Go to the Federal Communications Commission homepage at www.fcc.gov

Licensing and Management System

Approved by OMB 3060-1178
July 2019
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission)FCC Form 399: Eligibility Certification

Facility ID:
5957
Service:
LPT
Call Sign:
K16LN-D
Channel:
16 (UHF)
File Number:
0000089516
FRN:
0009080557
Eligibility Status:
Not Determined
Date Submitted:
11/14/2019

Applicant Information

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Applicant Address Phone Email Applicant Type

RURAL OREGON WIRELESS TELEVISION, INC.

PO Box 19058

PORTLAND, OR 97280

United States

+1 (503) 226-5004 dboyd@kgw.com Corporation

Contact Representatives (2)

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Contact Name Address Phone Email Contact Type

John M. Burgett , Esq .

Wiley Rein LLP

1776 K Street, N.W.

Washington, DC 20006

United States

+1 (202) 719-4239 jburgett@wileyrein.com Legal Representative

ERIK C SWANSON , P.E .

CONSULTING ENGINEER

HATFIELD & DAWSON CONSULTING ENGINEERS

9500 GREENWOOD AVE N

SEATTLE, WA 98103

United States

+1 (206) 783-9151 ESWANSON@HATDAW.COM Technical Representative

Eligibility Information

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Section Question Response
LPTV/Translator Eligibility Selected LMS File Number of Granted Displacement Construction Permit
There is no Granted Displacement Construction Permit for this facility because this facility has been granted a License to Cover. Yes
The Station was licensed or had an application for license (FCC Form 2100 Schedule D) pending on April 13, 2017. Yes
The Station was licensed and transmitting for not less than 2 hours in each day of the week and not less than a total of 28 hours per calendar week for 9 of the 12 months prior to April 13, 2017. Yes
Licensee has attached true copies of documents or other evidence that demonstrate the Station's operation as described in Section III.1.a.ii. Yes
Licensee is not requesting reimbursement for payments previously received or expected to be received from the Fund and is not requesting reimbursement of expenses paid or expected to be paid by any other source. Yes

Certification

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Section Question Response
Submission of Eligibility Certification WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS IN THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1)), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).
  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Eligibility Certification Form on behalf of the above-named entity.

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

  3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  4. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Alan Batdorf

ROWT Technical Assistant / Skyline Tower Site Manager


11/14/2019

Attachments

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Information not provided.