O I T 

Check [ I if there are workplaces on file that arc not identified here. 

^ . -

Signature '' Date 

">r^K:990/:X. 
INSTRUCTIONS FOR CERTIHCATION 

1. By signing and/or submitting this application or grant agreement the subsidized essential air service 

carrier is providing the certification. 

2. ITie certification is a material representation of fact upon which reliance is placed when the agency 

awards the subsidy. If it is later determined that the subsidized carrier knowingly rendered a false 

certification, or otherwise violated the requirements of the Drug-Free Workplace Act, the agency, in 

addition to any other remedies available to the Federal Government, may take action authorized under 

the Drug-Free Workplace Act. 

3. Workplaces under grants, tor grantees other than individuals, need not be identified on the 

certification. If known, they may be identified in the subsidy application. If the subsidized carrier does 

not identify the workplaces at the time of application, or upon award if there is no application, the 

carrier must keep the identity of the workplaces on file in its office and make the information available 

for Federal inspection. Failure to identify all known workplaces con.stitutes a violation of the 

subsidized carrier's drug-free workplace requirements. 

4. Workplace identifications mu.st include the actual address of buildings (or parts of buildings) or 

other sites where work under the grant takes place. Categorical descriptions may be used {e.g.,<i\\ 

counters at the airports served by the carrier). 

5. If the workplace identified to the agency changes during the perlbrmance of the subsidized service, 

the subsidized carrier shall Inform the agency of the change, if it previously identified the workplace in 

question. 

6. Definitions of terms in the Nonprocurement Suspension and Debarment common rule (49 CFR Part 

29) and Drug-Free Workplace common rule (49 CFR Part 29, Subpart F) apply to this certification. 

Ciuriers' attention is called, in particular, to the following definitions from these rules: 

Controlled substance means a controlled substance in Schedules I through V of the Controlled 

Substances Act (21 USC 812) and as ftirther defined by regulation (21 CFR 1308.11 through 1308.15); 

Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or 

both, by any judicial body charged with the responsibility to determine violations of the Federal or 

State criminal drug statutes; 

Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, 

distribution, dispensing, use, or possession of any controlled substance; 

Employee means the employee of a subsidized carrier directly engaged in the performance of work 

supported by the subsidy, including: (i) All direct char^^e employees; (ii) All indirect charge 

employees unless their impact or involvement is insignificant to the performance of subsidized service; 

and (iii) Temporary personnel and consultants who are directly engaged in the performance of work 

supported by the subsidy and who are on the subsidized carrier's payroll, fhis definition does not 

include workers not on the payroll of the subsidized carrier {e.g., volunteers, even if u.sed to meet a 

matching requirement; consultants or independent contractors not on the subsidized carrier's payroll; or 

employees of subrecipients or subcontractors in covered workplaces).