Applicant | Address | Phone | Applicant Type | |
---|---|---|---|---|
EBENEZER BROADCASTING GROUP, INC. |
WILLIAM ADORNO PO Box 13428 San Juan, Puerto Rico 00908 Puerto Rico |
7879990360 | ingenieriaebn@gmail.com | Not-for-Profit |
Applicant | Address | Phone | |
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[Confidential] |
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Applicant | Address | Phone | |
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The Preparer is same as the reimbursement contact. |
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Question | Response |
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Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. | Yes |
Briefly describe transition plan | Both station will be planning the installation at the same time with the same rigger company and possibly using the same transmitter/antenna manufacturer. |
Section | Question | Response |
---|---|---|
Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Transmitter Description | Type of change | Purchase New |
Use | Auxiliary (Backup) | |
Description of Use | Backup used when Main transmitter fail or needs repair/maintenace | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
Is this transmitter currently shared with another station? | No | |
Is this transmitter currently in operating condition? | Yes | |
Existing Transmitter Manufacturer and Type | Manufacturer | |
Model | Affinity | |
Year | 2000 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power Capacity | 0.5 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Auxiliary (Backup) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Manufacturer | ||
Model | EC701HP-BB | |
Transmitter Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power capacity | 1 kW | |
Justification for New Transmitter | Existing transmitter manufacturer not longer on the market. |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | No |
Switchgear (industrial 800 amp) | No | |
Transformer (480V) | No | |
Power | N/A | |
Rigid Conduit and Wiring | Yes | |
Size | 1 inches | |
Length | 30.0 feet | |
Other Electrical Service | Yes | |
Description | Panel breaker, grounding system, connecting cables. | |
HVAC Service | Does the replacement transmitter require HVAC Service? | No |
Type | N/A | |
Size | N/A | |
Other Size | N/A | |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | No |
Size | N/A | |
Channel 14 Costs | Is an RF Consulting Engineer needed? | N/A |
Is a channel 14 Mask Filer needed? | N/A | |
Is additional field engineering time needed? | N/A | |
Number of Days | N/A |
Section | Question | Response |
---|---|---|
Existing Transmitter Description | Type of change | Purchase New |
Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
Is this transmitter currently shared with another station? | No | |
Is this transmitter currently in operating condition? | Yes | |
Existing Transmitter Manufacturer and Type | Manufacturer | |
Model | Ultimate TDU2 1K40 | |
Year | 2006 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power Capacity | 1.4 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Manufacturer | ||
Model | EC702HP-BB | |
Transmitter Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power capacity | 2 kW | |
Justification for New Transmitter | Existing transmitter manufacturing company does not exist and/or is not bringing technical support to this transmitter. Transmitter TPO increased to achieve the assigned ERP with the selected antenna. |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | No |
Switchgear (industrial 800 amp) | No | |
Transformer (480V) | No | |
Power | N/A | |
Rigid Conduit and Wiring | Yes | |
Size | 2 inches | |
Length | 30.0 feet | |
Other Electrical Service | Yes | |
Description | Additional protection circuit breaker and surge suppressor, electrical conduits and cables, grounding system, etc. | |
HVAC Service | Does the replacement transmitter require HVAC Service? | No |
Type | N/A | |
Size | N/A | |
Other Size | N/A | |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | No |
Size | N/A | |
Channel 14 Costs | Is an RF Consulting Engineer needed? | N/A |
Is a channel 14 Mask Filer needed? | N/A | |
Is additional field engineering time needed? | N/A | |
Number of Days | N/A |
Section | Question | Response |
---|---|---|
Antenna Related Expenses | Do you have antenna related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Antenna Description | Type of change | Purchase New |
Antenna Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
Is the existing antenna shared with another station or stations? | No | |
Is the existing antenna directional? | Yes | |
Is antenna in operating condition? | Yes | |
Is antenna located on or in close proximity to an antenna farm? | No | |
Existing Antenna Manufacturer and Type | Class | Full Power |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Horizontal | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels | N/A | |
Design power capacity in use | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Other Antenna Type | N/A | |
ERP: | 50.1 kW | |
Manufacturer | ||
Model | ALP32M5-HSP-46 | |
Year | 2001 |
Section | Question | Response |
---|---|---|
New Antenna Description | Use | Primary (Main) |
Description of Use | N/A | |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Ownership | Owned | |
Owner | N/A | |
Is antenna shared? | No | |
Is antenna directional? | Yes | |
Will antenna be located on or in close proximity to an antenna farm? | No | |
New Antenna Manufacturer and Types | Class | Full Power |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Elliptical | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels/Bays | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Design power capacity in use | N/A | |
Other Antenna Type | N/A | |
ERP: | 40.3 kW | |
Manufacturer | ||
Model | JA/MS-24/34 SEC | |
Year | 2017 | |
Justification for New Antenna | Old slotted antenna is not tunable to new frequency. Antenna slots reduced to decrease the antenna size and weight, and decrease load to the tower. |
Section | Question | Response |
---|---|---|
Combiner for Shared Antenna | Do you need a Combiner for a Shared Antenna? | No |
Type | ||
Number of channels supported | N/A | |
Frequencies of channels supported | N/A | |
Frequency | N/A | |
Do you need a combiner output splitter/switcher for dual feed lines? | N/A | |
Elbow Complex | Do you require the separate purchase of the Elbow Complex? | Yes |
Broadband or Single Channel? | Single Channel | |
Feed Line Size | 3 1/8 inches inches | |
Side Mount Brackets | Do you require the separate purchase of side mount brackets for a high power antenna? | Yes |
Pattern Scatter Analysis | Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? | Yes |
Sweep Test | Do you require the sweep testing of transmission line and antenna? | Yes |
Name | Description |
---|---|
Elbows |
Three 3-1/8" Elbows to connect transmission line to antenna |
Rigid Line Section |
Rigid Line 3-1/8" pieces to connect the antenna to the transmission line |
Dehydrator |
Transmission line dehydrator, accessories. |
Section | Question | Response |
---|---|---|
New Antenna Description | Use | Interim |
Description of Use | N/A | |
Change Type | Purchase New | |
Ownership | Owned | |
Owner | N/A | |
Is antenna shared? | No | |
Is antenna directional? | No | |
Will antenna be located on or in close proximity to an antenna farm? | No | |
New Antenna Manufacturer and Type | Class | Full Power |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Horizontal | |
Type | Broadband Slot | |
Number of Stations Supported | 1 | |
Number of Panels/Bays | 1 | |
Lower Limit | 470.00 MHz | |
Upper Limit | 862.00 MHz | |
Design power capacity in use | 70.0 % | |
Other Antenna Type | N/A | |
ERP: | 20.0 kW | |
Manufacturer | ||
Model | SL-8 | |
Year | 2017 | |
Justification for New Antenna | To be used during installation of the new main antenna. Antenna could be used later with the new assigned channel after conversion. |
Section | Question | Response |
---|---|---|
Elbow Complex | Do you require the separate purchase of the Elbow Complex? | No |
Broadband or Single Channel? | N/A | |
Feed Line Size | N/A | |
Side Mount Brackets | Do you require the separate purchase of side mount brackets for an antenna? | Yes |
Pattern Scatter Analysis | Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? | No |
Sweep Test | Do you require the sweep testing of transmission line and antenna? | Yes |
Section | Question | Response |
---|---|---|
Transmission Line Related Expenses | Do you have transmission line related expenses? | Yes |
Section | Question | Response |
---|---|---|
New Transmission Line Costs | Use | Interim |
Description of Use | N/A | |
Change Type | Purchase New | |
Type | Flexible Foam | |
Diameter | 1 5/8 inches | |
Segment Length | N/A | |
Other Segment Length | ||
Number of parallel runs | 1 | |
Length | 300 feet per run | |
Justification for New Transmission Line | Transmission line to be used with the interim antenna during new main antenna installation. |
Name | Description |
---|---|
Connectors Adapters |
1-5/8" Adapters, connectors |
Section | Question | Response |
---|---|---|
Tower Equipment or Rigging Costs Changes | Do you have tower equipment or rigging costs changes? | Yes |
Section | Question | Response |
---|---|---|
Existing Tower Description | Type of change | Modify Existing |
Tower Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Is this tower consider Complex? | No | |
Is this tower currently shared with any other stations? | Yes | |
One or more FM, AM or TV radio broadcaster(s) | Yes | |
Others Types of Users | Yes | |
Is tower documented for structural analysis? | No | |
Is tower compliant with Rev G? | No | |
Existing Tower Structure Registration | Do you have a tower registration number? | No |
ASR Number | ||
Coordinates (NAD83) | Latitude (NAD83) | 18° 16' 37.0" N- |
Longitude (NAD83) | 065° 51' 08.0" W- | |
Overall Structure Height | 265.74 feet | |
Support Structure Height | 265.74 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 2522.94 feet | |
Structure Type | TOWER - Free Standing or Guyed Structure | |
Tower Owner | EBENEZER BROADCASTING GROUP INC | |
Date Constructed | 07/06/2000 |
Facility ID | Call Sign | Service |
---|---|---|
67190 | WVSN | DTV |
Users |
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Internet Wirele |
Section | Question | Response |
---|---|---|
Engineering Study | Please what type of engineering study is required, if any: | Study needed for undocumented/poorly documented tower |
Tower Reinforcements | Please select whether tower reinforcements are needed: | Minor Reinforcements needed |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
Section | Question | Response |
---|---|---|
Outside Project Management Services | Do you require outside project management services? | Yes |
Number of Hours | 160 | |
Explanation | Religious station with reduce technical personnel with the expertise necessary to handle this type of project. | |
Outside RF consulting Engineering Services | Perform engineering study for new channel assignment and antenna development | Yes |
Prepare engineering section of Form FCC Construction Permit Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare engineering section of Form FCC License to Cover Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare request for Special Temporary Authority | Yes | |
Quantity | 2 | |
Do you have Distributed Transmission System engineering services? | N/A | |
Critical Facility | N/A | |
Terrain-Shielded Facility | N/A | |
Attorney and Other Outside Consulting Services | Prepare and file Form FCC Construction Permit Application | Yes |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare and file Form FCC License to Cover Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare request for Special Temporary Authority | Yes | |
Quantity | 2 | |
NEPA Section 106 environmental review | No | |
Environmental Assessment | No | |
ASR Modification | Yes | |
FAA Consultation (including preparation of FAA Form 7460) | No | |
Negotiation of Lease and other Matter for Shared Locations | No | |
Prepare or Review FCC Form 399 for Reimbursement | Yes | |
Address transition timing and coordination issues w/ other stations and wireless providers | Yes | |
RF Field Engineering Services | Comprehensive coverage verification via field study | No |
RF exposure measurements | Yes | |
Additional Field Engineering Service | Yes | |
Number of Days | 10 | |
Justification | Verify installation and coordination with parallel installations in the same tower and buildings. |
Section | Question | Response |
---|---|---|
AM Pattern Disturbance | Is an Impact Study needed? | No |
Is Remediation needed? | No | |
Facility Expenses | Name | N/A |
Other Distributed Transmission System Expenses Not listed | N/A | |
Name | N/A | |
Is Notification of a Medical Facility required as a result of DTV broadcasting? | Yes | |
Permit and Filing Costs | Local Zoning | No |
Non-zoning permits | No | |
BLM or NFS Coordination | No | |
FCC Construction Permit Minor Change | Yes | |
FCC License to Cover Application | Yes | |
FCC Special Temporary Authority Application | Yes | |
Other Miscellaneous Expenses | Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? | Yes |
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? | Yes | |
Does this relocation require Equipment Storage? | Yes | |
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? | Yes | |
Does this relocation require MVPD Notification of a Channel Change? | Yes |
Name | Description |
---|---|
Station Personnel |
Extra time incurred by station personnel and travel expenses. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $257,680.00 | $165,650.00 | N/A | $0.00 | N/A |
Total for all systems | $846,365.00 | $731,385.00 | N/A | $0.00 | N/A |
Primary Transmitter EC702HP-BB | $129,780.00 | $123,750.00 | $0.00 | ||
Other Electrical Service: Additional protection circuit breaker and surge suppressor, electrical conduits and cables, grounding system, etc. | $3,000.00 | $3,000.00 | Estimated materials and installation costs. | N/A | N/A |
2" Rigid Conduit and Wiring (Cost per foot) | $780.00 | $750.00 | N/A | N/A | N/A |
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW | $126,000.00 | $120,000.00 | N/A | N/A | N/A |
Auxiliary Transmitter EC701HP-BB | $127,900.00 | $41,900.00 | $0.00 | ||
Other Electrical Service: Panel breaker, grounding system, connecting cables. | $1,500.00 | $1,500.00 | Electrical connection, materials and installation. | N/A | N/A |
1" Rigid Conduit and Wiring | $400.00 | $400.00 | Material and installation. | N/A | N/A |
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW | $126,000.00 | $40,000.00 | N/A | N/A | N/A |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $140,620.00 | $137,200.00 | N/A | $0.00 | N/A |
Total for all systems | $846,365.00 | $731,385.00 | N/A | $0.00 | N/A |
Interim Antenna SL-8 | $39,880.00 | $38,400.00 | $0.00 | ||
Side mount brackets for high power antennas (if not included in antenna base cost) | $23,150.00 | $22,000.00 | N/A | N/A | N/A |
Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | N/A | N/A |
UHF - High Power, Side Mount, basic slot antenna, 1 bay,, 20 kW input, horizontally polarized | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
Primary Antenna JA/MS-24/34 SEC | $100,740.00 | $98,800.00 | $0.00 | ||
UHF - High Power, Side Mount, basic slot antenna, 40 kW input, directional,, elliptically or circularly polarized | $50,000.00 | $50,000.00 | N/A | N/A | N/A |
Dehydrator | $4,500.00 | $4,500.00 | To pressurize with dry air the transmission line and antenna | N/A | N/A |
Rigid Line Section | $1,500.00 | $1,500.00 | 3-1/8" Rigid line to be cut as necessary to complete installation. | N/A | N/A |
Elbows | $2,000.00 | $2,000.00 | Five 3-1/8" elbows cost, shipping, installation | N/A | N/A |
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) | $5,260.00 | $5,000.00 | N/A | N/A | N/A |
Side mount brackets for high power antennas (if not included in antenna base cost) | $23,150.00 | $22,000.00 | N/A | N/A | N/A |
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) | $7,600.00 | $7,400.00 | If necessary | N/A | N/A |
Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | N/A | N/A |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $9,700.00 | $9,400.00 | N/A | $0.00 | N/A |
Total for all systems | $846,365.00 | $731,385.00 | N/A | $0.00 | N/A |
Interim Transmission Line | $9,700.00 | $9,400.00 | $0.00 | ||
Connectors Adapters | $2,500.00 | $2,500.00 | N/A | N/A | N/A |
Flexible Foam Transmission Line - dielectric, 1 5/8" | $7,200.00 | $6,900.00 | N/A | N/A | N/A |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $268,500.00 | $255,000.00 | N/A | $0.00 | N/A |
Total for all systems | $846,365.00 | $731,385.00 | N/A | $0.00 | N/A |
Primary Tower TOWER | $268,500.00 | $255,000.00 | $0.00 | ||
Short Tower (less than 500') | $84,200.00 | $80,000.00 | N/A | N/A | N/A |
Minor tower reinforcement/modifications | $158,000.00 | $150,000.00 | N/A | N/A | N/A |
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | $26,300.00 | $25,000.00 | N/A | N/A | N/A |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $89,875.00 | $84,750.00 | N/A | $0.00 | N/A |
Total for all systems | $846,365.00 | $731,385.00 | N/A | $0.00 | N/A |
Outside Professional Services | $89,875.00 | $84,750.00 | $0.00 | ||
Project management of the transition | $25,280.00 | $24,000.00 | N/A | N/A | N/A |
Additional Field Engineering Service, 10 Days | $5,000.00 | $5,000.00 | 10 days @ $500 per day professional services | N/A | N/A |
ASR modification (prepare FCC Form 854) | $2,105.00 | $2,000.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File request for Special Temporary Authorization | $7,360.00 | $7,000.00 | N/A | N/A | N/A |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $2,250.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | N/A | N/A | N/A |
Prepare request for Special Temporary Authorization | $4,100.00 | $3,000.00 | N/A | N/A | N/A |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | $1,580.00 | $1,500.00 | N/A | N/A | N/A |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | N/A | N/A |
Perform engineering study for new channel assignment and antenna development | $7,360.00 | $7,000.00 | N/A | N/A | N/A |
Address transition timing and coordination issues w/ other stations and wireless | $2,630.00 | $2,500.00 | N/A | N/A | N/A |
Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | N/A | N/A |
RF Exposure Measurements | $21,050.00 | $20,000.00 | N/A | N/A | N/A |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $79,990.00 | $79,385.00 | N/A | $0.00 | N/A |
Total for all systems | $846,365.00 | $731,385.00 | N/A | $0.00 | N/A |
Other Expenses | $79,990.00 | $79,385.00 | $0.00 | ||
Station Personnel | $14,300.00 | $14,300.00 | See attachment "WIDP Station Personnel Expenses" | N/A | N/A |
MVPD Notification of Channel Change | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
Develop and air announcement of upcoming channel change | $2,500.00 | $2,500.00 | N/A | N/A | N/A |
Equipment Delivery and Handling Charges | $15,000.00 | $15,000.00 | N/A | N/A | N/A |
Disposal Costs (for equipment and other waste, net of any salvage value) | $20,000.00 | $20,000.00 | N/A | N/A | N/A |
FCC Filing Fees - Special Temporary Authorization request | $195.00 | $190.00 | N/A | N/A | N/A |
FCC Filing Fees - Form 2100 minor change CP application | $1,110.00 | $1,070.00 | N/A | N/A | N/A |
DTV Medical Facility Notification | $11,550.00 | $11,000.00 | N/A | N/A | N/A |
Equipment Storage | $5,000.00 | $5,000.00 | N/A | N/A | N/A |
FCC Filing Fees - Form 2100 license to cover application | $335.00 | $325.00 | N/A | N/A | N/A |
Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
---|---|---|---|
Total for all systems | $846,365.00 | $731,385.00 | $0.00 |
Question | Response |
---|---|
The facility has ceased operating on its pre-auction channel. | No |
Construction of final facilities or all necessary modifications are complete. | No |
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. | No |
Section | Question | Response |
---|---|---|
Submission of Estimated Expenses Statements | WILLFUL FALSE STATEMENTS ON 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 STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT. |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Ricardo Montanez President 07/31/2017 |