State of Hawaii Department of Transportation AIRPORTS DIVISION BILL FOR COLLECTION Self-Invoice Airport Fees and Charges Airline: Mailing Address: Date Due: For Period Ending: Note: 12% INTEREST PER ANNUM ON ALL ACCOUNTS 30 DAYS OR MORE OVERDUE. SECTION 3 HOLDROOM, BAGGAGE AND lAB CHARGES Enplaned Passengers Deplaned Passengers Joint Use Holdroom Charges Ilnt'l Arrivals Building Charges e Intemational Joint Use Bag Total Total Arrivals System Rate Joint Use Preferential Enplaned Deplaned Passengers Passengers Rate ($/epax) Amount Due ($/dpax) (2) Amount Due Airport [A) [B) [A)+[B) [C) [D) [E)=[C)-[D) [F) [G)=[A) x [F] [H) [1)=[0) x [H] Honolulu Overseas Interisland Kahului Overseas Interisland I Kona Overseas Interisland Lihue Overseas Interisland Hilo Overseas e Interisland Total Primary Airports Overseas Interisland (Continued on Next Page) State of Hawaii Department of Transportation AIRPORTS DIVISION ILL FOR COLLECTION When Interisland Airlines (including ice Airport Fees and Charges Airline: Mailing Address: Hawaiian, Mesa, Mokulele and Pacific Date Due: Wings) operate from the main terminals, For Period Ending: please report the sum of overseas and Note: 12% INTEREST PER ANNUM ON ALL ACCOUNTS 30 DAYS OR MORE OVERDUE. interisland bag users from the prior page in this column SECTION 3 , BAGGAGE AND lAB CHARGES Honolulu Kahului Kona Lihue Hilo e Interisland Interisland Interisland Interisland Interisland Airlines (3) Other Airlines (3) Other Airlines (3) Other Airlines (3) Other Airlines (3) Other Joint Use Bag System [E) Passenaers 0&0 Ratio (5) [J) 72.5% 86.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Bag Ratio (5) [I<] 0.70 0.90 0.65 0.90 Joint Use Baggage Charae e Total Note: Reported amounts on this form are subjeclto audit. In the event of an audit, the following records are required to support the total monthly enplanement counts by flight, including but not limited to: (i) Departure date; (ii) Gate number; (iii) Aircraft type, series, and tail number; and (iv) Passenger counts. (1) epax = enplaned passengers (2) dpax = deplaned passengers (3) Interisland airlines include Hawaiian Airlines and other signatory airlines that primarily operate interisland flights, as determined by Department of Transportation. As of December 2010, interisland airlines include HA, YV, MW and LW. (4) Other airlines are airlines primarily operate overseas flights. (5) Estimated by Airlines Committee of Hawaii and agreed to by Department of Transportation for FY2011, and subject to adjustment by Department of Transportation from time to time thereafter. By: _ Date: Authorized Signature Name: Title: Phone: Email: State of Hawaii Department of Transportation AIRPORTS DIVISION BILL FOR COLLECTION Self-Invoice Airport Fees and Charges Airline: Mailing Address: Date Due: For Period Ending: Note: 12% INTEREST PER ANNUM ON ALL ACCOUNTS 30 DAYS OR MORE OVERDUE. SECTION 3 HOLDROOM, BAGGAGE AND lAB CHARGES Enplaned Passengers Deplaned Passengers Joint Use Holdroom Charges Ilnt'l Arrivals Building Charges e International Joint Use Bag Total Total Arrivals System Rate Joint Use Preferential Enplaned Deplaned Passengers Passengers Rate ($/epax) Amount Due ($/dpax) (2) Amount Due Airport [A] [B] [A]+[B] [C] [D] [E]=[C)-[D] [F] [G]=[A] X [F] [H] [I]=[D]x [H] Honolulu Overseas Interisland Kahului Overseas Interisland Kona Overseas Interisland Lihue Overseas Interisland Hilo Overseas Interisland e Total Primary Airports Overseas Interisland (Continued on Nex1 Page) State of Hawaii Department of Transportation AIRPORTS DIVISION BILL FOR COLLECTION s and Charges Airline: When Other Airlines (excluding Hawaiian, Mailing Address: Date Due: Mesa, Mokulele and Pacific Wings) operate For Period Ending: from the main terminals, please report the Note: 12% INTEREST PER ANNUM ON ALL ACCOUNTS overseas bag users, and interisland bag 30 DAYS OR MORE OVERDUE. users if any, from the prior page in this 3 column NO lAB CHARGES Honolulu Kahului Kona Lihue Hilo e Interisland Interisland Interisland Interisland Interisland Airlines (3) Other Airlines (3) Other _ Airlines (3) Other Airlines (3) Other Airlines (3) Other Joint Use Bag System [E) Passenaers 0&0 Ratio (5) 72.5% 100.0% 100.0% 100.0% Bag Ratio (5) 0.90 0.65 0.90 Joint Use Baggage Charae e Total Note: Reported amounts on this form are subject to audit. In the event of an audit, the following records are required to support the total monthly enplanement counts by flight, including but not limited to: (i) Departure date; (ii) Gate number; (iii) Aircraft type, series, and tail number; and (iv) Passenger counts. (1) epax = enplaned passengers (2) dpax = deplaned passengers (3) Interisland airlines include Hawaiian Airlines and other signatory airlines that primarily operate interisland flights, as determined by Department of Transportation. As of December 2010. interisland airlines include HA, YV. MWand LW. (4) Other airlines are airlines primarily operate overseas flights. (5) Estimated by Airlines Committee of Hawaii and agreed to by Department of Transportation for FY2011, and subject to adjustment by Department of Transportation from time to time thereafter. By: _ Date: Authorized Signature Name: Title: Phone: Email:.