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:
25382
Service:
DTV
Call Sign:
KWTV-DT
Channel:
25 (UHF)
File Number:
0000028014
FRN:
0015452238
Date Submitted:
09/25/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRIFFIN LICENSING, L.L.C.

Doing Business As: GRIFFIN LICENSING, L.L.C.

Trevor Wiseman

7401 N. KELLEY AVENUE

OKLAHOMA CITY, OK 73111

United States

+1 (405) 841-9106 trevor.wiseman@griffincommunications.net Limited Liability Company

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

The Preparer is same as the reimbursement contact.

 

 

 

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. Yes
Briefly describe transition plan Please see the attached Transition Plan 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 CDP3200P3
Year 2005
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 66 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 ULXTE-100
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 62.9 kW
Justification for New Transmitter Transmitter cannot be retuned to its post-auction channel. Please see attached "GatesAir_Channel_Change_Notice.pdf".

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
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

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? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top 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: 1000.0 kW
Manufacturer
Model ATW25H3-HTO-39S
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? Yes
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: 1000.0 kW
Manufacturer
Model TFU-22GTH/VP-R 06
Year 2018
Justification for New Antenna Antenna is slotted coaxial and cut to a single channel. As such, it is not retunable.

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 8 3/16 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

Information not provided.

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? Yes
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 26
Lower Limit 527.00 MHz
Upper Limit 539.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-26DSC/VP-R O4
Year 2018
Justification for New Antenna Interim antenna to operate lower on the tower on the post-auction channel in order to meet the construction deadline.

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? S
Feed Line Size 8 3/16 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

Enter a list of RF channel numbers.

RF Channel Number
25
23

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 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1860 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 8 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1860 feet per run
Justification for New Transmission Line Existing rigid line section length of 20 ft. is a prohibited length on the new channel 25.

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 8 3/16 inches
Segment Length 19 ½ '
Other Segment Length
Number of parallel runs 1
Length 1400 feet per run
Justification for New Transmission Line Interim transmission line to connect the transmitter to the interim antenna for the post-auction channel in order to meet the construction deadline.

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 Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1045226
Coordinates (NAD83) Latitude (NAD83) 35° 35' 52.1" N-
Longitude (NAD83) 097° 29' 23.2" W-
Overall Structure Height 1646.96 feet
Support Structure Height 1549.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 1102.02 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC.
Date Constructed 02/01/1999

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
84225 KOCM DTV
50205 KETA-TV DTV
66222 KFOR-TV DTV
38214 KSBI DTV
50182 KAUT-TV DTV
2566 KOPX-TV DTV

Other Types of Users

Users
K213EM 90.5MHz
KBRU 94.7MHz
KJYO 102.7MHz
KTST 101.9MHz
KXXY 96.1MHz

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 tower with candelabra
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 Candelabra
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Interim Installation

Install interim antenna and 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 850
Explanation Tower owner will have project manager assigned to coordinate installation. The station has multiple transmitter sites (4TV & 44TV Translators) and operates with minimal staff. It does not have personnel available or trained for any of these tasks/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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

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? Yes
Permit and Filing Costs Local Zoning Yes
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 Yes
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

Other Expenses

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Other Expenses Not Listed

Name Description

AirTech - Existing Cooler Move

Required to move existing transmitter (CH39) Glycol Fluid Cooler to make room for the new (CH25) Cooler for new transmitter install.

American Tower Other Costs

Broadcaster share of American Towers Cost(s): Outside RF consulting Engineering services Attorney and Other Outside Constultant Costs Other Professional Service Expenses Not Listed Site Coordination Meeting

Electrical Permit

Shawver Son Inc, Permit cost for electrical work.

Electrical work to remove Staco

Shawver Son Inc, to make room for new CH25 transmitter unit work was required to remove a staco unit previously used on the existing transmitter for CH39.

Equipment Storage

KWTV does not have a building large enough to store antenna, line, and items related to repack. Requires us to secure 3 x 53' trailers to securely store items at KWTV.

Extend Condenser Power and Controls

Shawver Son Inc, required work to extend existing transmitter cooling units to make room for new CH25 transmitter cooling units.

Interim Aux - Shared Combiner Components

Need waveguide, e-plane elbows and support components to hook up the shared combiner to the 2-channel antenna (Interim Aux)

Interim Aux 4 inch Line, Elbows, Flange Assy and Reducer

Interim Aux 4" Line Required to keep KWTV on air while replacing 8" transmission line.

Overtime

Shawver Son Inc - overtime for electrical work completed for new transmitter.

RF Plumbing Components

Interconnect Kit and System Bypass Switch required to switch between Main system and Interim system for transition.

Security Camera System

Tower site does not have security cameras. KWTV adding security cameras for security purposes of storing millions of dollars worth of repack at KWTV's building at tower site.

Tower King II Interim Aux EQ Offload

Tower King II - TOWER SERVICE Mobilize a 4 man crew from Cedar Hill TX to Oklahoma City OK to Offload and Store the Interim Aux / Main Antenna and 8" Line for the FCC Repack Antenna Change. April 26 through April 30, 2018.

Furnish and install 112.5kva Transformer

Shawver Son Inc, Furnish and Install 112.5kva transformer and ground both transformers as per code.

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 $1,978,754.33 $1,976,154.33 N/A $1,919,314.87 N/A
Total for all systems $5,158,720.67 $4,792,765.92 N/A $3,302,142.92 N/A
Primary Transmitter ULXTE-100 $1,978,754.33 $1,976,154.33 $1,919,314.87
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $95,610.00 Over cost estimate due to using original FCC PN for Catalog of Expenses DA-17-154A2. Quote was not available at the time of filing 399 form for verification.
UHF - Liquid Cooled Solid State Transmitter 62.9 kW $1,926,154.33 $1,926,154.33 N/A $1,808,544.87 03/05/2018 - Refer to Q-73489-20171108-1723-signed.pdf for Change Order to orignal quote KWTVULXTE100-082317rev2.pdf Quote #GA-00021839. GatesAir did a tech review of equipment order post original quote and needed to change some equipment = +$18,872.21.
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A $15,160.00 Over cost estimate due to using original FCC PN for Catalog of Expenses DA-17-154A2. Quote was not available at the time of filing 399 form for verification.

Components

Actual Information Description File Name
Switchgear - industrial 800 amp

Component Description:
Items 7,8,9,10 from Quote: Install new 1200amp 120/208 panel, funish 1200amp feed, add new 200 amp breaker in existing panel and feed to transmformer, run power circuits to new equipment as per panel schedule.
Amount:
$95,610.00
UHF - Liquid Cooled Solid State Transmitter 62.9 kW

Component Description:
Payment 3/3 for Transmitter.
Amount:
$610,188.59

Component Description:
1/3 Due Before Shipment Invoice for transmitter ULXTE-100.
Amount:
$602,323.51

Component Description:
Down payment for transmitter. 1/3 ARO.
Amount:
$596,032.77
Service entrance 3 phase/800 amp/208 volt

Component Description:
Item 3. and 4. on Quote: Install New 600 Amp feed from main power panel to new transformer and re-work new 600 Amp service to transformer.
Amount:
$15,160.00

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 $630,870.00 $569,112.50 N/A $354,967.36 N/A
Total for all systems $5,158,720.67 $4,792,765.92 N/A $3,302,142.92 N/A
Interim Antenna TFU-26DSC/VP-R O4 $319,390.00 $286,532.50 $201,936.46
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
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $13,582.50 N/A $34,164.46 Had to order additional cut pieces to plumb KWTV to it's interum aux and combiner.
New combiner, cost per channel (without antenna) $84,200.00 $55,000.00 Combiner 2-Channel Ch23/Ch25 KSBI Main / KW Interim. $27,225.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $4,224.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 26 bay,, 1000 kW input, horizontally polarized $184,800.00 $184,800.00 This is the price the antenna was quoted from the manufacture. $121,968.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $21,750.00 N/A $14,355.00 N/A
Primary Antenna TFU-22GTH/VP-R 06 $311,480.00 $282,580.00 $153,030.90
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $44,400.00 This antenna has a more complicated elbow complex due to being installed on a top mount of a candelabra tower. $21,978.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $4,224.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $231,780.00 Upgraded equipment. Station will bear the cost of the difference in price. $126,828.90 N/A

Components

Actual Information Description File Name
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
R64682 Elbow 8-75 EIA Digit for interim aux - Quote 1696158
Amount:
$3,600.00

Component Description:
Elbow Complex 8-75 EIA Digit 12 x24. Item No. 4 on Sales Order - 1696158
Amount:
$21,600.00

Component Description:
Elbow Complex 8-75 Digit KSBI/KWTV CH23/25 Standard Elbow Complex. Item No. 32 on invoice. 33% ARO
Amount:
$4,482.23

Component Description:
Elbow Complex 8-75 Digit KSBI/KWTV CH23/25 Standard Elbow Complex. Item No. 32 on invoice. 33% Prior to Shipping
Amount:
$4,482.23
New combiner, cost per channel (without antenna)

Component Description:
Combiner for Shared Antenna 2-Channel Ch23/Ch25 KSBI Main / KW Interim. Interconnect Kit, and System Bypass Switching. Items No. 26 on invoice. 33% Prior to Shipping.
Amount:
$13,612.50

Component Description:
Combiner for Shared Antenna 2-Channel Ch23/Ch25 KSBI Main / KW Interim. Interconnect Kit, and System Bypass Switching. Items No. 26 on invoice. 33% ARO
Amount:
$13,612.50
Sweep test of existing antenna

Component Description:
Sweep - One Field Engineer On-site. Item No. 56 on invoice. 33% ARO
Amount:
$2,112.00

Component Description:
Sweep - One Field Engineer On-site. Item No. 56 on invoice. 33% Prior to Shipping
Amount:
$2,112.00
UHF - High Power, Side Mount, basic slot antenna, 26 bay,, 1000 kW input, horizontally polarized

Component Description:
Side Mount Antenna TFU-26DSC Input CH23 KSBI (Main) / CH25 KWTV Interim. Item 29 & 30 on invoice. 33% ARO
Amount:
$60,984.00

Component Description:
Side Mount Antenna TFU-26DSC Input CH23 KSBI (Main) / CH25 KWTV Interim. Item 29 & 30 on invoice. 33% Prior to Shipping.
Amount:
$60,984.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Side Mount Brackets for High Power Antennas - Includes a Scatter Study Mounts TFU-26/DSC. Item 31 on invoice. 33% ARO
Amount:
$7,177.50

Component Description:
Side Mount Brackets for High Power Antennas - Includes a Scatter Study Mounts TFU-26/DSC. Item 31 on invoice. 33% Prior to Shipping
Amount:
$7,177.50
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
Elbow Complex 8-75 Digit KWTV Main & Feed Through Complex KWTV Main. Items No 4 & 5 on invoice. 33% Prior to Shipping
Amount:
$10,989.00

Component Description:
Elbow Complex 8-75 Digit KWTV Main & Feed Through Complex KWTV Main. Items No 4 & 5 on invoice. 33% ARO
Amount:
$10,989.00
Sweep test of existing antenna

Component Description:
Sweep - One Field Engineer On-site. Item No. 57 on invoice. 33% ARO
Amount:
$2,112.00

Component Description:
Sweep - One Field Engineer On-site. Item No. 57 on invoice. 33% Prior to Shipping
Amount:
$2,112.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Top Mount Main One-Channel Antenna - TFU-22GTH - CH25 KWTV/TOP Plate-Adapter; items No. 1 and 3 on invoice. 33% ARO. Does not include VPOL item 2 from invoice.
Amount:
$63,414.45

Component Description:
Top Mount Main One-Channel Antenna - TFU-22GTH - CH25 KWTV/TOP Plate-Adapter; items No. 1 and 3 on invoice. 33% Prior to Shipping. Does not include VPOL item 2
Amount:
$63,414.45

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 $1,131,220.00 $890,272.75 N/A $531,651.45 N/A
Total for all systems $5,158,720.67 $4,792,765.92 N/A $3,302,142.92 N/A
Interim Transmission Line $485,800.00 $340,314.75 $233,682.74
Rigid Transmission Line - copper, 8 3/16" $485,800.00 $340,314.75 N/A $233,682.74 N/A
Primary Transmission Line $645,420.00 $549,958.00 $297,968.71
Rigid Transmission Line - copper, 8 3/16" $645,420.00 $549,958.00 N/A $297,968.71 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 8 3/16"

Component Description:
R0006730502 - Hanger Hor 8 3/16 for line. Quote 1696158
Amount:
$2,501.25

Component Description:
RTLSCR8-15 Transmission Line Rigid 8/75 cut pieces - Quote 1696158
Amount:
$4,470.00

Component Description:
RTLSCR8-10 Transmission Line Rigid 8/75 cut pieces - Quote 1696158
Amount:
$2,103.75

Component Description:
Rigid Transmission Line and T/L 8-75 EIA Length 15' to 20' Fixed FLG 1 END/SWIVEL FLG 1 End. Items No. 33 & 37 on invoice. 33% Prior to Shipping
Amount:
$112,303.87

Component Description:
Rigid Transmission Line and T/L 8-75 EIA Length 15' to 20' Fixed FLG 1 END/SWIVEL FLG 1 End. Items No. 33 & 37 on invoice. 33% ARO
Amount:
$112,303.87
Rigid Transmission Line - copper, 8 3/16"

Component Description:
Rigid Transmission Line - copper T/L 8-75 and T/L 8-75 15' to 20' FIXED FLG 1 End/Swivel FLG 1 End. Item No 6 & 10 on invoice. 33% ARO
Amount:
$148,984.36

Component Description:
Rigid Transmission Line - copper T/L 8-75 and T/L 8-75 15' to 20' FIXED FLG 1 End/Swivel FLG 1 End. Item No 6 & 10 on invoice. 33% Prior to Shipping
Amount:
$148,984.35

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 $841,000.00 $819,550.00 N/A $306,613.50 N/A
Total for all systems $5,158,720.67 $4,792,765.92 N/A $3,302,142.92 N/A
Primary Tower GTOWER $841,000.00 $819,550.00 $306,613.50
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 Estimated cost for replacing stacked, top mount antenna and transmission line on candelabra. $103,988.50 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $19,550.00 As per American Tower Pricing sheet - see attachments $26,600.00 May have PO Line 4- Tower Permit Drawing and Tower Mapping for $4,700 and $12,400 in the wrong component section of 399. If needed I can move to appropriate section.
Interim Installation $400,000.00 $400,000.00 Install interim antenna and transmission line. $176,025.00 N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
MS1 25% Capital Contribution from broadcaster (KWTV-DT) for Major Tower Reinforcement/Mods. As per schedule / customer project cost estimation on page two in the PDF attached to this component. Reference 3-A-1.
Amount:
$11,588.50

Component Description:
Moved from Interim Install as per email 8/3/18 from Jean Hairston over to Complex Tower.
Amount:
$92,400.00
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Broadcast Tower Mapping
Amount:
$12,400.00

Component Description:
PO Line 4 - Tower Permit Drawing Package ATC ID 7400.
Amount:
$4,700.00

Component Description:
Broadcast Structural - Revised to include cover letter to explain why the entire line item is over estimated.
Amount:
$9,500.00
Interim Installation

Component Description:
Filed in the incorrect cost component. This has been re-entered in the Complex Tower Section. Please disregard this component in the Interim section of this 399.
Amount:
$92,400.00

Component Description:
Tower Services for Interim Aux Install. 45% Down Payment and Mobilization of Crew for the KWTV Repack.
Amount:
$75,600.00

Component Description:
Tower King II cost for line prep for temp line for KWTV transition and line layout for interim aux for repack transistion to CH 25. See KWTV Line Layout ProposalQuote and INV 3082 PDF in Attachments.
Amount:
$8,025.00

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 $288,095.00 $259,130.00 N/A $22,730.00 N/A
Total for all systems $5,158,720.67 $4,792,765.92 N/A $3,302,142.92 N/A
Outside Professional Services $288,095.00 $259,130.00 $22,730.00
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $0.00 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 request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $0.00 N/A $0.00 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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $0.00 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 $2,250.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,500.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $625.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,500.00 N/A
Project management of the transition $134,300.00 $121,380.00 Marsand - $111,900 American Tower - $9480 $10,855.00 N/A

Components

Actual Information Description File Name
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
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 Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application
Amount:
$2,250.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Perform engineering study for new channel assignment and antenna development - complex system: multi-channel, shared combiner, multi-tenant site
Amount:
$6,500.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
MS1 25% Capital Contribution from broadcaster (KWTV-DT) for Prof. Services: transition timing and coordination issues. As per schedule / customer project cost estimation on page two in the PDF attached to this component. Reference 1-A-1
Amount:
$625.00
Prepare and or review reimbursement form

Component Description:
Prepare and or review reimbursement form
Amount:
$2,500.00
Project management of the transition

Component Description:
PO Line 1 - NTP Billable - Project Mgmt - ATC Site 7400 for KWTV-DT 25382 transition.
Amount:
$9,480.00

Component Description:
PO LINE 3 - Building Permit Billable - Project Mgmt - ATC Site: 7400, KWTV FIN: 25382 tranistion
Amount:
$750.00

Component Description:
MS1 25% Capital Contribution from broadcaster (KWTV-DT) for Construction Project Management. As per schedule / customer project cost estimation on page two in the PDF attached to this component. Reference 3-D-1.
Amount:
$625.00

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 $288,781.34 $278,546.34 N/A $166,865.74 N/A
Total for all systems $5,158,720.67 $4,792,765.92 N/A $3,302,142.92 N/A
Other Expenses $288,781.34 $278,546.34 $166,865.74
Furnish and install 112.5kva Transformer $18,710.00 $18,710.00 Furnish and install new 112.5kva transformer. Ground both transformers as per code. $18,710.00 N/A
Tower King II Interim Aux EQ Offload $10,068.25 $10,068.25 TOWER SERVICE Mobilize a 4 man crew from Cedar Hill TX to Oklahoma City OK to Offload and Store the Interim Aux / Main Antenna and 8" Line for the FCC Repack Antenna Change. April 26 through April 30, 2018. $10,068.25 N/A
Security Camera System $3,625.35 $3,625.35 Tower site does not have security camera's on station transmission building complex. KWTV is adding security camera's to KWTV's building so to keep secure the repack equipment being stored during install. $3,887.31 Difference in estimated and actual cost was due to the need of adding two more camera's - reference the Amazon order.
RF Plumbing Components $65,703.75 $65,703.75 Interconnect kit and RF System Bypass Switch allowing switching between Main and Interim systems for transition. $43,364.48 N/A
Interim Aux - Shared Combiner Components $7,189.00 $7,189.00 Components - waveguide and elbows to hook up transmitter to shared combiner for 2-channel interim aux antenna. $7,058.56 N/A
Equipment Storage $3,113.00 $3,113.00 KWTV does not have a building to store antenna, line, and repack related items pre-installation. We have leased 3 x 53' tractor trailers to securely store repack equipment until they are installed on the tower. $3,113.00 One trailer stored back to KWTV Studio before having it delivered back to the Milestone Yard - unplanned. Kept third trailer longer than 2 months quoted. Charged extra for transport driver time due to a delay in personnel on pickup from studio / tower.
Electrical work to remove Staco $2,950.00 $2,950.00 Electrical work necessary to remove a staco unit from the CH39 transmitter to make room for equipment associated with the new CH25 transmitter. $2,950.00 N/A
Electrical Permit $250.00 $250.00 Permit necessary for electrician - Shawver Son Inc. $250.00 N/A
American Tower Other Costs $2,500.00 $2,500.00 Broadcaster share of American Towers Cost(s): Outside RF consulting Engineering services Attorney and Other Outside Constultant Costs Other Professional Service Expenses Not Listed Site Coordination Meeting $625.00 N/A
AirTech - Existing Cooler Move $2,880.00 $2,880.00 Existing Glycol Fluid Cooler for the CH39 transmitter needed to be moved to make space for the cooler system associated with our new CH25 transmitter. $2,880.00 N/A
MVPD Notification of Channel Change $500.00 $500.00 N/A $500.00 N/A
Develop and air announcement of upcoming channel change $43,000.00 $43,000.00 Cost estimates associated with outsourcing the production of the viewer announcements for the upcoming channel change. Refer to KWTV GMSRepackRescanEstimate.pdf in the attachments. N/A N/A
Equipment Delivery and Handling Charges $68,256.00 $68,256.00 Main Antenna - $22,318 Interm Aux - $22,318 Combiner - $6,320 Transmitter - $17,300 $57,746.35 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $26,000.00 $26,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $2,440.00 N/A $2,316.80 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $0.00 N/A N/A N/A
Local Zoning $7,450.00 $7,450.00 As per American Tower Pricing Sheet; see attachments - ATC Repack Services Pricing Includes: Zoning, Permitting, and Tower Permit Drawing Package. $0.00 N/A
Interim Aux 4 inch Line, Elbows, Flange Assy and Reducer $11,675.99 $11,675.99 Require to install a interim aux 4" line while replacing 8" transmission line for KWTV to stay on air. $11,675.99 N/A
Overtime $1,400.00 $1,400.00 N/A $1,400.00 N/A
Extend Condenser Power and Controls $320.00 $320.00 Necessary to extend and move out of the way the existing cooling condenser to make room for new cooling condenser units on new transmitter. $320.00 N/A

Components

Actual Information Description File Name
Furnish and install 112.5kva Transformer

Component Description:
Item 5 and 6 on Quote. Furnish and install new 112.5kva transformer. Ground both transformers as per code.
Amount:
$18,710.00
Tower King II Interim Aux EQ Offload

Component Description:
TOWER SERVICE Mobilize a 4 man crew from Cedar Hill TX to Oklahoma City OK to Offload and Store the Interim Aux / Main Antenna and 8" Line for the FCC Repack Antenna Change. April 26 through April 30, 2018.
Amount:
$10,068.25
Security Camera System

Component Description:
Network switch support/smartnet for Security Camera System at tower site for equpiment storage.
Amount:
$170.85

Component Description:
Network switch for Security Camera System at tower site for equpiment storage.
Amount:
$1,725.30

Component Description:
Tough Cbl Connectors and 1080P Camera's. See B&H Security Camera Quote and Invoice 141702772 attachment.
Amount:
$914.27

Component Description:
Dome Cameras and NVR. See B&H Security Camera Quote and Invoice 141661024 attachment.
Amount:
$616.69

Component Description:
Two cameras for security necessary to keep transmitter room secured where equipment is stored and being installed.
Amount:
$261.96

Component Description:
Ethernet Surge Protector. See B&H Security Camera Quote and Invoice 141633486 attachment.
Amount:
$65.94

Component Description:
Tough Cable Level 1 1000' box. See B&H Security Camera Quote and Invoice 141671461 attachment.
Amount:
$132.30
RF Plumbing Components

Component Description:
Interconnect Kit and System Bypass Switch required for switching between Main and Interim during transition. Item 27&28 on Dielectric Inv. 33% with order amount.
Amount:
$21,682.24

Component Description:
Interconnect Kit and System Bypass Switch required for switching between Main and Interim during transition. Item 27&28 on Dielectric Inv. 33% Prior to Shipping
Amount:
$21,682.24
Interim Aux - Shared Combiner Components

Component Description:
Components to hook up transmitter to shared combiner for 2-channel interim aux.
Amount:
$7,058.56
Equipment Storage

Component Description:
Revised w/cover letter - Milestone Leasing - Pick up trailers at KW Studio to deliver to Customer Location at Tower Site. Invoice #M00030546
Amount:
$587.50

Component Description:
Rent for trailer 3 of 3 for 7/1 - 7/13. Invoice M00035261.
Amount:
$83.34

Component Description:
M00032831 moves one trailer back to KW Studio from Tower Site for security purposes. Moves two trailers back to Milestone Yard. Requesting less due to credits owed on trailer U688651.
Amount:
$390.00

Component Description:
Montly rental of storage trailers to securely store transmission equipment and line for the period of 4/11 - 4/30 for invoice M00027747.
Amount:
$378.22

Component Description:
Montly rental of storage trailers to securely store transmission equipment and line for the period of 5/1 - 5/31 for invoice M00030173.
Amount:
$586.59

Component Description:
Montly rental of storage trailers to securely store transmission equipment and line for the period of 6/1 - 6/30 for invoice M00032629
Amount:
$567.35

Component Description:
Pick up trailer 3 of 3 from OKC to back to Milestone's yard. Invoice M00033118
Amount:
$130.00

Component Description:
Delivery to KWTV station 3 x 53' tractor trailers to securely store repack equipment. KW Equipment Storage Invoice_Quote_VendorW9_041618.pdf
Amount:
$390.00
Electrical work to remove Staco

Component Description:
Electrical work necessary to remove a staco unit from the CH39 transmitter to make room for equipment associated with the new CH25 transmitter. Item 2 on Quote.
Amount:
$2,950.00
Electrical Permit

Component Description:
Item 13 on Quote - Electrician permit - Shawver Son Inc.
Amount:
$250.00
American Tower Other Costs

Component Description:
MS1 25% Capital Contribution from broadcaster (KWTV-DT) for Outside RF Consulting and Other Professional Services. As per schedule / customer project cost estimation on page two in the PDF attached to this component. Reference 1-A-1, 1-A-3, 1-B-1
Amount:
$625.00
AirTech - Existing Cooler Move

Component Description:
Existing Glycol Fluid Cooler for the CH39 transmitter needed to be moved to make space for the cooler system associated with our new CH25 transmitter.
Amount:
$2,880.00
MVPD Notification of Channel Change

Component Description:
MVPD Notification Letter invoice. Refer to quote KWTV MVPD.pdf in the attachments of this 399 form.
Amount:
$500.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Delivery and Handling Charges

Component Description:
UPS NDA for four elbows shipped from storage.
Amount:
$3,904.12

Component Description:
UPS NDA for Hangers
Amount:
$2,051.41

Component Description:
UPS NDA for Test Transistion and One Elbow
Amount:
$2,164.29

Component Description:
FEDEX Freight For Three Cut Sections - Too long for overnight delivery.
Amount:
$1,265.69

Component Description:
Freight to KWTV SITE, Antenna and TL / Freight for AUX Combiner to KWTV SITE. Items No. 52-55 on invoice. 33% ARO
Amount:
$24,180.42

Component Description:
Freight to KWTV SITE, Antenna and TL / Freight for AUX Combiner to KWTV SITE. Items No. 52-55 on invoice. 33% Prior to Shipping.
Amount:
$24,180.42
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical Notification Letters invoice and quote. $0.70 a letter.
Amount:
$2,316.80
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Local Zoning Information not provided.
Interim Aux 4 inch Line, Elbows, Flange Assy and Reducer

Component Description:
Interim 4" line while replacing our 8" line for KWTV. See quote and invoice Dielectric 1083003 Quote and Invoice 141010.pdf.
Amount:
$11,675.99
Overtime

Component Description:
After hours work necessary to install new electrical service and panels for new transmitter - item 12 on Shawver Quote
Amount:
$1,400.00
Extend Condenser Power and Controls

Component Description:
Extend existing condenser power & controls to make room for new cooling units for CH25 transmitter. Item 1 on Quote.
Amount:
$320.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $5,158,720.67 $4,792,765.92 $3,302,142.92

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.

Trevor L Wiseman

VP of Technology


09/25/2018

Certification

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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).

  1. The Authorized Person signing below certifies and represents 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 certifies that the statements in this form and attached documentation are true, complete, and correct.

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

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

  5. 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 (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

  6. 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.

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

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

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

Trevor L Wiseman

VP of Technology


09/25/2018

Attachments

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