Metropolitan Washington Airports Authority Washington Dulles International Airport IAD Certified Stateme

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Metropolitan Washington Airports Authority Washington Dulles International Airport IAD Certified Stateme Powered By Docstoc
					                                Metropolitan Washington Airports Authority
                         Washington Dulles International Airport (IAD)
                                   Certified Statements - Signatory Air Carrier
This form can be completed using Excel or printed and completed by hand. Using Excel is preferred, as these
forms are designed to auto-fill certain blanks, based on the information entered below. Only blanks in yellow
should be completed when using Excel.            Send to CertifiedStmts@mwaa.com
Please enter Air Carrier's name below:                                           Original Submission
                                                                                 Amended


Please select the appropriate month and year:January                                          2011
(place an "X" in the appropriate box)        February                                         2010
                                             March                                            2009
                                             April                                           (for any other years, please
                                             May                                             request a revised form)
                                             June
                                             July
                                             August
                                             September
                                             October
                                             November
                                             December
Please indicate which of the following forms are included: Landed Weights
(Note that completing the sheets in the indicated order will save time) Int'l Arrivals
                                                                                 Jet Apron
                                                                                 Low Vol Common Use
                                                                                 Air Traffic Stats
                                                                                 Summary of Amounts Due

Please enter your name, title and contact information below:


Name                                                                             Phone


Title                                                     E-mail address
(Note: for certification purposes, please record your name on each applicable form)
This form must be completed and submitted by the 7th calendar day of the month immediately following the month in which
activity is being reported. Send completed forms via e-mail to CertifiedStmts@mwaa.com or by fax to 703-417-8984 (via e-mail
is preferred.) Questions about this form can be directed by e-mail to CertifiedStmts@mwaa.com or by phone to 703-417-8723
(for questions regarding rates and fees due) or to 703-417-8759 (for questions regarding statistical information).
                                     Metropolitan Washington Airports Authority
                               Washington Dulles International Airport (IAD)
           MONTHLY CERTIFIED STATEMENT OF AIRCRAFT LANDINGS - SIGNATORY AIRLINES

Pursuant to Section 8.02 of the Air Carrier Use/Lease Agreement effective January 1, 1990, a Signatory Airline
shall pay a Landing Fee for Chargeable Landings made during each month, based on the following information
which is to be supplied by the air carrier:


AIR CARRIER                                                           MONTH & YEAR OF ACTIVITY

       1                2                  3              4               5              6                    7
 Aircraft Mfr,   Max. Cert. Gross # of Scheduled # of Other Rev. # of Non-Rev. Total # Landings Total Weight Landed (lbs)
Series, Model    Landed Wt (lbs)     Landings       Landings       Landings       (3+ 4 + 5)             (2 x 6)




                            Totals


                                     GRAND TOTAL WEIGHT LANDED (lbs)


                                     Grand Total Weight Landed Divided by 1,000


                                        Multiplied by                                    = $
                                     Fee per 1,000 lbs (see "Rates" if blank)                         Total Fee Due

This is to certify that the above is a true and correct statement of activity at Washington Dulles International Airport

                                                 Certified by
Date
                                                              Title
       (Please note that the below payment and submission instructions will print on a separate page.)


This form must be completed and submitted by the 7th calendar day of the month immediately following the month in which
activity is being reported. Send completed forms via e-mail to CertifiedStmts@mwaa.com or by fax to 703-417-8984 (via e-mail
is preferred.) Questions about this form can be directed by e-mail to CertifiedStmts@mwaa.com or by phone to 703-417-8723
(for questions regarding rates and fees due) or to 703-417-8759 (for questions regarding statistical information).

Payment is due on the 10th calendar day of the month immediately following the month of activity. Electronic payments
are encouraged. Wiring instructions provided on request. Late charges will begin on the 21st calendar day of the month.

Send payments by check to:



                         Metropolitan Washington Airports Authority
                         P.O. Box 402816
                         Atlanta, GA 30353-2816
                                      Metropolitan Washington Airports Authority
                                   Washington Dulles International Airport (IAD)
      MONTHLY CERTIFIED STATEMENT OF IAB AND IAF PASSENGERS - SIGNATORY AIRLINES

Pursuant to Sections 8.07 and 8.09 of the Air Carrier Use/Lease Agreement effective January 1, 1990, a Signatory
Airline shall pay a fee per international Deplaning Passenger using the International Arrivals Building (IAB) or
International Arrivals Facilities (IAF) during each month, based on the following information which is to be supplied
by the air carrier:


AIR CARRIER                                                                             MONTH & YEAR OF ACTIVITY


Number of Deplaning Passengers
Cleared Through IAB Facilities
                           Multiplied by                                                  = $
                                 Fee per Passenger (see "Rates" if blank)                              IAB Fee Due

Number of Deplaning Passengers
Cleared Through IAF Facilities
                           Multiplied by                                                  = $
                                 Fee per Passenger (see "Rates" if blank)                              IAF Fee Due

                                                    Total IAB & IAF Fees Due $
                                                                                                        Total Fee Due

This is to certify that the above is a true and correct statement of activity at Washington Dulles International Airport.

                                 Certified by
Date
                                            Title

This form must be completed and submitted by the 7th calendar day of the month immediately following the month in which
activity is being reported. Send completed forms via e-mail to CertifiedStmts@mwaa.com or by fax to 703-417-8984 (via e-mail
is preferred.) Questions about this form can be directed by e-mail to CertifiedStmts@mwaa.com or by phone to 703-417-8723
(for questions regarding rates and fees due) or to 703-417-8759 (for questions regarding statistical information).

Payment is due on the 10th calendar day of the month immediately following the month of activity. Electronic payments
are encouraged. Wiring instructions provided on request. Late charges will begin on the 21st calendar day of the month.

Send payments by check to:
                                            Metropolitan Washington Airports Authority
                                            P.O. Box 402816
                                            Atlanta, GA 30353-2816
                                         Metropolitan Washington Airports Authority
                                    Washington Dulles International Airport (IAD)
                              MONTHLY CERTIFIED STATEMENT OF JET APRON USAGE

Pursuant to Section 8.04.4 of the Air Carrier Use/Lease Agreement effective January 1, 1992, an Airline shall pay a fee
based on the number of landed aircraft using jet apron hardstands during each month, based on the following
information which is to be supplied by the air carrier:




AIR CARRIER                                                                                    MONTH & YEAR OF ACTIVITY


Number of Landed Aircraft Using Jet Apron
Hardstands during the Month


                                    Multiplied by                                               =     $
                       Fee per Landed Aircraft (see "Rates" if blank)                                                  Total Fee Due

This is to certify that the above is a true and correct statement of activity at Washington Dulles International Airport.

                                               Certified by
Date
                                                          Title




This form must be completed and submitted by the 7th calendar day of the month immediately following the month in which
activity is being reported. Send completed forms via e-mail to CertifiedStmts@mwaa.com or by fax to 703-417-8984 (via e-mail
is preferred.) Questions about this form can be directed by e-mail to CertifiedStmts@mwaa.com or by phone to 703-417-8723
(for questions regarding rates and fees due) or to 703-417-8759 (for questions regarding statistical information).

Payment is due on the 10th calendar day of the month immediately following the month of activity. Electronic payments
are encouraged. Wiring instructions provided on request.

Late charges will begin on the 21st calendar day of the month. Send payments by check to:



                           Metropolitan Washington Airports Authority
                           P.O. Box 402816
                           Atlanta, GA 30353-2816
                                      Metropolitan Washington Airports Authority
                                 Washington Dulles International Airport (IAD)
                    MONTHLY CERTIFIED STATEMENT OF LOW VOLUME COMMON USE

Pursuant to Section 8.03.6 of the Air Carrier Use/Lease Agreement effective January 1, 1990, a Signatory Airline
that is a Low Volume Airline shall pay a monthly Low Volume Common Use charge in lieu of the payment of
Common Use charges for each Rate Period, based on the following information which is to be supplied by
the air carrier:



AIR CARRIER                                                                              MONTH & YEAR OF ACTIVITY


                 Enplaned Passengers


                 Deplaned Passengers


                 Total Passengers


                                  Multiplied by                                              =       $
                              Fee per Passenger (see "Rates" if blank)                                           Total Fee Due

This is to certify that the above is a true and correct statement of activity at Washington Dulles International Airport.

                                          Certified by
Date
                                                     Title


This form must be completed and submitted by the 7th calendar day of the month immediately following the month in which
activity is being reported. Send completed forms via e-mail to CertifiedStmts@mwaa.com or by fax to 703-417-8984 (via e-mail
is preferred.) Questions about this form can be directed by e-mail to CertifiedStmts@mwaa.com or by phone to 703-417-8723
(for questions regarding rates and fees due) or to 703-417-8759 (for questions regarding statistical information).

Payment is due on the 10th calendar day of the month immediately following the month of activity. Electronic payments
are encouraged. Wiring instructions provided on request. Late charges will begin on the 21st calendar day of the month.


Send payments by check to:
                                       Metropolitan Washington Airports Authority
                                       P.O. Box 402816
                                       Atlanta, GA 30353-2816
                                               Metropolitan Washington Airports Authority
                                        Washington Dulles International Airport (IAD)
                                      MONTHLY CERTIFIED STATEMENT OF AIR TRAFFIC

Pursuant to Section 8.12 of the Air Carrier Use/Lease Agreement effective January 1, 1990, a Signatory Airline shall report its
monthly air traffic activity as requested below:



AIR CARRIER                                                                      MONTH & YEAR OF ACTIVITY

                                          DOMESTIC                                                INTERNATIONAL

# OF FLIGHTS:        DEPARTURES           ARRIVALS              TOTAL             DEPARTURES         ARRIVALS             TOTAL
REVENUE
NON - REVENUE
TOTAL


# OF                                      DOMESTIC                                                INTERNATIONAL
PASSENGERS             ENPLANED           DEPLANED                                 ENPLANED         DEPLANED
(Rev & Non-Rev)        (Outbound)          (Inbound)            TOTAL              (Outbound)        (Inbound)            TOTAL
O&D
ON/OFF LINE
TRANSFERS
TOTAL


                                          DOMESTIC                                                INTERNATIONAL
WEIGHT OF              ENPLANED           DEPLANED                                 ENPLANED         DEPLANED
CARGO (LBS):           (Outbound)          (Inbound)            TOTAL              (Outbound)        (Inbound)            TOTAL
MAIL
FREIGHT &
EXPRESS
TOTAL

Summary of information from other certified statements, if applicable:
Total Revenue Landings                                                          IAB Passengers
Total Non-Revenue Landings                                                      IAF Passengers
Grand Total Landings                                                            Grand Total Deplaned Int'l Pax
                                                                                Jet Apron Landings
Landed Weights (LBS)                                                            Low Volume Pax Enplaned
                                                                                Low Volume Pax Deplaned


This is to certifiy that the above is a true and accurate statement of activity at Washington Dulles International Airport.


       Date:                                                        Signed:

                                                                       Title:
This form must be completed and submitted by the 7th calendar day of the month immediately following the month in which
activity is being reported. Send completed forms via e-mail to CertifiedStmts@mwaa.com or by fax to 703-417-8984 (via
e-mail is preferred.) Questions about this form can be directed by e-mail to CertifiedStmts@mwaa.com or by phone to 703-
417-8723 (for questions regarding rates and fees due) or to 703-417-8759 (for questions regarding statistical information).
                               Metropolitan Washington Airports Authority
                        Washington Dulles International Airport (IAD)
                                Summary of Amounts Due - Signatory Airlines

Payment is due on the 10th calendar day of the month immediately following the month of activity. Electronic payments
are encouraged. Wiring instructions provided on request. Late charges will begin on the 21st calendar day of the month.

Send payments by check to:
                                          Metropolitan Washington Airports Authority
                                                        P.O. Box 402816
                                                    Atlanta, GA 30353-2816




AIR CARRIER                                                                               MONTH & YEAR OF ACTIVITY

            Amounts Due (as applicable)
                                              Landed Weights
                                                     Int'l Arrivals
                                                        Jet Apron

                                     Low Vol Common Use


                                          Total Amount Due


              Billing Contact Information
To insure the proper application of your payment, please provide billing contact information below.



Name                                                                             Phone


Address (line 1)                                                                 Address (line 2)


City, State and Zip Code                                                         E-mail address

Questions about the amounts due can be directed by e-mail to CertifiedStmts@mwaa.com or by phone to 703-417-8723.
Inclusion of this form with your payment would help to insure proper application of your payment to your account.
                         Metropolitan Washington Airports Authority
                Washington Dulles International Airport (IAD)
                                  Signatory Airline Rates


Landing Fees (per 1,000 lbs)                       January - June     July - December
                   2009                               $2.67                 $2.67
                   2010                               $3.40                 $3.40
                   2011                               $3.35                  TBD

IAB Fees (per deplaning int'l passenger)           January - June     July - December
                   2009                               $4.15                 $4.15
                   2010                               $6.79                 $6.79
                   2011                               $7.22                  TBD

IAF Fees (per deplaning int'l passenger)           January - June     July - December
                   2009                               $4.53                 $4.53
                   2010                               $5.18                 $5.18
                   2011                               $5.49                  TBD

Jet Apron (per landed aircraft)                    January - June     July - December
                    2009                              $190.22             $190.22
                    2010                              $336.55             $336.55
                    2011                              $374.32                TBD

Low Volume (per passenger)                         January - June     July - December
                  2009                                 $1.18                $1.22
                  2010                                 $1.69                $1.69
                  2011                                 $1.53                 TBD

				
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