STC SR02609NY-D

FAA Form 8110-2 (5/14) Page 1 of

Part of the

Signature

Title SR02609NY-D Sikorsky Aircraft Corporation 6900 Main Street Stratford, CT 06615 Federal Aviation Regulations.

1. Installation of the LifePort CF1-165 Patient Loading and Utility System (PLUS) in accordance with Keystone Helicopter Installation drawing List IDL02501 Rev. C dated 12/15/2010 or later FAA approved revision.

2. Keystone Helicopter Instructions for Continued Airworthiness, LifePort CF1-165 Patient Loading and Utility System (PLUS) Installed in Sikorsky S-76C Aircraft, Report No. IC02501 Rev. - dated November 1, 2010 or later FAA accepted revision is required for this modification.

3. FAA Approved Rotorcraft Flight Manual Supplement, Supplement No. FM02501 Rev. - dated 12/16/2010 or later FAA approved revision is required for this modification.

1. The installer must determine whether this design change is compatible with previously approved modifications.

2. If the holder agrees to permit another person to use this certificate to alter a product, the holder must give the other person written evidence of that permission.

Gaetano Sciortino Manager New York Aircraft Certification Office Sikorsky S-76C October 1, 2011, December 17, 2014 November 2, 2010 December 16, 2010 H1NE 3

FAA Form 8110-2 (5/14) Page 2 of

To (Name and address of transferee)

From (Name and address of grantor)

3 SR02609NY-D

FAA Form 8110-2 (5/14) Page 3 of

3 Date Reissued: December 17, 2014

Certification Basis:

Based on 14 CFR §§ 21.115 and 21.101, and the FAA policy for significant changes in FAA Order 8110.48, the certification basis for the Sikorsky S-76C is as follows:

a. The type certification basis for Sikorsky S-76C is shown on TCDS H1NE for parts not changed or not affected by the change.

b. The certification basis for parts changed or affected by the change since the reference date of application is based upon Part 29 as amended by Amendment 29-52. Based on 14 CFR §§ 21.115 and 21.101, and the FAA policy for significant changes in FAA Order 8110.48, the certification basis for this modification was determined to be:

Regulations at the latest amendment 29-0 through 29-52

29.301, 29.303, 29.305(a), 29.307(a), 29.337, 29.601, 29.603, 29.607, 29.609, 29.613(a)(b)(d), 29.625,

29.785(a)(b)(e)(k), 29.803(a)(b)(e), 29.807(b), 29.809(a)(b), 29.813(c)(2), 29.853(a)(b), 29.1301, 29.1307(b),

29.1309(b)(2)(d)(g), 29.1351(a), 29.1353(a), 29.1357(a)(c), 29.1359(a)(c), 29.1413(b), 29.1431, 29.1501,

29.1529, 29.1541, 29.1557(a), 29.1581(a)(b)(d), 29.1585(a)

Regulations at an intermediate amendment N/A

Regulations at the amendment level in TCDS H1NE

29.561(a)(b)(3)(c), 29.811(a)(b)(c) ----------END---------- SR02609NY-D