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

FCC Form 399: Reimbursement Request

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

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Facility ID:
65942
Service:
DTV
Call Sign:
WMPT
Channel:
21 (UHF)
File Number:
0000027913
FRN:
0003857380
Date Submitted:
08/10/2017

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MARYLAND PUBLIC BROADCASTING COMMISSION

Doing Business As: MARYLAND PUBLIC BROADCASTING COMMISSION

Larry D. Unger, President & CEO

11767 OWINGS MILLS BOULEVARD

OWINGS MILLS, MD 21117

United States

+1 (410) 356-5600 lunger@mpt.org Government Entity

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Joseph L. Snelson , Jr .

Technical Consultant

Meintel, Sgrignoli & Wallace

1282 Smallwood Drive, Suite 372

Waldorf, MD 20603

United States

+1 (303) 344-8037 joe.snelson@mswdtv.com

Broadcaster Information and Transition Plan

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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 Current transmission system consists of a main/aux transmitter feeding a transmission line connected to an antenna. An interim antenna and line will be needed as the main antenna must be removed and replaced. See attached narrative.

Transmitters

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Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Primary Transmitter

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Existing Transmitter Information

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 CCT-U-DCX2
Year 1999
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40.0 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model HPTV-PRLX-U24
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 40.0 kW
Justification for New Transmitter See attached quotes for IOT vs Solid State. Note that IOT is more than $200,000 higher. Also see attached letter from Comark regarding status of IOT replacement transmitters and narrative.

Primary Transmitter

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Other Transmitter Costs

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 Yes
Description Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor.
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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Remote Control Interface

License required to interface transmitter into current remote control system

CIF Mask Filter

Constant Impedance mask Filter. Current mask filter is a CIF.

Site Design and Survey

Incorporates all aspects of the transmitter room design, including power distribution requirements, equipment placement, RF system layout, plumbing, and remote control.

Magic Tee Combiner

Used for summing output of two transmitters together. Pre-repack transmitter has this equipment.

Rigid Coax Line

Rigid interconnection coax lines from transmitter to filter to antenna switch.

Coolant

The coolant used for the transmitter heat exchanger is not included in the transmitter price

Motorized Switch

Electric actuated switch to switch transmitters into antenna or station load. Current transmitter has this capability but switch cannot be moved as it is in pre-repack service.

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

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 Top Mount
Antenna position in stack Top
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: 516.0 kW
Manufacturer
Model TFU-24-GTH-R04
Year 2001

Primary Antenna

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New Antenna Costs

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 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: 415.0 kW
Manufacturer
Model TFU-20GTH/VP-R O4
Year 2018
Justification for New Antenna The current antenna is tuned for channel 42 and cannot be retuned to the repack channel of 31. Applicant is proposing to replace with similar make and model tuned to the repack channel and with elliptical polarization. See attached narrative.

Primary Antenna

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Other Antenna Costs

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 6 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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Mounting Pole

62.7 ft. mounting pole to bring Center of Radiation to current height.

RF Feed Though Components

Elbows and cut line segments to feed antenna to tower top plate

Wedding Cake Adaptor

Joins antenna to mounting pole

Interim Antenna

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New Antenna Costs

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? Yes
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 Panel
Number of Stations Supported 1
Number of Panels/Bays 32
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 516.0 kW
Manufacturer
Model TUA-O4-8/32H-1-R SM
Year 2018
Justification for New Antenna See attached narrative regarding Interim facility.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 6 1/8 inches
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? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

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Existing Transmission Line

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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 935 feet per run

Primary Transmission Line

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New Transmission Line

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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 935 feet per run
Justification for New Transmission Line Current line, Channel 42, is incorrect length for repack channel 31.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 6 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 800 feet per run
Justification for New Transmission Line See attached narrative regarding Interim facility.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

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Existing Tower

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? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1225569
Coordinates (NAD83) Latitude (NAD83) 39° 00' 36.7" N-
Longitude (NAD83) 076° 36' 31.8" W-
Overall Structure Height 902.88 feet
Support Structure Height 786.08 feet
Ground Elevation Above Mean Sea Level (AMSL) 146.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Maryland Public Broadcasting Commission
Date Constructed 04/01/2003


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 400
Explanation Applicant has limited internal resources to oversee installing and commissioning this repack project. It will rely on outside services to manage all work required.
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 1
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 1
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 No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Progress Reporting

Prepare and file 10 required progress reports on FCC Form 2100, Schedule 387 on a quarterly basis with the FCC.

Other Expenses

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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 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? Yes
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? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,622,399.00 $1,256,066.00 N/A $0.00 N/A
Total for all systems $3,204,256.00 $2,756,248.00 N/A $0.00 N/A
Primary Transmitter HPTV-PRLX-U24 $1,622,399.00 $1,256,066.00 $0.00
Other Electrical Service: Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor. $28,400.00 $28,400.00 Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor for two transmitter cabinets. See attached quote for each. N/A N/A
Remote Control Interface $2,205.00 $2,205.00 License required to interface transmitter into current remote control system. N/A N/A
Motorized Switch $18,440.00 $18,440.00 Electric actuated switch to switch between main transmitter, load and antenna. Current transmitter has this capability but switch cannot be moved as it is in pre-repack service. N/A N/A
Magic Tee Combiner $38,220.00 $38,220.00 Used to combine two transmitters to obtain licensed power for feeding to the antenna. Not an upgrade as current pre-repack facility has this. N/A N/A
CIF Mask Filter $40,690.00 $40,690.00 Constant Impedance mask Filter. Current mask filter is a CIF. N/A N/A
Coolant $2,000.00 $2,000.00 The coolant used for the transmitter heat exchanger is not included in the transmitter price. Cost reflects what is need for two transmitter cabinets. N/A N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,106,667.00 N/A N/A N/A
Rigid Coax Line $4,144.00 $4,144.00 Rigid interconnection coax lines from transmitter to filter to antenna switch. N/A N/A
Site Design and Survey $15,300.00 $15,300.00 Incorporates all aspects of the transmitter room design, including power distribution requirements, equipment placement, RF system layout, plumbing, and remote control. N/A N/A

Components

Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $775,312.00 $646,688.00 N/A $0.00 N/A
Total for all systems $3,204,256.00 $2,756,248.00 N/A $0.00 N/A
Interim Antenna TUA-O4-8/32H-1-R SM $271,740.00 $266,348.00 $0.00
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
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 516 horizontally polarized $222,900.00 $222,900.00 See attached narrative regarding Interim facility. N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $10,298.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $21,750.00 N/A N/A N/A
Primary Antenna TFU-20GTH/VP-R O4 $503,572.00 $380,340.00 $0.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $10,298.00 N/A N/A N/A
Mounting Pole $155,806.00 $155,806.00 62.7 ft. mounting pole to bring Center of Radiation to current height. N/A N/A
Wedding Cake Adaptor $18,330.00 $18,330.00 Joins antenna to mounting pole N/A N/A
RF Feed Though Components $20,906.00 $20,906.00 Elbows and cut line segments to feed antenna to tower top plate N/A N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $168,600.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $374,470.00 $253,344.00 N/A $0.00 N/A
Total for all systems $3,204,256.00 $2,756,248.00 N/A $0.00 N/A
Interim Transmission Line $185,600.00 $126,227.50 $0.00
Rigid Transmission Line - copper, 6 1/8" broadband $185,600.00 $126,227.50 N/A N/A N/A
Primary Transmission Line $188,870.00 $127,116.50 $0.00
Rigid Transmission Line - copper, 6 1/8" $188,870.00 $127,116.50 N/A N/A N/A

Components

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $223,100.00 $400,755.00 N/A $0.00 N/A
Total for all systems $3,204,256.00 $2,756,248.00 N/A $0.00 N/A
Primary Tower TOWER $223,100.00 $400,755.00 $0.00
Tall Tower (greater than 500') $210,500.00 $393,755.00 See attached quote. N/A N/A
Structural engineering tower load study for well documented tower $12,600.00 $7,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $126,280.00 $121,250.00 N/A $0.00 N/A
Total for all systems $3,204,256.00 $2,756,248.00 N/A $0.00 N/A
Outside Professional Services $126,280.00 $121,250.00 $0.00
Progress Reporting $35,000.00 $35,000.00 Prepare and file 10 required progress reports on FCC Form 2100, Schedule 387 on a quarterly basis with the FCC. N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 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 and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $63,200.00 $60,000.00 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 request for Special Temporary Authorization $2,050.00 $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

Components

Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $82,695.00 $78,145.00 N/A $0.00 N/A
Total for all systems $3,204,256.00 $2,756,248.00 N/A $0.00 N/A
Other Expenses $82,695.00 $78,145.00 $0.00
Disposal Costs (for equipment and other waste, net of any salvage value) $41,145.00 $41,145.00 See transmitter quote for equipment removal from building. N/A N/A
DTV Medical Facility Notification $11,550.00 $7,000.00 N/A N/A N/A
MVPD Notification of Channel Change $1,000.00 $1,000.00 Notification will need to be made to MVPD's as required. Applicant to explore using an outside firm to determine which facilities will need to be notified and send the appropriate notification letters. N/A N/A
Equipment Storage $9,840.00 $9,840.00 Station may receive antenna and transmission line prior to tower crew availability. No on-site storage is available. Obtained estimate from manufacturer for 60 days of storage. N/A N/A
Equipment Delivery and Handling Charges $19,160.00 $19,160.00 See attached transmitter quote. Estimating $10,000 for two antennas and mounting pole. N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,204,256.00 $2,756,248.00 $0.00

Reimbursement Status

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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

Certification

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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.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

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

  3. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

  7. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite 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.

Larry D. Unger

President and CEO


08/10/2017

Attachments

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