Applicant | Address | Phone | Applicant Type | |
---|---|---|---|---|
PERMIAN BASIN PUBLIC TELECOMMUNICATIONS, INC. Doing Business As: KPBT-TV |
Jazmin Shotts P.O. BOX 8940 MIDLAND, TX 79708 United States |
+1 (432) 563-5728 | jshotts@basinpbs.org | Not-for-Profit |
Applicant | Address | Phone | |
---|---|---|---|
[Confidential] |
|
|
|
Applicant | Address | Phone | |
---|---|---|---|
David Sanderford Marsand, Inc. |
David Sanderford 1957 Reynolds Dr Azle, TX 76020 United States |
+1 (817) 783-5566 | david@marsand.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 | See attached Transition Plan Narrative. |
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 | 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 | DHD60P2 | |
Year | 2001 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power Capacity | 14 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Manufacturer | ||
Model | THU9-12Evo | |
Transmitter Type | Solid State | |
Solid State Cooling | Liquid Cooled | |
Solid State Power capacity | 19 kW | |
Justification for New Transmitter | Solid State Power Capacity is "pre-mask filter". See attached Transition Plan Narrative. |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | Yes |
Switchgear (industrial 800 amp) | Yes | |
Transformer (480V) | Yes | |
Power | 300 kVA | |
Rigid Conduit and Wiring | Yes | |
Size | 3 inches | |
Length | 180.0 feet | |
Other Electrical Service | Yes | |
Description | Build out electrical to accommodate the addition of the existing UPS and generator and then move the UPS and generator after the transition to comply with WARN act. | |
HVAC Service | Does the replacement transmitter require HVAC Service? | Yes |
Type | Cooling Only | |
Size | 10 tons | |
Other Size | N/A | |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | Yes |
Size | 800.0 square feet | |
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 |
---|---|
Remove Existing Equipment |
Remove pre-auction channel transmitter and interior RF system. |
Transmitter Installation |
Installation, commissioning and proof of performance documentation. |
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? | No | |
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: | 220.0 kW | |
Manufacturer | ||
Model | ATL20H3-HSO-38 | |
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: | 500.0 kW | |
Manufacturer | ||
Model | SAA28-ATW_P3-J300-ES6R-28 | |
Year | 2018 | |
Justification for New Antenna | See attached Transition Plan Narrative. |
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? | 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 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 |
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 | 315 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 | 4 inches | |
Other Diameter | N/A | |
Segment Length | N/A | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 900 feet per run | |
Justification for New Transmission Line | See attached Transition Plan Narrative. |
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? | No | |
Is this tower currently shared with any other stations? | Yes | |
One or more FM, AM or TV radio broadcaster(s) | No | |
Others Types of Users | Yes | |
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 | 1215312 | |
Coordinates (NAD83) | Latitude (NAD83) | 31° 53' 50.3" N- |
Longitude (NAD83) | 102° 20' 15.5" W- | |
Overall Structure Height | 367.78 feet | |
Support Structure Height | 350.06 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 2917.62 feet | |
Structure Type | MAST - Mast | |
Tower Owner | Gray Television Group, Inc. | |
Date Constructed | 12/23/2000 |
Users |
---|
KOSA-TV STL |
K238AZ FM Trans |
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: | No reinforcements needed |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
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? | 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 | No | |
Is tower documented for structural analysis? | Yes | |
Is tower compliant with Rev G? | Unknown | |
Existing Tower Structure Registration | Do you have a tower registration number? | Yes |
ASR Number | 1053361 | |
Coordinates (NAD83) | Latitude (NAD83) | 32° 05' 11.0" N- |
Longitude (NAD83) | 102° 17' 12.0" W- | |
Overall Structure Height | 1131.88 feet | |
Support Structure Height | 1030.17 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 2909.09 feet | |
Structure Type | GTOWER - Guyed Structure Used for Communication Purposes | |
Tower Owner | Subcarrier Communications Inc | |
Date Constructed | 01/01/1963 |
Facility ID | Call Sign | Service |
---|---|---|
41856 | KMRK-FM | FM |
65306 | KMCM | FM |
9667 | KCRS-FM | FM |
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: | 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 | 350 | |
Explanation | Please see attached Transition Plan Narrative. | |
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 | No |
RF exposure measurements | No | |
Additional Field Engineering Service | No | |
Number of Days | N/A | |
Justification | N/A |
Name | Description |
---|---|
Site Survey |
Required for specifying the final equipment needs and installation planning. |
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? | 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 |
Name | Description |
---|---|
Studio to Transmitter Link |
Fiber or microwave radio connection from the studio to the transmitter site. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $1,057,560.00 | $795,630.11 | N/A | $205,458.74 | N/A |
Total for all systems | $2,004,640.00 | $1,622,985.11 | N/A | $294,971.97 | N/A |
Primary Transmitter THU9-12Evo | $1,057,560.00 | $795,630.11 | $205,458.74 | ||
Other Electrical Service: Build out electrical to accommodate the addition of the existing UPS and generator and then move the UPS and generator after the transition to comply with WARN act. | $94,025.00 | $94,025.00 | Please see attached quotations for generator and UPS decommissioning, move and commissioning. | $47,685.49 | N/A |
Transmitter Installation | $30,000.00 | $30,000.00 | Please see attached transmitter installation quotation. | N/A | N/A |
Remove Existing Equipment | $15,000.00 | $15,000.00 | Dismantle and remove the transmitter and interior RF components. | N/A | N/A |
Other -- Building Addition Size: 800.0 | $96,875.00 | $96,875.00 | See attached Building Modification quote. | $59,787.50 | N/A |
10 Ton system | $38,900.00 | $14,645.80 | See attached HVAC quote (6 ton system). | N/A | N/A |
3" Rigid Conduit and Wiring (Cost per foot) | $9,360.00 | $8,820.00 | N/A | N/A | N/A |
Transformer 3 phase/480v - 300 KVA | $36,800.00 | $35,000.00 | N/A | N/A | N/A |
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW | $684,000.00 | $451,264.31 | See attached transmitter quotation. | $97,985.75 | N/A |
Service entrance 3 phase/800 amp/208 volt | $14,400.00 | $13,700.00 | N/A | N/A | N/A |
Switchgear - industrial 800 amp | $38,200.00 | $36,300.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
Other Electrical Service: Build out electrical to accommodate the addition of the existing UPS and generator and then move the UPS and generator after the transition to comply with WARN act. | |
Transmitter Installation | Information not provided. |
Remove Existing Equipment | Information not provided. |
Other -- Building Addition Size: 800.0 | |
10 Ton system | Information not provided. |
3" Rigid Conduit and Wiring (Cost per foot) | Information not provided. |
Transformer 3 phase/480v - 300 KVA | Information not provided. |
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW | |
Service entrance 3 phase/800 amp/208 volt | Information not provided. |
Switchgear - industrial 800 amp | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $177,640.00 | $172,350.00 | N/A | $0.00 | N/A |
Total for all systems | $2,004,640.00 | $1,622,985.11 | N/A | $294,971.97 | N/A |
Primary Antenna SAA28-ATW_P3-J300-ES6R-28 | $177,640.00 | $172,350.00 | $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 |
Side mount brackets for high power antennas (if not included in antenna base cost) | $23,150.00 | $18,450.00 | See attached antenna quotation. | 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, 500 kW input, directional,, elliptically or circularly polarized | $142,500.00 | $142,500.00 | See attached antenna quotation (cost for comparable Hpol only antenna). | N/A | N/A |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $66,600.00 | $30,000.00 | N/A | $0.00 | N/A |
Total for all systems | $2,004,640.00 | $1,622,985.11 | N/A | $294,971.97 | N/A |
Primary Transmission Line | $66,600.00 | $30,000.00 | $0.00 | ||
Flexible Air Transmission Line - dielectric, 4" | $66,600.00 | $30,000.00 | See attached antenna quotation. | N/A | N/A |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $491,600.00 | $418,555.00 | N/A | $78,353.23 | N/A |
Total for all systems | $2,004,640.00 | $1,622,985.11 | N/A | $294,971.97 | N/A |
Primary Tower GTOWER | $381,100.00 | $362,000.00 | $61,798.23 | ||
Minor tower reinforcement/modifications | $158,000.00 | $150,000.00 | N/A | $10,700.75 | N/A |
Structural engineering tower load study for well documented tower | $12,600.00 | $12,000.00 | N/A | $4,000.00 | N/A |
Tall Tower (greater than 500') | $210,500.00 | $200,000.00 | Installation of antenna and transmission line. | $47,097.48 | N/A |
Primary Tower MAST | $110,500.00 | $56,555.00 | $16,555.00 | ||
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | $26,300.00 | $16,555.00 | See attached series of invoices labeled Initial Tower Studies | $16,555.00 | N/A |
Short Tower (less than 500') | $84,200.00 | $40,000.00 | This tower is not able to be brought into conformance with the TIA-222-G specification. Existing antenna and transmission line removal only post-transition. | N/A | N/A |
Actual Information Description | File Name |
---|---|
Minor tower reinforcement/modifications | |
Structural engineering tower load study for well documented tower | |
Tall Tower (greater than 500') | |
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | |
Short Tower (less than 500') | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $94,490.00 | $90,250.00 | N/A | $11,160.00 | N/A |
Total for all systems | $2,004,640.00 | $1,622,985.11 | N/A | $294,971.97 | N/A |
Outside Professional Services | $94,490.00 | $90,250.00 | $11,160.00 | ||
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | N/A | $690.00 | N/A |
Site Survey | $10,000.00 | $10,000.00 | Please see attached Site Survey quotation. | $3,000.00 | 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 |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $2,250.00 | N/A | $1,620.00 | 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 |
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 | $5,850.00 | N/A |
Project management of the transition | $55,300.00 | $52,500.00 | Please see attached Project Management quotation. | N/A | N/A |
Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | 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 |
Actual Information Description | File Name |
---|---|
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | |
Site Survey | |
Attorney Fees - Negotiation of lease and other matters for shared locations | Information not provided. |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | Information not provided. |
Perform engineering study for new channel assignment and antenna development | |
Project management of the transition | Information not provided. |
Prepare and or review reimbursement form | Information not provided. |
Address transition timing and coordination issues w/ other stations and wireless | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $116,750.00 | $116,200.00 | N/A | $0.00 | N/A |
Total for all systems | $2,004,640.00 | $1,622,985.11 | N/A | $294,971.97 | N/A |
Other Expenses | $116,750.00 | $116,200.00 | $0.00 | ||
Studio to Transmitter Link | $60,000.00 | $60,000.00 | Construct fiber "last mile" connection for STL link (preferred). Microwave radio link is more expensive. | N/A | N/A |
MVPD Notification of Channel Change | $1,200.00 | $1,200.00 | N/A | N/A | N/A |
Develop and air announcement of upcoming channel change | $6,000.00 | $6,000.00 | N/A | N/A | N/A |
Equipment Delivery and Handling Charges | $23,000.00 | $23,000.00 | Freight for antenna and transmission line. Offloading equipment rental and labor. | N/A | N/A |
Disposal Costs (for equipment and other waste, net of any salvage value) | $15,000.00 | $15,000.00 | Disposal of old transmitter, antenna, line and misc. electrical. | 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 | $2,004,640.00 | $1,622,985.11 | $294,971.97 |
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. | Jazmin Shotts Interim GM 04/02/2018 |
Section | Question | Response |
---|---|---|
Submission of Actual Cost Documentation Statements | WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733). |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Jazmin Shotts Interim GM 04/02/2018 |