| Applicant | Address | Phone | Applicant Type | |
|---|---|---|---|---|
|
WSBS LICENSING, INC. Doing Business As: WSBS LICENSING, INC. |
Spanish Broadcasting System, Inc. 7007 NW 77TH AVE. MIAMI, FL 33166 United States |
+1 (305) 441-6901 | licensemanagement@sbscorporate.com | Corporation |
| Applicant | Address | Phone | |
|---|---|---|---|
|
[Confidential] |
|
|
|
| Applicant | Address | Phone | |
|---|---|---|---|
|
Nancy A. Ory , Ory . Legal Representative Lerman Senter PLLC |
Nancy A. Ory Lerman Senter PLLC 2001 L Street, NW, Suite 400 Washington, DC 20036 United States |
+1 (202) 416-6791 | nory@lermasenter.com |
| Question | Response |
|---|---|
| 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. | No |
| Briefly describe transition plan | WSBS-CD will be re-tuning its main transmitter and replacing the mask filter. An auxiliary transmitter will need to be replaced and a new antenna and line will be required to meet repack assignments and timelines. |
| Section | Question | Response |
|---|---|---|
| Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
| Section | Question | Response |
|---|---|---|
| Existing Transmitter Description | Type of change | Retune Existing |
| Use | Primary (Main) | |
| Ownership | Owned | |
| Owner | 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 | Harris |
| Model | UAX2500AT | |
| Year | 2010 | |
| Type | Solid State | |
| Solid State Cooling | Air Cooled | |
| Solid State Power capacity | 2.5 kW |
| Section | Question | Response |
|---|---|---|
| New IOT Tubes | Number of Tubes (including accessories) needed | N/A |
| New Mask Filter | ||
| Power | 3 kW | |
| Other Power | N/A | |
| New Exciter | Is a new exciter needed? | Yes |
| Exciter Type | Dual exciter with changeover |
| 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 | No | |
| Size | N/A | |
| Length | N/A | |
| Other Electrical Service | No | |
| Description | N/A | |
| 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 |
| Name | Description |
|---|---|
Installation |
Installation and tuning charges to install new exciters and re-tune transmitter to CH 19 |
| Section | Question | Response |
|---|---|---|
| Existing Transmitter Description | Type of change | Purchase New |
| Use | Auxiliary (Backup) | |
| Description of Use | Back-Up Transmitter | |
| 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 | SSTVU-5000 | |
| Year | 1996 | |
| Type | Solid State | |
| Solid State Cooling | Air Cooled | |
| Solid State Power Capacity | 5 kW |
| Section | Question | Response |
|---|---|---|
| New Transmitter | Use | Auxiliary (Backup) |
| Change Type | Purchase New | |
| Is this a request for upgraded equipment? | No | |
| Manufacturer | ||
| Model | UAXTE-2R37 | |
| Transmitter Type | Solid State | |
| Solid State Cooling | Air Cooled | |
| Solid State Power capacity | 1.2 kW | |
| Justification for New Transmitter | Current Auxiliary transmitter will not tune to new CH 19 assignment. |
| 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 | No | |
| Size | N/A | |
| Length | N/A | |
| Other Electrical Service | No | |
| Description | N/A | |
| 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? | Yes | |
| Existing Antenna Manufacturer and Type | Class | Class A |
| 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: | 15.0 kW | |
| Manufacturer | ||
| Model | ALP16L4-CDP50 | |
| Year | 2007 |
| 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? | No | |
| 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? | Yes | |
| New Antenna Manufacturer and Types | Class | Class A |
| Mounting | Top 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: | 7.98 kW | |
| Manufacturer | ||
| Model | TFU-10GTH TFU | |
| Year | 2018 | |
| Justification for New Antenna | Current Antenna is not capable of broadcasting on channel 19. |
| 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? | No |
| 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 |
|---|---|---|
| Existing Transmission Line Description | Type of change | Purchase New |
| Use | Primary (Main) | |
| Description of Use | N/A | |
| Ownership | Owned | |
| Owner | N/A | |
| Site | N/A | |
| Is the existing transmission line shared with another station or stations? | No | |
| Is Transmission Line in operating condition? | Yes | |
| Existing Transmission Line Manufacturer and Type | Manufacturer | |
| Type | Flexible Air | |
| Diameter | 4 inches | |
| Other Diameter | N/A | |
| Segment Length | N/A | |
| Other Segment Length | N/A | |
| Number of parallel runs | 1 | |
| Length | 800 feet per run |
| Section | Question | Response |
|---|---|---|
| New Transmission Line Costs | Use | Primary (Main) |
| Description of Use | N/A | |
| Change Type | Purchase New | |
| Is this a request for upgraded equipment? | No | |
| Type | Flexible Air | |
| Diameter | 3 inches | |
| Other Diameter | N/A | |
| Segment Length | N/A | |
| Other Segment Length | N/A | |
| Number of parallel runs | 1 | |
| Length | 1000 feet per run | |
| Justification for New Transmission Line | Current line need for continued operation on existing channel. New Line will allow for testing and turn-up of Ch19 according to repack timelines. |
| Name | Description |
|---|---|
Building Penetration |
Costs for building penetration and re-sealing. |
| 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 | Leased | |
| Is this tower consider Complex? | Candelabra | |
| 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 | No | |
| Is tower documented for structural analysis? | Unknown | |
| Is tower compliant with Rev G? | Unknown | |
| Existing Tower Structure Registration | Do you have a tower registration number? | Yes |
| ASR Number | 1224225 | |
| Coordinates (NAD83) | Latitude (NAD83) | 25° 59' 10.0" N- |
| Longitude (NAD83) | 080° 11' 36.3" W- | |
| Overall Structure Height | 1019.02 feet | |
| Support Structure Height | 942.90 feet | |
| Ground Elevation Above Mean Sea Level (AMSL) | 11.15 feet | |
| Structure Type | GTOWER - Guyed Structure Used for Communication Purposes | |
| Tower Owner | American Towers, LLC. | |
| Date Constructed | 10/12/2001 |
| Facility ID | Call Sign | Service |
|---|---|---|
| 4366 | WIMP-CD | DTV |
| 29567 | WSFS | FM |
| 64971 | WSCV | DTV |
| 51979 | WZTU | FM |
| 67193 | WMIB | FM |
| 51978 | WMIA-FM | FM |
| 11965 | WBGG-FM | FM |
| 41381 | WHYI-FM | FM |
| 63154 | WTVJ | DTV |
| 60536 | WAMI-DT | DTV |
| 51349 | WBEC-TV | DTV |
| 48608 | WPXM-TV | DTV |
| 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 | Candelabra |
| Helicopter Services Required | Are helicopter services required? | No |
| Name | Description |
|---|---|
Ground and Building Drawing Package |
Generation of permitting drawing package. |
Tower Permit Drawing Package |
Generation of permitting drawing package. |
Tower Modification Project Manager |
Tower Modification Project Management. |
| Section | Question | Response |
|---|---|---|
| Outside Project Management Services | Do you require outside project management services? | Yes |
| Number of Hours | 100 | |
| Explanation | Project management fee for pre-construction services (including initial antenna placement and RF compatibility review, zoning and permitting requirements review; leasing application services) to support the transition of (1) broadcasters. | |
| 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 | No | |
| Quantity | N/A | |
| 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 | No | |
| Quantity | N/A | |
| NEPA Section 106 environmental review | No | |
| Environmental Assessment | No | |
| ASR Modification | No | |
| FAA Consultation (including preparation of FAA Form 7460) | No | |
| Negotiation of Lease and other Matter for Shared Locations | Yes | |
| 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 | Yes |
| RF exposure measurements | Yes | |
| Additional Field Engineering Service | No | |
| Number of Days | N/A | |
| Justification | N/A |
| Name | Description |
|---|---|
Transition Coordination |
Coordination and transition planning with all parties onsite and management of the timelines and schedules occurring during the repack. |
Site Meetings |
Coordination and transition planning with all parties onsite and management of the timelines and schedules occurring during the repack. |
| 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 | Yes |
| Non-zoning permits | Yes | |
| BLM or NFS Coordination | No | |
| FCC Construction Permit Minor Change | No | |
| FCC License to Cover Application | No | |
| FCC Special Temporary Authority Application | No | |
| 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? | No | |
| Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? | No | |
| Does this relocation require MVPD Notification of a Channel Change? | No |
| Name | Description |
|---|---|
Professional Labor |
Labor to re-plumb existing RF switch and dummy load to accommodate new line and transmitter. |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $302,705.00 | $165,400.00 | N/A | $0.00 | N/A |
| Total for all systems | $1,231,125.00 | $916,200.00 | N/A | $0.00 | N/A |
| Primary Transmitter UAX2500AT | $176,705.00 | $79,400.00 | $0.00 | ||
| Installation | $20,000.00 | $20,000.00 | Installation, configuration, and re-tuning of existing transmitter. | N/A | N/A |
| 3 kW mask filter | $4,155.00 | $4,400.00 | Due to physical location within rack additional hardware needed for correct installation. | N/A | N/A |
| UHF and VHF - minor banding issues | $105,200.00 | $10,000.00 | N/A | N/A | N/A |
| Dual exciter system with change over | $47,350.00 | $45,000.00 | N/A | N/A | N/A |
| Auxiliary Transmitter UAXTE-2R37 | $126,000.00 | $86,000.00 | $0.00 | ||
| UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW | $126,000.00 | $86,000.00 | N/A | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $44,330.00 | $43,800.00 | N/A | $0.00 | N/A |
| Total for all systems | $1,231,125.00 | $916,200.00 | N/A | $0.00 | N/A |
| Primary Antenna TFU-10GTH TFU | $44,330.00 | $43,800.00 | $0.00 | ||
| Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) | $7,600.00 | $7,400.00 | N/A | N/A | N/A |
| UHF - Lower Power, Top Mount, Class A, basic slot antenna, 8 kW input, directional,, elliptically or circularly polarized | $30,000.00 | $30,000.00 | N/A | N/A | N/A |
| Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $63,000.00 | $60,000.00 | N/A | $0.00 | N/A |
| Total for all systems | $1,231,125.00 | $916,200.00 | N/A | $0.00 | N/A |
| Primary Transmission Line | $63,000.00 | $60,000.00 | $0.00 | ||
| Building Penetration | $4,000.00 | $4,000.00 | Cost for boring through concrete building, flashing, and sealing. | N/A | N/A |
| Flexible Air Transmission Line - dielectric, 3" | $59,000.00 | $56,000.00 | N/A | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $625,300.00 | $460,000.00 | N/A | $0.00 | N/A |
| Total for all systems | $1,231,125.00 | $916,200.00 | N/A | $0.00 | N/A |
| Primary Tower GTOWER | $625,300.00 | $460,000.00 | $0.00 | ||
| Ground and Building Drawing Package | $5,000.00 | $5,000.00 | The generation of a permitting drawing package for one (1) broadcasters/customers. | N/A | N/A |
| Tower Permit Drawing Package | $5,000.00 | $5,000.00 | The generation of a permitting drawing package for one (1) broadcasters/customers. | N/A | N/A |
| Minor tower reinforcement/modifications | $158,000.00 | $30,000.00 | 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 | $10,000.00 | N/A | N/A | N/A |
| Tower Modification Project Manager | $10,000.00 | $10,000.00 | Project management fee for pre-construction services (including initial antenna placement and RF compatibility review, zoning and permitting requirements review; leasing application services) to support the transition of (1) broadcasters. 100Hrs @ $100HR | N/A | N/A |
| Complex Tower (includes, for example, those with candelabras and/or stacked antennas) | $421,000.00 | $400,000.00 | N/A | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $156,240.00 | $148,000.00 | N/A | $0.00 | N/A |
| Total for all systems | $1,231,125.00 | $916,200.00 | N/A | $0.00 | N/A |
| Outside Professional Services | $156,240.00 | $148,000.00 | $0.00 | ||
| Site Meetings | $3,000.00 | $3,000.00 | Coordination and transition planning with all parties onsite and management of the timelines and schedules occurring during the repack. | N/A | N/A |
| Transition Coordination | $3,000.00 | $3,000.00 | Coordination and transition planning with all parties onsite and management of the timelines and schedules occurring during the repack. | N/A | N/A |
| RF Exposure Measurements | $21,050.00 | $20,000.00 | N/A | N/A | N/A |
| Comprehensive coverage verification via field study, if needed | $84,200.00 | $80,000.00 | 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 |
| 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 - Negotiation of lease and other matters for shared locations | $4,210.00 | $4,000.00 | 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 |
| Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | 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 |
| Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | N/A | N/A |
| Project management of the transition | $15,800.00 | $14,250.00 | N/A | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $39,550.00 | $39,000.00 | N/A | $0.00 | N/A |
| Total for all systems | $1,231,125.00 | $916,200.00 | N/A | $0.00 | N/A |
| Other Expenses | $39,550.00 | $39,000.00 | $0.00 | ||
| Equipment Delivery and Handling Charges | $5,000.00 | $5,000.00 | Fork-Lift Rental and operator for equipment delivery. | N/A | N/A |
| Disposal Costs (for equipment and other waste, net of any salvage value) | $5,000.00 | $5,000.00 | Disposal of old ch 50 antenna, line, and transmitter. | N/A | N/A |
| Non-zoning permits | $5,000.00 | $5,000.00 | Permits for local municipality for road closures need for tower rigging. | N/A | N/A |
| Local Zoning | $3,000.00 | $3,000.00 | Obtain local permits (costs associated with preparation, filing, and fees) | N/A | N/A |
| Professional Labor | $10,000.00 | $10,000.00 | Labor to re-plumb existing RF switch and dummy load to accommodate new line and transmitter. Labor to assist in installation and removal of heavy broadcast equipment. | N/A | N/A |
| DTV Medical Facility Notification | $11,550.00 | $11,000.00 | N/A | N/A | N/A |
| Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
|---|---|---|---|
| Total for all systems | $1,231,125.00 | $916,200.00 | $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. |
|
| I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Joseph A Garcia Senior Executive Vice President 08/16/2017 |
