Exhibit 5 Airplane Pilot Qualification record.pdf
PDF 452 KB Posted
- Attached to
- National Light Fixed Wing - Multiple Award Task Order Contract (NLFW MATOC) Reopen Federal contract opportunity
- Solicitation number
- 1202SA25R9402
- Issued by
- Department of Agriculture Forest Service
About this file
This document is an Airplane Pilot Qualifications and Approval Record that captures detailed information about the pilot's background, licensure, experience, and qualifications. It includes fields for the pilot's name and contact information, employment history, medical certificate details, airman certificate information, and comprehensive flight hour data across various mission types and aircraft. The form also has sections for vendor pilot card information, indicating the specific special use missions the pilot is qualified to perform, as well as any previous agency approvals or denials. Overall, this document serves to comprehensively document a pilot's credentials and suitability to fly on federal contract missions.
The related federal contract opportunity is for the National Light Fixed Wing - Multiple Award Task Order Contract (NLFW MATOC) Reopen, issued by the U.S. Department of Agriculture Forest Service. The intent is to obtain call-when-needed fixed-wing aircraft operated by qualified personnel to support the administration and protection of public lands, including missions such as fire, project, resource, law enforcement, and point-to-point administrative flights. The contract will utilize a Task Order Request for Proposal (TORP) process to select Exclusive Use aircraft. The contract is open to interagency and cooperative agreements with federal, state, and private entities.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 1202SA25R9402 A00001.pdf | ||
| 1202SA25R9402 A00001.pdf | ||
| Exhibit 1 SOI.xlsx | XLSX spreadsheet | |
| Exhibit 4 Weight and Balance.xlsx | XLSX spreadsheet | |
| 1202SA25R9402 NLFW Reopener.pdf | ||
| Exhibit 7 Avionics.pdf | ||
| Exhibit 6 Rev 9.1 09242024 FINAL.xlsx | XLSX spreadsheet | |
| Exhibit 1 SOI.xlsx | XLSX spreadsheet |
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Text version
AIRPLANE PILOT QUALIFICATIONS AND APPROVAL RECORD
► S E C T I O N I – P I L O T I N F O R M A T I O N ( F i l l i n t h e b l a n k s ) ◄
1. Name (Last, First, Middle Initial) 2. Email Address 3. Telephone No.
4. Home Address (Street, City, State & Zip Code)
5. Employed by 6. Address 7. Telephone No. 8. Employed since
9. Previous Employer 10. Address 11. Telephone No. 12. Period Employed
13. Previous Employer 14. Address 15. Telephone No. 16. Period Employed
17. Medical Certificate
a. Class
b. Date
18. Airman Certificate (Check all that apply)
b. ATP e. Com h. Instrument
c. SEL f. MEL i. SES
d. MES g. CFI j. Type Ratings
19. A/C to be Flown
Flight Type Hours FAA FLIGHT CHECKS Date Make/Model A/C VFR IFR IFR W/AP
20. Total Pilot Time (Airplane) 35.
21. Pilot-in-Command (PIC) Airplane 36.
22. Total X-Country 37.
23. PIC Total Night 38.
24. PIC Instrument: Total Note: FAA Flight Checks Must Cover Type of Operations Required By Contract.
25. PIC Instrument: Actual
a. OAS
27. PIC Airplane: Mountainous Terrain
No Yes 42. Previous OAS or USFS Approval Denied, Suspended, or Revoked:
(If yes, Attach Date and Explanation)
28.
43. PIC "USFS Special Mission” Operations in the Last 24 Months:
33. PIC, Single Engine Airplane Land
Sea
34. PIC, Multi-Engine Airplane Land
Sea 45. Date
VENDOR PILOT CARD INFORMATION (Vendors select appropriate Special Use Mission(s)) A/C and IFR Quals Desired Ski Operations
Fire Detection
SEL IFR W/SIC
Remote Water Operations Infrared Mapping SES IFR, Single Pilot Backcountry Airstrip Aerial Photography MEL Single Engine IFR Unprepared Landing Site
Sketch Mapping
MES
Resource Reconnaissance Air Tactical
USFS Contract No(s):
Light Fixed-Wing Checklist. (Please provide copies of the following)
1. Pilot Certificate
2. Pilot Medical
3. Logbook (Last 12 months)
4. 8410(135.293, 135.297 if req’d & 135.299)
5. A-110 HazMat Training (if req'd)
6. Signed Safety Brief Statement
Additional Requested Documents:
Yes (If yes, Attach Date 41. Aircraft Accidents/FAA Violations Filed Within Last 5 Years: No and explanation)
Total PIC PIC last 12 Mo.
1. ___________ ________ _______
2. ___________ ________ _______
3. ___________ ________ _______
a. OAS
a. Number________________________
40. Date of Last Agency Flight Check39. Date of Previous Agency Card Approval
b. USFS b. USFS
I certify that the information listed on this form is true and correct.
44. Signature (Pilot)
Signature:(Chief Pilot)
Other IAA
26. PIC Airplane: Last 12 Months
29.
30.
31.
32.
Radio Telemetry
Float/Amphib
Law Enforcement Mountainous Terrain Point To Point
Mission 1, 2A & 2B
Mission 4A, 4B & 4C Mission 7
Mission 3A & 3B
Night
EXHIBIT 5 - AIRPLANE PILOT QUALIFICATIONS RECORD
SECTION D
EXHIBITS AND ATTACHMENTS
pdmcdonald Highlight mamorris Pencil mamorris Line
| 1 Name Last First Middle Initial: |
| 3 Telephone No: |
| 4 Home Address Street City State Zip Code: |
| 5 Employed by: |
| 6 Address: |
| 7 Telephone No: |
| 8 Employed since: |
| 9 Previous Employer: |
| 10 Address: |
| 11 Telephone No: |
| 12 Period Employed: |
| 13 Previous Employer: |
| 14 Address: |
| 15 Telephone No: |
| 16 Period Employed: |
| Hours21 PilotinCommand PIC Airplane: |
| Hours22 Total XCountry: |
| Hours23 Total Night: |
| Hours24 Instrument In Flight: |
| Hours25 Instrument Actual: |
| Hours26 Instrument Simulated: |
| Hours27 PIC Airplane Last 12 Months: |
| Hours28 PIC Airplane Last 60 Days: |
| Hours29 PIC Low Level Opns 500 AGL: |
| Hours30 PIC Mountainous Terrain: |
| 42 Previous OAS or USFS Approval Denied Suspended or No Yes Revoked If yes Attach Date and Explanation: |
| Hours31 PIC Aircraft over 12500 Gr Wt: |
| 43 PIC Air Tactical Operations Number of Missions in the Last 24 Months: |
| Hours32 PIC AirtankerDispensing Operations: |
| HoursLand: |
| HoursSea: |
| HoursLand_2: |
| HoursSea_2: |
| Date18_af_date: |
| Date19_af_date: |
| Date20_af_date: |
| Date21_af_date: |
| Text22: |
| Text23: |
| Text24: |
| Text25: |
| Check Box26: Off |
| Check Box29: Off |
| Check Box32: Off |
| Check Box34: Off |
| Check Box35: Off |
| Check Box37: Off |
| Date38_af_date: |
| Date39_af_date: |
| Check Box43: Off |
| Check Box44: Off |
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| Check Box46: Off |
| Check Box50: Off |
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| Check Box55: Off |
| Check Box56: Off |
| Check Box48: Off |
| Check Box52: Off |
| Check Box47: Off |
| Check Box59: Off |
| Check Box61: Off |
| Check Box62: Off |
| Check Box63: Off |
| Check Box64: Off |
| Text65: |
| Check Box66: Off |
| Check Box67: Off |
| Check Box68: Off |
| Check Box69: Off |
| Check Box71: Off |
| Check Box72: Off |
| Check Box73: Off |
| Text93: |
| Date94_af_date: |
| Date100_af_date: |
| Date10_af_date: |
| Date11_af_date: |
| Check Box28: Off |
| Check Box31: Off |
| Check Box27: Off |
| Check Box30: Off |
| Check Box33: Off |
| Check Box36: Off |
| Medical class: |
| Medical Date: |
| Certificate Number: |
| ATP: Off |
| SEL: Off |
| MES: Off |
| COM: Off |
| MEL: Off |
| CFI: Off |
| Instrument: Off |
| SES: Off |
| Type Ratings: |
| AC to be flown 1: |
| AC to be flown 2: |
| AC to be flown 3: |
| total PIC 1: |
| Total PIC 2: |
| Total PIC 3: |
| Total PIC in 12 2: |
| Total PIC in 12 3: |
| Total PIC in 12 1: |
| Total Time: |
| Text2: |
| Check Box70: Off |
| Check Box60: Off |
| Check Box57: Off |
| Check Box4: Off |
| Check Box1: Off |
| Check Box2: Off |
| Check Box3: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Text8: |
| Text9: |
File details come from the government source that posted it. Updated .