Exhibit_E-3_-_Aircraft_Questionaire_0002.pdf

SECTION E – OFFEROR’S REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS

DOI Fixed Wing On-Call Solicitation # 140D0425R0090

Alaska

EXHIBIT E-3

AIRCRAFT QUESTIONAIRE

You may recreate this form, but it must include all the information listed

This questionnaire accurately completed will be used to determine the proposed aircraft payload capability.

REPRODUCE AND SUBMIT FOR EACH AIRCRAFT OFFERED - COMPLETE SHADED BLOCKS

Contractor (Business) Name:

Minimum Requirements:

Item # Aircraft Seating

2 Tandem seat N/A

3 Single engine piston Four (4) seats or greater

4 Single engine turbine Four (4) seats or greater

5 Multi-engine piston Four (4) seats or greater

6 Multi-engine turbine Six (6) seats or greater

7 Multi-engine piston Ten (10) seats or greater

8 Multi-engine turbine Ten (10) seats or greater

9 Multi-engine jet Ten (10) seats or greater

Aircraft Make and Model: FAA Registration Serial # # Insured Passenger Seats (excludes pilot seat)

Operation for Which Approved VFR IFR

Single Pilot IFR in accordance with Part 135 (ME or SE Turbine) Yes No

Special Aircraft Equipment

Cargo Doors Yes No

Long Range Fuel Tank Yes No

FM Programmable Radio – Narrow Wide Band Digital Yes No

GPS Yes No

Intercom Yes No

STOL Yes No

Amphibious Floats Yes No

Floats Yes No

Skis Yes No

Wheel Skis Yes No

Tundra Tires – Size: Type: Yes No

Camera Port Yes No

FLIR Yes No

Satellite Phone #: Yes No

Iridium Satellite Aircraft Tracking (ISAT) Yes No

ELT/AFF – Type: NOAA Exp Date: Yes No

Other: Yes No

Other: Yes No

By signing below, I acknowledge that I have included the applicable equipment and certify to the best of my knowledge that the above information is accurate.

Name and Signature of Representative Completing this Form Date

OFFEROR’S NAME