EXHIBIT E-3 Aircraft Questionnaire.docx
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- Alaska Fixed Wing On Call
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- 140D8120R0004
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EXHIBIT E-3
AIRCRAFT QUESTIONNAIRE
You may recreate this form, but it must include all the information listed
REPRODUCE AND SUBMIT FOR EACH AIRCRAFT OFFERED - COMPLETE SHADED BLOCKS
Contractor (Business) Name:
Minimum Requirements:
ITEM #2 DESCRIPTION: Type Aircraft: Tandem seat aircraft ITEM #3 DESCRIPTION: Type Aircraft: Single engine piston a Seating: Four (4) or greater ITEM #4 DESCRIPTION: Type Aircraft: Single engine turbine Seating: Four (4) or greater ITEM #5 DESCRIPTION: Type Aircraft: Multi engine piston Seating: Six (6) or greater ITEM #6 DESCRIPTION: Type Aircraft: Multi engine turbine Seating: Six (6) or greater ITEM #7 DESCRIPTION: Type Aircraft: Multi engine piston Seating: Ten (10) or greater ITEM #8 DESCRIPTION: Type Aircraft: Multi engine turbine Seating: Ten (10) or greater ITEM #9 DESCRIPTION: Type Aircraft: Multi engine jet Seating: Ten (10) or greater
| Aircraft Make and Model |
| FAA Registration # |
| Serial # |
| # of Insured Passenger Seats (excludes pilot seat) |
| Operations for Which Approved: |
| VFR ☐ |
| IFR ☐ |
| Single Pilot IFR in accordance with Part 135 (ME or SE Turbine): |
| Yes ☐ |
| No ☐ |
Special Aircraft Equipment:
| EQUIPMENT ITEM |
| YES/NO |
Cargo Doors
Long Range Fuel Tank
FM Programmable Radio (☐ Narrow ☐ Wide Band ☐ Digital)
GPS
Intercom
STOL
Amphibious Floats
Floats
Skis
Wheel Skis
Tundra Tires (Size: _________________/Type: ______________)
Camera Port
FLIR
Satellite Phone #
ISAT (Iridium Satellite Aircraft Tracking)
ELT/AFF (Type: _________________) NOAA Exp Date: ____________
Other:
Other:
NOTE: 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
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