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

FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

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

(REFERENCE COPY - Not for submission)FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

File Number:
0000027516
FRN:
0001620178
Facility ID:
37444
Repack Channel:
17 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
08/30/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

LIFE OF VICTORY TV, INC.

Doing Business As: LIFE OF VICTORY TV, INC.

Linda D. Freeman

PO Box 1227

LEWISTON, ID 83501

United States

+1 (208) 413-2320 linda.gospeltv@gmail.com Corporation

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

Lincoln Thomason

Engineering Consultant

Bullet Proof Electronics, Inc.

Lincoln Thomason

8470 N Horseshoe Bend Rd

Boise, ID 83714

United States

+1 (208) 816-3842 bpe4electronics@gmail.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 Our transition plan consists of 7 phases, 1. CP filing, 2. File during 2nd Window, 3. Order verify and store equipment, 4. Tower work, 5. Install Transmitter and Test, 6. Commence broadcasting, 7. Terminate Ch #42 operations and remove equipment.

Transmitters

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

Primary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Primary (Main)
Description of Use  
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer BEXT
Model SCT-020U
Year 2004
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 00.10 kw
Other Transmitter Type  

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed  
New Mask Filter Power Other kw
Other Power .40
New Exciter Is a new exciter needed? No
Exciter Type

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
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service No
Description  
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Retune Exciter

Retuning of the existing transmitter's exciter to the new assigned channel. Includes parts, shipping and on channel verification tests.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use  
Change Type Lease New
Manufacturer
Model UAX 100
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 00.10 kw
Other Transmitter Type  
Justification for New Transmitter Repacking requires operation on both UHF channel 17 and 42 during the testing period the current transmitter is not capable of simultaneously TX on both. So renting in combination with retuning the existing equipment is most cost effective approach.

Interim 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
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service Yes
Description Installation of a temporary electrical service
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Rent

Renting of a UHF channel 17 transmitter will allow operation during the testing period and while the primary transmitter exciter and filter mask are being retuned.

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 Class A
Mounting Side-mount
Antenna position in stack Top
Polarization Horizontal
Type Other Type
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 Para-Panel
ERP: 2.61 kW
Manufacturer
Model 4DR-16S
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? 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? No
New Antenna Manufacturer and Type Class Class A
Mounting Side-mount
Antenna position in stack Top
Polarization Horizontal
Type Other Type
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 Quad Para-panel
ERP: 1.54 kW
Manufacturer
Model 4DR-16S
Year 2017
Justification for New Antenna The Pre-Auction Antenna (Ch 42) will not work on the Post auction Channel 17 (488-494 MHz) due to the antenna being frequency specific.

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? 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? 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

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 Utilize Existing
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 Andrew
Type Flexible Foam
Diameter 1 5/8 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 100 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Transmission line rental

Repacking requires operation on both UHF channels 17 & 42 during the testing period. Renting a transmission line temporary is the most cost effective approach. Then after the testing period & equipment retuning the existing line will be re-utilized.

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 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? Yes
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 46° 27' 03.5" N-
Longitude (NAD83) 117° 02' 03.5" W-
Overall Structure Height 40.00 feet
Support Structure Height 40.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 2871.00 feet
Structure Type UTOWER - Unguyed - Free Standing Tower
Tower Owner Idaho Public TV
Date Constructed 07/01/1997


Other Types of Users

Users
K17JR-D
K21CC-D
K24JN-D
K35BW-D
K44JC-D
K45FZ
K47BW
K49EU
K51HY-D

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: Minor 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

Rigging, Installation and Removal

1st stage consists of adding 2-3/8" dia. supports, mounting 4 - 4DR-4S antennas, installing power divider, distribution cabling & installing rented feed line by 10/19/19, 2nd stage removing the Ch 42 Antennas, equipment & rented feed line by 1/17/20.

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 290
Explanation KVBI is owned and operated by Life of Victory, Inc. a 501 C3 non profit, and does not currently staff personal with sufficient expertise to manage the repacking transition to Ch 17. So we must rely on outside project management 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 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 Yes
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 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

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

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? No
Permit and Filing Costs Local Zoning No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Antenna Price Reduction

Negative Adjustment Antenna Cost

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 $113,895.00 $11,495.00 N/A $0.00 N/A
Total for all systems $592,995.00 $111,861.00 N/A $41,898.61 N/A
Interim Transmitter UAX 100 $5,940.00 $5,940.00 $0.00
UHF - Air Cooled Solid State Transmitter 00.10 kW $0.00 $0.00 The reason that this estimate is $0.00 is because it's the per-auction transmitter. Estimated costs to utilize this existing transmitter are itemized separately. See “Retune Exciter” & “Other .40 kW mask filter” Descriptions for associated estimates. N/A N/A
Other Electrical Service: Installation of a temporary electrical service $450.00 $450.00 Installation of a temporary electrical service to facilitate the leased transmitter during the testing period and retuning phase is required. Followed by the subsequent removal of the electrical service upon completion of lease. N/A N/A
Transmitter Rent $5,490.00 $5,490.00 Rental of transmitter equipment to begin not later than 10/1/19 and to continue at a rate $1,372.50 per month until transition is complete. The worst case rental duration is four months. N/A N/A
Primary Transmitter SCT-020U $107,955.00 $5,555.00 $0.00
UHF and VHF - minor banding issues $102,400.00 $0.00 N/A N/A N/A
Other .40 kW mask filter $1,875.00 $1,875.00 Retuning of the existing transmitter's output filter mask to the new assigned channel. Includes shipping and on channel verification tests. N/A N/A
Retune Exciter $3,680.00 $3,680.00 Retuning of the existing transmitter's exciter to the new assigned channel. Includes parts, shipping and on channel verification tests. 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 $32,150.00 $10,744.00 N/A $5,744.00 N/A
Total for all systems $592,995.00 $111,861.00 N/A $41,898.61 N/A
Primary Antenna 4DR-16S $32,150.00 $10,744.00 $5,744.00
Sweep test of existing antenna $6,550.00 $5,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $25,600.00 $5,744.00 N/A $5,744.00 The original Quote was for $6,991. So our Estimated cost was $6,991. However one of our suppliers has reduced the amount by $947 or 14.15 % making the actual final cost for the antenna $5744.

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
The system has invoice 2680-23 listed twice. We are unable to remove the duplication so we are entering a negative amount to correct the error.
Amount:
($5,744.00)

Component Description:
Antenna for KVBI-CD Facility ID: 37444
Amount:
$5,744.00

Component Description:
Reimbursement of actual final cost which equals $5,744
Amount:
$5,744.00

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 $1,072.00 $1,072.00 N/A $0.00 N/A
Total for all systems $592,995.00 $111,861.00 N/A $41,898.61 N/A
Primary Transmission Line $1,072.00 $1,072.00 $0.00
Transmission line rental $1,072.00 $1,072.00 Repacking requires operation on both UHF ch 17 & 42 during the testing period. Renting a transmission line temporarily is the most cost effective approach. Then after the testing period & equipment retuning the existing line will be re-utilized. 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 $259,550.00 $23,850.00 N/A $0.00 N/A
Total for all systems $592,995.00 $111,861.00 N/A $41,898.61 N/A
Primary Tower UTOWER $259,550.00 $23,850.00 $0.00
Rigging, Installation and Removal $11,850.00 $11,850.00 N/A N/A N/A
Short Tower (less than 500') $81,900.00 $0.00 N/A N/A N/A
Minor tower reinforcement/modifications $153,500.00 $0.00 N/A N/A N/A
Structural engineering tower load study for well documented tower $12,300.00 $12,000.00 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 $181,620.00 $60,000.00 N/A $36,154.61 N/A
Total for all systems $592,995.00 $111,861.00 N/A $41,898.61 N/A
Outside Professional Services $181,620.00 $60,000.00 $36,154.61
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A $7,000.00 N/A
Comprehensive coverage verification via field study, if needed $81,900.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,305.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,120.00 $5,000.00 N/A $5,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,535.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $3,000.00 N/A $3,000.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,560.00 $2,500.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,240.00 $0.00 N/A N/A N/A
Project management of the transition $44,660.00 $36,250.00 N/A $18,654.61 N/A
Prepare and or review reimbursement form $2,560.00 $2,500.00 N/A $2,500.00 N/A
RF Exposure Measurements $20,500.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Perform engineering study for new channel assignment and antenna development

Component Description:
Performed engineering study for new channel assignment and antenna development for UHF Channel 17 KVBI-CD
Amount:
$7,000.00

Component Description:
The engineering study for the new channel assignment and the antenna development for UHF Channel 17 has been completed.
Amount:
$7,000.00
Comprehensive coverage verification via field study, if needed 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 cost for preparation and filing of Form 2100 Construction Permit.
Amount:
$5,000.00
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

Component Description:
The engineering section was completed and construction permit was filed, so 100% of the amount is requested.
Amount:
$3,000.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
Project management of the transition

Component Description:
This constitutes 19.96 % of the est. Project Management funds. These last several months have included: Engineering study & antenna development, antenna procurement as well as vendor coordination which has required more project management time.
Amount:
$7,235.86

Component Description:
This constitutes 19.96 % of the est. Project Management funds. These last several months have included: Engineering study & antenna development, antenna procurement as well as vendor coordination which has required more project management time.
Amount:
$7,235.86

Component Description:
Disproportionate percentage as compared to the timeline is due to the fact that these early stages (Engineering, Legal, filing CP and 399 Forms) have required more management time.
Amount:
$11,418.75
Prepare and or review reimbursement form

Component Description:
All the preparation and review has been completed and the 399 Form has been filed.
Amount:
$2,500.00
RF Exposure Measurements 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 $4,708.00 $4,700.00 N/A $0.00 N/A
Total for all systems $592,995.00 $111,861.00 N/A $41,898.61 N/A
Other Expenses $4,708.00 $4,700.00 $0.00
Antenna Price Reduction $0.00 $0.00 The original Quote was for $6,991. However one of our suppliers has reduced the amount by $947 or 14.15 % making the actual cost for the antenna $5744. N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,070.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $333.00 $325.00 N/A N/A N/A
Equipment Delivery and Handling Charges $375.00 $375.00 N/A N/A N/A
Equipment Storage $1,430.00 $1,430.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,250.00 $1,250.00 N/A N/A N/A
MVPD Notification of Channel Change $250.00 $250.00 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 $592,995.00 $111,861.00 $41,898.61

Construction Status

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Question Response
Is construction complete? 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.

Lincoln Thomason

Engineering Consultant


08/30/2018

Attachments

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