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:
51102
Service:
DTV
Call Sign:
KOZK
Channel:
16 (UHF)
File Number:
0000027902
FRN:
0002487056
Date Submitted:
03/14/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

BOARD OF GOVERNORS OF MISSOURI STATE UNIVERSITY

Doing Business As: BOARD OF GOVERNORS OF MISSOURI STATE UNIVERSITY

Tammy Wiley

901 S. NATIONAL AVE.

SPRINGFIELD, MO 65897

United States

+1 (417) 836-5878 TAMMYWILEY@MISSOURISTATE.EDU 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

Matthew Anderson Sanderford , Jr. .

President

Marsand, Inc. 211 Pack Saddle Trail Weatherford, TX 76088

Matthew Sanderford

211 Pack Saddle Trail

Weatherford, TX 76088

United States

+1 (817) 783-5566 engineering@marsand.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 See attached narrative transition plan.

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 DHD20P1
Year 2003
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 5.5 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? No
Manufacturer
Model THU9-4
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.5 kW
Justification for New Transmitter Existing transmitter is not supported by manufacturer for retune.

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 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

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

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? 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 2
Number of Panels/Bays 16
Lower Limit 500.00 MHz
Upper Limit 626.00 MHz
Design power capacity in use 60.0 %
Other Antenna Type N/A
ERP: 85.0 kW
Manufacturer
Model RD-16RFS(OM)-500626-SL
Year 2017
Justification for New Antenna Interim antenna used as contingence plan only in the event extensive tower modification and main transmission line replacement can not be completed by November 2018.

Interim Antenna

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Other Antenna Costs

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? 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

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 Other
Other Segment Length 18.4 feet
Number of parallel runs 1
Length 1942 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 Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 2100 feet per run
Justification for New Transmission Line Existing transmission line stick length does not support CH16. Broadband length will accommodate both Ch 23 and Ch 16.

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 Flexible Air
Diameter 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 1100 feet per run
Justification for New Transmission Line Interim transmission line used as contingence plan only in the event extensive tower modification and main transmission line replacement can not be completed by November 2018.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Interim Line and Antenna Installation

Cost to install interim line and antenna

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? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1007736
Coordinates (NAD83) Latitude (NAD83) 37° 10' 11.0" N-
Longitude (NAD83) 092° 56' 31.0" W-
Overall Structure Height 1959.62 feet
Support Structure Height 1893.35 feet
Ground Elevation Above Mean Sea Level (AMSL) 1564.94 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Board of Governors of Missouri State University
Date Constructed 08/01/2003


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: Serious 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

Name Description

Transmission Line Change Out

Cost to replace transmission line.

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 200
Explanation The station has multiple transmitter sites (2 TV) and operates with minimal staff. It does not have personnel available for any of these tasks, nor is the staff trained to provide any of these services.
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

Site Survey

Site visit to determine final equipment needs and installation planning

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? No
Does this relocation require Equipment Storage? No
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

Other Expenses

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Other Expenses Not Listed

Name Description

site check

Site check to determine constraints and installation of transmitter requirements

Required bid advertising

Advertising costs are incurred as state statutes require projects/equipment with a value of $100,000 or greater be advertised to reach potential bidders.

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 $273,500.00 $260,000.00 N/A $236.25 N/A
Total for all systems $2,500,980.00 $3,390,670.00 N/A $39,923.68 N/A
Primary Transmitter THU9-4 $273,500.00 $260,000.00 $236.25
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $260,000.00 Final quote not received. Maximum estimate used in its place. $236.25 N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
Portion of bill for state-required transmitter advertising for KOZK.
Amount:
$236.25

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 $56,730.00 $56,400.00 N/A $0.00 N/A
Total for all systems $2,500,980.00 $3,390,670.00 N/A $39,923.68 N/A
Interim Antenna RD-16RFS(OM)-500626-SL $56,730.00 $56,400.00 $0.00
UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 85 kW input, horizontally polarized $50,000.00 $50,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A

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 $652,100.00 $625,700.00 N/A $0.00 N/A
Total for all systems $2,500,980.00 $3,390,670.00 N/A $39,923.68 N/A
Interim Transmission Line $164,900.00 $161,600.00 $0.00
Flexible Air Transmission Line - dielectric, 3" $64,900.00 $61,600.00 N/A N/A N/A
Interim Line and Antenna Installation $100,000.00 $100,000.00 N/A N/A N/A
Primary Transmission Line $487,200.00 $464,100.00 $0.00
Rigid Transmission Line - copper, 6 1/8" broadband $487,200.00 $464,100.00 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 $1,387,420.00 $2,321,320.00 N/A $24,080.90 N/A
Total for all systems $2,500,980.00 $3,390,670.00 N/A $39,923.68 N/A
Primary Tower TOWER $1,387,420.00 $2,321,320.00 $24,080.90
Transmission Line Change Out $112,320.00 $112,320.00 Cost assumes tower has been rigged as part of tower modifications. $0.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $9,000.00 N/A $8,240.00 N/A
Tall Tower (greater than 500') $210,500.00 $0.00 Tower Rigging cost is include in tower modification cost. N/A N/A
Serious tower reinforcement/modifications $1,052,000.00 $2,200,000.00 See station transition plan $15,840.90 N/A

Components

Actual Information Description File Name
Transmission Line Change Out Information not provided.
Structural engineering tower load study for well documented tower

Component Description:
Tower Analysis
Amount:
$8,240.00
Tall Tower (greater than 500') Information not provided.
Serious tower reinforcement/modifications

Component Description:
Portion of bill for state-required advertising for tower modification bids.
Amount:
$534.90

Component Description:
Down Payment for TCI services needed for tower modifications.
Amount:
$15,306.00

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 $69,680.00 $66,250.00 N/A $15,606.53 N/A
Total for all systems $2,500,980.00 $3,390,670.00 N/A $39,923.68 N/A
Outside Professional Services $69,680.00 $66,250.00 $15,606.53
Site Survey $10,000.00 $10,000.00 N/A $0.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $0.00 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 $678.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $0.00 N/A
Project management of the transition $31,600.00 $30,000.00 N/A $5,312.75 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,204.50 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,161.28 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,250.00 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

Components

Actual Information Description File Name
Site Survey Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal Fees related to Construction Permit
Amount:
$228.00

Component Description:
Legal Fees related to Construction Permit
Amount:
$450.00
Prepare request for Special Temporary Authorization Information not provided.
Project management of the transition

Component Description:
Portion of the bill for Project Management
Amount:
$2,500.00

Component Description:
Legal Project Management Fees
Amount:
$194.00

Component Description:
Legal Project Management Fees
Amount:
$631.00

Component Description:
Legal Fees related to Project Management for KOZK.
Amount:
$24.25

Component Description:
Legal Fees for Project Management
Amount:
$194.00

Component Description:
Legal Project Management Fees
Amount:
$361.50

Component Description:
Legal fees related to Project Management
Amount:
$237.50

Component Description:
Legal Fees for Project Management
Amount:
$1,073.50

Component Description:
Legal fees for Project Management
Amount:
$97.00
Prepare and or review reimbursement form

Component Description:
Legal Fees-preparation/review of Form 399
Amount:
$616.00

Component Description:
Legal Fees related to preparation/review of Form 399.
Amount:
$588.50
Perform engineering study for new channel assignment and antenna development

Component Description:
Portion of bill for engineering study
Amount:
$4,500.00

Component Description:
Engineering Services for channel assignment and antenna development
Amount:
$1,661.28
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare Engineering for CP
Amount:
$2,250.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application 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 $61,550.00 $61,000.00 N/A $0.00 N/A
Total for all systems $2,500,980.00 $3,390,670.00 N/A $39,923.68 N/A
Other Expenses $61,550.00 $61,000.00 $0.00
Required bid advertising $4,000.00 $4,000.00 State of Missouri statutes require advertising for projects/equipment with a value of $100,000 or greater. N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $20,000.00 $20,000.00 Remove existing Sigma Diamond CD transmitter to make room for new transmitter, including Glycol draining and disposal. N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 Spot creation, talent, production. N/A N/A
MVPD Notification of Channel Change $11,000.00 $11,000.00 Send notification to cable companies, MVPD locations, follow up on signal reception after repack switch. N/A N/A
site check $10,000.00 $10,000.00 N/A 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 $2,500,980.00 $3,390,670.00 $39,923.68

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.

James Baker , Dr. .

VP, Missouri State University


03/14/2018

Attachments

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