STATE OF OREGON DEPARTMENT OF FORESTRY
Helicopter Rental Rates
Helicopter Rental Rates 2020.docx/Jaz F (Prot) Page 1 February 2020
Operator Information
Company Name:
Address:
Day Phone #:
Taxpayer Identification #:
Night Phone #: Air Taxi Cert #:
Other Phone #: External Load Cert #:
Email Address:
HAZMAT Authorization: Yes No Applicators Cert #:
Aircraft information
1
2
3
4
5
Aircraft Rates - rates listed understood to include approved aircraft, pilot(s), fuel, oil, maintenance services and service crew.
flight hour minimum when at home base (offset by actual
Rate
Authorized Signature
Name Printed:
Title:
Signature:
*By signing I acknowledge I have read and agree with the terms of the State of Oregon,
Department of Forestry Form #04-05-003, Terms of Agreement for Hiring Aircraft
Note: Extended personnel standby is not authorized under this agreement.
Date Signed:
click to sign
signature
click to edit
STATE OF OREGON DEPARTMENT OF FORESTRY
Helicopter Rental Rates
Helicopter Rental Rates 2020.docx/Jaz F (Prot) Page 2 February 2020
Company Name:
Aircraft information
6
7
8
9
10
Aircraft Rates - rates listed understood to include approved aircraft, pilot(s), fuel, oil, maintenance services and service crew.
flight hour minimum when at home base (offset by actual
Aircraft information
11 12 13 14 15
Aircraft Rates - rates listed understood to include approved aircraft, pilot(s), fuel, oil, maintenance services and service crew.
flight hour minimum when at home base (offset by actual
STATE OF OREGON DEPARTMENT OF FORESTRY
Helicopter Summary
Helicopter Summary 2020.docx/Jaz F (Prot) Page 1 of 4 February 2020
Company Name:
Aircraft Details
1
2
3
Aircraft #1 Photo
Aircraft #2 Photo
1. FAA "N" Number/Tail Number
2. FAA Certificate (Part 135, 137, etc.)
3. Aircraft Color(s)
4. Empty Weight
5. Gross Weight
6. Total Gallons Fuel
7. Total Hours of Fuel
8. 100 hr. Inspection Date (or enter “Progressive”)
9. Engine horse power
10. Number of Passengers (excld. Pilot)
11. Gallons per bucket/tank with 1.5 hrs. fuel
12. (30 degrees Celsius at 4,000 feet pressure
altitude)
13. External load weight with 1.5 hrs. fuel on board
(30 degrees Celsius at 4,000 feet pressure
altitude)
14. Main Rotors painted in contrast color (YES/NO)
15. GPS (Y/N)
16. VHF FM Radio? (# of channels selectable)
Aircraft #3 Photo
17. # VHF FM Radios (per aircraft)
18. # VHF AM Radios (per aircraft)
19. Cargo hook? (Y/N)
20. Longline length(s) in feet?
21. Crash Kit with aircraft? (Y/N)
22.
23.
24.
25.
26.
27.
STATE OF OREGON DEPARTMENT OF FORESTRY
Helicopter Summary
Helicopter Summary 2020.docx/Jaz F (Prot) Page 2 of 4 February 2020
Company Name:
Aircraft Details
4
5
6
Aircraft #4 Photo
Aircraft #5 Photo
1. FAA "N" Number/Tail Number
2. FAA Certificate (Part 135, 137, etc.)
3. Aircraft Color(s)
4. Empty Weight
5. Gross Weight
6. Total Gallons Fuel
7. Total Hours of Fuel
8. 100 hr. Inspection Date (or enter “Progressive”)
9. Engine horse power
10. Number of Passengers (excld. Pilot)
11. Gallons per bucket/tank with 1.5 hrs. fuel
12. (30 degrees Celsius at 4,000 feet pressure
altitude)
13. External load weight with 1.5 hrs. fuel on board
(30 degrees Celsius at 4,000 feet pressure
altitude)
14. Main Rotors painted in contrast color (YES/NO)
15. GPS (Y/N)
16. VHF FM Radio? (# of channels selectable)
Aircraft #6 Photo
17. # VHF FM Radios (per aircraft)
18. # VHF AM Radios (per aircraft)
19. Cargo hook? (Y/N)
20. Longline length(s) in feet?
21. Crash Kit with aircraft? (Y/N)
22.
23.
24.
25.
26.
27.
STATE OF OREGON DEPARTMENT OF FORESTRY
Helicopter Summary
Helicopter Summary 2020.docx/Jaz F (Prot) Page 3 of 4 February 2020
Company Name:
Aircraft Details
7
8
9
Aircraft #7 Photo
Aircraft #8 Photo
1. FAA "N" Number/Tail Number
2. FAA Certificate (Part 135, 137, etc.)
3. Aircraft Color(s)
4. Empty Weight
5. Gross Weight
6. Total Gallons Fuel
7. Total Hours of Fuel
8. 100 hr. Inspection Date (or enter “Progressive”)
9. Engine horse power
10. Number of Passengers (excld. Pilot)
11. Gallons per bucket/tank with 1.5 hrs. fuel
12. (30 degrees Celsius at 4,000 feet pressure
altitude)
13. External load weight with 1.5 hrs. fuel on board
(30 degrees Celsius at 4,000 feet pressure
altitude)
14. Main Rotors painted in contrast color (YES/NO)
15. GPS (Y/N)
16. VHF FM Radio? (# of channels selectable)
Aircraft #9 Photo
17. # VHF FM Radios (per aircraft)
18. # VHF AM Radios (per aircraft)
19. Cargo hook? (Y/N)
20. Longline length(s) in feet?
21. Crash Kit with aircraft? (Y/N)
22.
23.
24.
25.
26.
27.
STATE OF OREGON DEPARTMENT OF FORESTRY
Helicopter Summary
Helicopter Summary 2020.docx/Jaz F (Prot) Page 4 of 4 February 2020
Company Name:
Aircraft Details
10
11
12
Aircraft #10 Photo
Aircraft #11 Photo
1. FAA "N" Number/Tail Number
2. FAA Certificate (Part 135, 137, etc.)
3. Aircraft Color(s)
4. Empty Weight
5. Gross Weight
6. Total Gallons Fuel
7. Total Hours of Fuel
8. 100 hr. Inspection Date (or enter “Progressive”)
9. Engine horse power
10. Number of Passengers (excld. Pilot)
11. Gallons per bucket/tank with 1.5 hrs. fuel
12. (30 degrees Celsius at 4,000 feet pressure
altitude)
13. External load weight with 1.5 hrs. fuel on board
(30 degrees Celsius at 4,000 feet pressure
altitude)
14. Main Rotors painted in contrast color (YES/NO)
15. GPS (Y/N)
16. VHF FM Radio? (# of channels selectable)
Aircraft #12 Photo
17. # VHF FM Radios (per aircraft)
18. # VHF AM Radios (per aircraft)
19. Cargo hook? (Y/N)
20. Longline length(s) in feet?
21. Crash Kit with aircraft? (Y/N)
22.
23.
24.
25.
26.
27.
STATE OF OREGON DEPARTMENT OF FORESTRY
Aircraft Pilot Summary
Aircraft Pilot Summary.docx/Jaz F (Prot) Page 1 of 3 February 2020
Company Name:
Pilot 1
Pilot 2
Pilot 3
Pilot 4
Pilot 6
Pilot 6
Pilot 7
General
Last Name
First Name
FAA Pilot Certificate (Commercial, ATP)
FAA Pilot Certificate Number
FAA Pilot Certificate Ratings
FAA Pilot Certificate Type Ratings
FAA Medical Certificate Class
FAA Medical Certificate (MM/DD/YY)
Oregon Pilot Registration (MM/DD/YY)
14 CFR 133 Check (MM/DD/YY, or blank)
14 CFR 135 Check (MM/DD/YY, or blank)
14 CFR 137 Check (MM/DD/YY, or blank)
USFS/OAS Approval (MM/DD/YY)
Total PIC All Aircraft (hrs)
Airplane Experience (PIC Only)
Airplane Single-Engine (hrs)
Airplane Multi-Engine (hrs)
Mountainous Terrain (hrs)
PIC Last 12 Months (hrs)
Fire Reconnaissance (hrs)
Air Tactical Group Supervisor (hrs)
Level 1,2 IA Approval
Helicopter Experience (PIC Only)
Total PIC Helicopter (hrs)
Type 1 Helicopter (hrs)
Type 2 Helicopter (hrs)
Type 3 Helicopter (hrs)
Type 4 Helicopter (hrs)
Last 12 Months (hrs)
Longline Bucket (hrs)
Longline Cargo (hrs)
Total Fire Experience (hrs)
Last Fire Flown (MM/DD/YY)
Delivery of Aerial fire fighters? Y/N
STATE OF OREGON DEPARTMENT OF FORESTRY
Aircraft Pilot Summary
Aircraft Pilot Summary.docx/Jaz F (Prot) Page 2 of 3 February 2020
Company Name:
Pilot 8 Pilot 9 Pilot 10 Pilot 11 Pilot 12 Pilot 13 Pilot 14
General
Last Name
First Name
FAA Pilot Certificate (Commercial, ATP)
FAA Pilot Certificate Number
FAA Pilot Certificate Ratings
FAA Pilot Certificate Type Ratings
FAA Medical Certificate Class
FAA Medical Certificate (MM/DD/YY)
Oregon Pilot Registration (MM/DD/YY)
14 CFR 133 Check (MM/DD/YY, or blank)
14 CFR 135 Check (MM/DD/YY, or blank)
14 CFR 137 Check (MM/DD/YY, or blank)
USFS/OAS Approval (MM/DD/YY)
Total PIC All Aircraft (hrs)
Airplane Experience (PIC Only)
Airplane Single-Engine (hrs)
Airplane Multi-Engine (hrs)
Mountainous Terrain (hrs)
PIC Last 12 Months (hrs)
Fire Reconnaissance (hrs)
Air Tactical Group Supervisor (hrs)
Level 1,2 IA Approval
Helicopter Experience (PIC Only)
Total PIC Helicopter (hrs)
Type 1 Helicopter (hrs)
Type 2 Helicopter (hrs)
Type 3 Helicopter (hrs)
Type 4 Helicopter (hrs)
Last 12 Months (hrs)
Longline Bucket (hrs)
Longline Cargo (hrs)
Total Fire Experience (hrs)
Last Fire Flown (MM/DD/YY)
Delivery of Aerial fire fighters? Y/N
STATE OF OREGON DEPARTMENT OF FORESTRY
Aircraft Pilot Summary
Aircraft Pilot Summary.docx/Jaz F (Prot) Page 3 of 3 February 2020
Company Name:
Pilot 15 Pilot 16 Pilot 17 Pilot 18 Pilot 19 Pilot 20 Pilot 21
General
Last Name
First Name
FAA Pilot Certificate (Commercial, ATP)
FAA Pilot Certificate Number
FAA Pilot Certificate Ratings
FAA Pilot Certificate Type Ratings
FAA Medical Certificate Class
FAA Medical Certificate (MM/DD/YY)
Oregon Pilot Registration (MM/DD/YY)
14 CFR 133 Check (MM/DD/YY, or blank)
14 CFR 135 Check (MM/DD/YY, or blank)
14 CFR 137 Check (MM/DD/YY, or blank)
USFS/OAS Approval (MM/DD/YY)
Total PIC All Aircraft (hrs)
Airplane Experience (PIC Only)
Airplane Single-Engine (hrs)
Airplane Multi-Engine (hrs)
Mountainous Terrain (hrs)
PIC Last 12 Months (hrs)
Fire Reconnaissance (hrs)
Air Tactical Group Supervisor (hrs)
Level 1,2 IA Approval
Helicopter Experience (PIC Only)
Total PIC Helicopter (hrs)
Type 1 Helicopter (hrs)
Type 2 Helicopter (hrs)
Type 3 Helicopter (hrs)
Type 4 Helicopter (hrs)
Last 12 Months (hrs)
Longline Bucket (hrs)
Longline Cargo (hrs)
Total Fire Experience (hrs)
Last Fire Flown (MM/DD/YY)
Delivery of Aerial fire fighters? Y/N