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• J P.O . 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 Fairbank s lnt i Airport 645 0 Airpor t Way Suit e 2 0 Fairbanks , Alask a 9970 9

907-474-001 8 FA X - 907-474-895 4 Proposa l t o Provid e Essentia l Ai rServic e

A t Chisana , Alask a Docke t GS T 1998-4S7 4 Februar y 17 , 201 2 Rout e TKJ-CZN-TKJ Frequency : 2 Roun d Trip s pe rWee k Aircraf t Type : Cessn a 185( 3 seats) , 20 6 o r207( 4 seats ) Annua l Bloc k

Hour s 1 190. 7 r.' 1 "'!-:(: ; ;x )

Revenue Passenge r Carg o Space Availabl e Carg o Mai l Tota l Operatin g Revenu e Direc t Ooeratini ! Expense s Pilo t & Copilo t Fue l & Oil Maintenanc e Depreciatio n Insuranc e Agen t fe e Tota l Direc t Operatin g Expense s Rat e 2 $97.6 7 $ ,4 2 $ .1 6 $ .89198 8 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 Anr»t/ibs .

9 5 2,00 0 26,00 0 8,00 0

$20.0 0 pe rCZN dept . Indirec t Operatin g Expense s @ 40 % o f Direc t Ne t o f Depreciatio n Tota l Operatin g Expense s Operatin g Los s Profi t Elemen t @5 % o f Tota l Operatin g Expense s Subsid y Nee d (S>100

% Revenu e $9,278.6 5 $ 840.0 0 $4,160.0 0 $ 7.135.9 0 $21,414.5 5 Expens e $18,307.2 0 $19,451.4 0 $17,735.1 0 $ 4,357.49 5 $9,010.5 8 $ 2.080.0 0 $70,941.7 8 $26,633.7 1 $97,575.4 9 $76,160.9 4 $4,878.7 7 $81,039.7 1 l_Bloc k hour s = (TK

J - CZ N -TKJ , 1.8 3 hours ) x2 flights/wee k x5 2 = 190. 7 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 , SKIkS , FLOATS , PACKAG E HUNTS . FLY-I N FISHING , FLIGHTSEEING , BUL KFUE L HAULIN GIMTU ) SI A I F S O FAMKUI C A DFPARTME N r

O FTRANSPORTAHO N OFF K RO FIM FSK ( R Ff.AR Y OFFIC E O FAVIATIO N ANALVSl. S flTL E V I AS M RANC E (Implementin u Fitl c V I o f th e Civi l Ri(>ht s .Ve

t o f 1%4 , a. s amended ) ASSURANC E CONCERNING ; NONDISCRIMINATIO N O N HI E BASI S O FDISABILIT Y I N FEDERALLY-ASSISTE D PROGRAM S AN D ACTIVITIE S RECEIVIN G O RBENEFITIN G FRO M

FEDERA L FINANCIA L ASSISTANC E (Implementin g th e Rehabilitatio n Ac t o f 1*>73 . u. s amended , an dth e \ i r Carrie r .Acces s Ac t

o f 1«)86 ) 4 9 CF RPart s 2 1 an d2 7 an d1 4 CF RPart s 271 . an d38 2

'^C-'^'^^- '' ^ /.^'

- " ' ( • ^^<

- ^ ' "^- ^ - l.-M^^^' ^ KccipiciU ) ilHRHB Y A(iRhF; S TliAi . (Nam e o f Recipient ) I . A s acoiuiiiio n t o receivin g any |-cdcni i linancial a.ssistanc c fro mth e rx^panmcn t

ofT'ransportation . i

t will comply : wit

h lill c V i olth c Civi l Right s .Ve

t oi ' 1904 . a s amended . 4 2 U.S.C . 2000d—4 2 IJ.S.C . 2()()()d-4 : all requirement s impose db y i) r pursuant to : Titl e 49 , Cod e o f

Federa l Regulations . Par

t 21 . Nondiscriminatio n i

n Federally-Assiste d Program s o f

th e Departmen t

ot' ! ransportation-hlTectualio n o f Fill e V I ot'th e Civi l Right s Ac t o f 1964 ; an dothe r

pertinen t directive s s o tha

t no perso n i

n th e Unite dSlate s shall , o n th e ground s o f

race , color , o r

nationa l origin , b e exclude diVo

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

, o r b e otherwis e subjecte dto discriminatio n under an y progra mo r activit y lo r whic h th e Recipien t

receive s Federal llnancial assistanc e trot n th e Departmen t

ot" Trattsportation . I'hi s a.ssurdnc e i s require dby I iti e 49 , Cod e ol " Federal Regulations , ^ectio n 21.7(a ) andTitl e 14 . Cod e o f Federa l Regiilalii)ns . sectio n 271.9(c) . II . A s aconditio n t o receivin g an y I eder;t l tinancia l ;isj>islanc

e ii'o mth e Departmen t

o f Transportation , i

t will comply with : sectio n ii H o f th e Rehabilitaticui Ac

t o\ ' 1973 . a s amende d(2 9 li.S.C . 794) : th e Ai r Carrie r Acces s Ac t

ot 198 6 (4 9 L.S.C . 1374(c)) ; an dal l requirement s im|.X)se db y o r pursuant to T itI e M . Cod e t) f

Federa l Regulations . Par

t 27 . Nondiscriminatio n o n th e Basi s o f Handica p i n Program s andActivitie s Receivin g u v Benefittin g fro

mFedera l Financial Assistance . Titl e 14 , Cod e o f

Federa l Regulations . Par

t 382 , Nondiscriminatio n o n th e Basi s o f

Handica p i n .Ai r 1 ravel ; andother

pertinent directive ss o tha t n o otherwis e qualilie dperso n w it h adisiibility , Ix ; exclude dfro mparticipatio n in . b e denie dth e benefit s of

. b e diseriminatet

i agains t b y reasiM i o f such handica

p i n th e pt\)visio n (.i f ai r tninsportation , o r

otherwis e b e subjecte dto discriminatio n under any progra

mfo r whic h th e Recipien t

receive s Federal linancia l a,ssisiaiic e fro mth e Departmen t

o f 'Transportation . Thi s assuranc e i s require db y Titl e 49 . Cotl e o f

Federa l Reguiatit)ns . sectio n 27. 9 an dTitle 14 . CcKi

e o f Federal Regulation.s . ^ection s 271.9(c ) an d382.9 . HI . I t wil l promptl y tak e an y meaure s necessar y to cflectuat e thi s agreement . Th e Recipien t furthe r agree s that

i t shal l take reasonabl e action s t o guarante e tha t it . it s contractor s ;in

dsubcontractor s subjec t

t o th e Departmen t

o f 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 Transp<,M-tatio

n regulation s cite dabove , othe r pertinen t directives , an dth e abov e assurances . IV . Thes e assurance s obligat e th e Recipien t to r th e perio ddurin g whic h Federal tinancial assistanc e i s extended . Th e Recipien t

agree s tha

t th e Unite dState s ha s arigh t t o see k judicia l enforcemen t

wit h regardt o any matte r

arisin g unde r

th e statute s an dDepartmen t o f Transpt)rtatio n regulation s cite dabove , othe r |->ertinen t directives , an dth e aU)v e assurances . V . Tlies c assurance s ar e give n fo r th e purpos e o f

obtainin g Federal subsidy under th e Essential Ai r

Servic e Progra

man dar e bindin g on th e Recipien t contractors , subcontractors , transferees , successor s i n interest , an dal l odie r

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

Servic e Program . I h e perso n o r person s whos e signature s appear belo w are authorize dt o sig n thi s agreemen t on 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 tile : asummar y ol'al l complaint s tile dagains t

i t withi n th e pa.s

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

y th e Recipien t

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 Act

o f 1973 , a s amended , o r

th e Ai r Carrie r Acces s .Ac

t of 19,S6 : o r astatemen t

tha t ther e hav e l)ecn n o coinpiainL s tile dagains t it . I h e sumtnar

v shoul dinclude th e dat e th e complain t wa s (tied , th e natur e o f

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

th e complain t

(Te^ . whether

i t i s stil l |x:ndin g o r

how i t wa s resolved) .

• . ,.••'• • \ Dal e Lega l Name o l Recipient Bv : Signatur e o l Authorize dOtiicia lIJNI I El ) STATE S O FAMERIC A DEPARTMEN T O FFRANSPOR FVFIO N OFFIC E O FTH E SECR E FAR V OFFIC E O FAVIAHO N ANALYSI S CERTIFICATIO N RE(;ARI)IN< ; INEL l KN ( LN GA C FIV I IIE S Certificatio n fo r

Contracts , (irants . Loans , an dCooperativ e .\{»rceaicnt s Th e undersigne dcertifies , to th e bes t o f hi s o r he r kno w ledg e an dbelie f

thai : (1 ) N o Federal appropriate dfund s hav e lx:e n pai dor will b e paid , b

y or o n behal f o f th e undersigned , t o an y perso n fo r inlliiencin g o r

attemptin g t

o inlluenc e a

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

o f Congress , a

n officer or employe e o f

Congress , o r

a n employe e o f aMcinbe r

o f Congres s i

n connectio n wit

h th e awardin g o f

any Federa

l contnic L th e makin g o f

any Federal gran t

th e tnakin g o f

an y Federa l loan , th e enterin g int

o o f an v cooperativ e agreemen t

andth e extension , continuation , renewal , amendmen t or modificatio n o f

any Federa

l contract , grant , loan , o r

coo(x:raiiv e agreement . (2 ) I f 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 any perso n fo r influencin g o r

attemptin g t

o inlluenc e a

n ofilcc r o r employe e o f

an y agency , a Membe r o f Congress , a

n officer o r employe e o f

Congress , o r

a n employe e o f

aMembe r

o f (^^ongres s i

n connectio n wil h thi s Federa l contrac t gran L loan , o r coitperaliv e agreement , th e undersigne dshal l complet e an dsubmi t StandardFonii- T 1,

1 . "Disclosure lon n to Repor t Influencin g Activities, " i

n accoixlanc e wil

h it s instructions . (3 ) Th e undersigne dshal l require tha t th e languag e o f

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

r al l subaward s a

t al l tier s (includin g subcontracts , -^ubgranls . and contract s unde r

grants , loan s an dccx^perative agreements ) an dtha t al l siibrecipient s shal l certif y an ddisclos e accordingK . Thi s certificatio n i s amaterial representatio n of"fact upon whic h relianc e wa s place dwhen ihi s Iransiictio n wa s mad e o r entere dinto . Submissio n o f thi s certillcatio n i s aprerequisit e fo r makin g o r

enterin g into thi s trtuisactio n impose db y sectio n 1352 . titl e 31 . I .'.S . Code . An y perso n wh o fail s to til e th e requirei l certillcatio n .shal l b e subjec t

t o acivi l penally otno t les s tha n SI0.00 0 an dtiot

more tha n .SI00.00 0 fo

r eac h such laikire .
Signatur e

•'^/••.

- Title

, • • i . {. ' '. • > ' i '

•'... / , ; ,,^---

-

. . . •'••- > .•' • - ,' '

•
/ ^ / I ):it e \ii ' ( . arrie r Fssential Ai

f Servic e Point(s ) T

o Which ( cnitkatio n Applie s

### I NF I El ) S F A FE S O FAMER

K A DEPARFVIENTO FIR.ANSPORI.VriO N OFFI C E O FFII

E SE C R E lAR V OFFI C E O FAVI

A riO N ANALYSI

S CERTiFic:Ari<) N RE(;ARDINC ; DR I C;-FRE E WORKPLA C E REQLIREMENI S 

### I N TH E PERFORMANC E O FSLIJSIDIZEl ) ESSENTIA L AI RSERVIC E .A . Th e subsidize dessential ai r

servic e carrier

certifie s tha

t i t w ill . or will continue , t o provid e adrug

free workplac e by :

(a ) Publishin g a statemen t notifvin g einplovee s tha i th e unlawfu l manufacture , distribution , dispensing , possessio n o rus e o f a controlle d substanc e i s prohibite d i n th e carrier' s workplace , an d specifyin g th e action s tha t wil l b e take n agains t employee s fo rviolatio n o f suc h prohibition ;

(b ) Establishin g a n ongoin g drug-fre e awarenes s progra m t o infor m emplovce s ;ibout - (1 ) Th e danger s o f dru g abus e i n th e workplace ; (2 ) Th e grantee' s polic yo f maintainin g a drug-fre e workplace ; (3 ) An y availabl e dm g counseling , rehabilitation , an d employe e assistanc e programs ; an d (4 ) Th e penaltie s tha t ma y Ix ; impose d upo n emplovce s fo rdru g abu.s e violation s *iccurrin g i n th e workplace ; (c ) Vlakin g i t a requiremen t tha t eac h empkne e t o b e engage d i n th e pertl)rm;inc e o i wor k supporte d b y th e subsid y b e give n a cv\i \ o f th e statemen t require d b vparagrap h (a) : (d ) Notifyin g th e emplove e i n th e statemen t require d b yparagrap h (a ) that , a s a conditio n o f employmen t supporte d b y th e subsidy , th e etnploye e will — (1 ) Abid e b y th e temi s o f ih e statement ; an d (2 ) Notif y th e employe ri n writin g o f hi s o rhe rconvictio n fo ra violatio n o f a crimina l dru g statut e occurrin g i n th e workplac e n o late rtha n fiv e calenda rd:iy s afte rsuc h ci.>nviction ; (e ) Notifyin g th e agenc y i n writing , withi n te n calenda rday s alte rreceivin g notic e unde r jxiragrap h (d)(2 ) tro m a n employe e o rotherwis e receivin g acttia i notic e o f conviction , fimployer s o f convicte d employee s mus t provid e notice , includin g posititi n title , t o th e Offic e o f Aviatio n Analysis . Notic e shal l includ e th e orde rnumbe ro f eac h affecte d subsidize d service ; (t ) I'akin g on e o f th e followin g actions , withi n 3 0 day s o f receivin g notic e unde rparagrap h (d)(2) , wit h respec t t o an y emplove e wh o i s --o convicted- - (1 ) fakin g appropriat e fX'rsonne l actio n agains t suc h a n emplovee . u p t o an d includin g termination , consisten t wit h tii e requirement s o l th e Rehabilitatio n Ac t o f 197!i . ;i s amended , o r (2 ) Requirin g suc h employe e t o participat e salisliiciorii vi n a dru g abus e assistanc e o r rehabilitatio n progra m approve d fo rsuc h purpose s b y a Federal . Slat e o rItKa l health , la w cntbrcemen t o rothe rappropriat e auencv ;

### (g ) Makin g agoodfait

h efTor t t o continue t

o maintai n adrug-fre

e workplac e throug

h implementatio

n o f paragraph s (a) , (b) , (c) , (d) , (e ) an d(f) . B . Th e subsidize dessentia

l ai r servic e carrie

r may . bu t i s no t requiredto , inser

t i n the space provide

d below the sit

e fo r the performance o f

wor k don e i n connection wit

h th e specific grant . Place s o f Performanc e (stree

t address , city , county , state , zi p code) . Fo

r the provision o f

essentia l air service , workplace s includ

e outstations , maintenanc e sites , headquarters office locations , training site s an dan y other worksite s wher

e wor k i s performe

dtha t i s supporte

db y the subsidy .

- A 

# y ^ V'O^i/ e / C y- i J^;^iLrt/^ s ^Z^- / />C:^^^//

- Chec k I j i f ther e ar e workplace s o

n fil e tha t ar e no t identifie dhere . ? ,^ y 

### Signatur e ' ' Dat e

### INSTRUCTION S FO RCERTIFICATIO N

1 . B y signin g and/o r

submittin g thi s applicatio n o r grant agreemen t

th e .subsidizedessential air servic e carrie r i s providin g th e certification . 2 . Th e certificatio n i s amateria l repre.sentatio n o f fact upo n whic h relianc e i s place dwhe n th e agenc y award s di 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 Federa l Government , ma

y tak e actio n authorize dunde r th e Drug-Fre e Workplac e Act . 3 . Workplace s unde r

grants , fo

r grantee s othe r

tha n individuals , nee dno t

b e identifie don th e certification . I f

known , the y ma

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

doe s no t identif y th e workplace s a

t 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 di e workplace s on file i

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

part s o f buildlng.s ) 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(^.;?. , al

l 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 performanc 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 . Carriers ' 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 furthe r define dby regulatio n (2 1 CF R1308.1 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 bod

y charge dwit

h th e resp<?nsibilit

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

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

any 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 charg e employees : (ii ) Al l indirec t charg e employee s unles s thei r

impac t o r involvement

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 supptirte db

y th e subsidy an dwh o ar e o n th e subsidize dcarrier' s payroll . Thi s definitio n doc 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 etnployee s o f

subrecipient s o r

subcontractor s in covere dworkplaces) .