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)

⁭ X Not a Consortium ⁭ Interstate Consortium ⁭ Intrastate Consortium

⁭ Community now receives EAS subsidy

⁭ X Community (or Consortium member) previously received a Small Community Grant

If previous recipient : Date of Grant: 09/20/02 E xpiration date of grant: 02/28/05

Date of Grant: 01/31/08 Expiration date of grant: 06/10/10



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

Public Private

1. ___________________________________ 1.______________________________________

2.____________________________________ 2.______________________________________

3.____________________________________ 3.______________________________________

4.____________________________________ 4._______________________________

_______ 5.____________________________________ 5.______________________________________



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

⁭ Marketing ⁭ Upgrade Aircraft ⁭ X New Route

⁭ Travel Bank ⁭ Service Restoration ⁭ Subsidy

⁭ Surface Trans portation ⁭ Regional Service Revenue Guarantee ⁭

X Launch New Carrier Start Up Cost Offset First Service

Study ⁭ Secure Additional Carrier Other (explain below)

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_________________________________________________________________________________ ________________APPENDIX C

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⁭



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

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

⁭ X 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 finan cial contribution $0

Local cash financial contribution

3a Airport cash funds $15,000

3b Non

- airport cash funds $0

3 Total local cash funds ( 3a +3b ) $15,000

4 TOTAL CASH FUNDING ( 1+2+3 ) $515,000

In

- Kind contribution

5a Airport In

- Kind c ontribution** $40,000

5b Other In

- Kind contribution** $0

5 TOTAL IN

- KIND CONTRIBUTION

( 5a + 5b ) $40,000

6 TOTAL PROJECT COST (4+8) $555,000



### F. IN

- KIND CONTRIBUTIONS**

For funds in lines 5a (Airport In

- Kind contribution) and 5 b (Other In

- Kind contri bution), please describe the

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

Airport billboard sign for 12 months; Waiver of landing fees for 3 months; Waiver of lease fees for 3 monthsAPPENDIX C

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

⁭ a

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

(date)

___________________.

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

⁭ X c. Program is not covered by E.O. 12372.



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

⁭ X No ⁭ Yes (explain)

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