| Applicant | Address | Phone | Applicant Type | |
|---|---|---|---|---|
|
ION MEDIA KNOXVILLE LICENSE, INC. Doing Business As: ION MEDIA KNOXVILLE LICENSE, INC. |
Bianca Frye 601 Clearwater Park Road West Palm Beach, FL 33401 United States |
+1 (561) 682-4110 | BiancaFrye@ionmedia.com | Corporation |
| Applicant | Address | Phone | |
|---|---|---|---|
|
[Confidential] |
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| Applicant | Address | Phone | |
|---|---|---|---|
|
The Preparer is same as the reimbursement contact. |
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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 | Install a broadband interim antenna and operate using current transmitter on pre repack channel. Install a new transmitter, combiner and RF system. Current broadband transmission line and antenna can be used for post repack channels. |
| 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 | DCX | |
| Year | 2000 | |
| Type | Inductive Output Tube | |
| IOT Power Type | Two | |
| Power Capacity | 40 kW |
| Section | Question | Response |
|---|---|---|
| New Transmitter | Use | Primary (Main) |
| Change Type | Purchase New | |
| Is this a request for upgraded equipment? | Yes | |
| Manufacturer | ||
| Model | HPTV-PRLX-U30 | |
| Transmitter Type | Solid State | |
| Solid State Cooling | Liquid Cooled | |
| Solid State Power capacity | 48.5 kW | |
| Justification for New Transmitter | See attached Transmitter Exhibits. See attached Transmitter Upgrade Disclaimer. |
| Section | Question | Response |
|---|---|---|
| Electrical Service | Service Entrance (3 phases 800A 208V) | No |
| Switchgear (industrial 800 amp) | No | |
| Transformer (480V) | Yes | |
| Power | 500 kVA | |
| 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? | Yes |
| Type | Cooling Only | |
| Size | 5 tons | |
| 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 |
| Name | Description |
|---|---|
Removal of Existing Equipment |
Removal of existing transmitters and equipment / Site Prep |
RF Interconnect |
Interconnect between RF system and transmission line |
| Section | Question | Response |
|---|---|---|
| Antenna Related Expenses | Do you have antenna related expenses? | Yes |
| Section | Question | Response |
|---|---|---|
| Existing Antenna Description | Type of change | Retune Existing |
| Antenna Use | Primary (Main) | |
| Description of Use | N/A | |
| Ownership | Leased | |
| Owner | Amercian Tower | |
| Site | N/A | |
| Is this antenna currently shared with any other stations? | Yes | |
| Is this antenna directional? | No | |
| 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 | Broadband Panel | |
| Number of Stations Supported | 3 | |
| Number of Panels | 16 | |
| Design power capacity in use | 75.0 % | |
| Lower Limit | 470.00 MHz | |
| Upper Limit | 698.00 MHz | |
| Other Antenna Type | N/A | |
| ERP: | 1000.0 kW | |
| Manufacturer | Dielectric | |
| Model | TUDO5-16/80H-2-B | |
| Year | 2010 |
| Facility ID | Call Sign |
|---|---|
| 71082 | WATE-TV |
| 19200 | WTNZ |
| Section | Question | Response |
|---|---|---|
| Sweep Test of Existing Antenna | Do you need a sweep test of existing antenna? | Yes |
| Section | Question | Response |
|---|---|---|
| Combiner for Shared Antenna | Do you need a Combiner for a Shared Antenna? | Yes |
| Type | New | |
| Number of channels supported | 3 | |
| Frequencies of channels supported | RF channel | |
| Frequency | N/A |
| RF Channel Number |
|---|
| 26 |
| 15 |
| 18 |
| Name | Description |
|---|---|
Combiner installation |
Combiner installation/reconfiguration and installation material |
| 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? | Yes | |
| Is antenna directional? | Yes | |
| 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 | 3 | |
| Number of Panels/Bays | 16 | |
| Lower Limit | 470.00 MHz | |
| Upper Limit | 698.00 MHz | |
| Design power capacity in use | 75.0 % | |
| Other Antenna Type | N/A | |
| ERP: | 250.0 kW | |
| Manufacturer | ||
| Model | TFU-WB-16 | |
| Year | 2017 | |
| Justification for New Antenna | Final design of equip isn't complete, ION included estimates based on current understanding of design. 2 repack stations share equip, ION responsible for 50% of the costs assoc with shared equip. See AT and Shared Equipment Exhibits for more information. |
| 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? | B | |
| Feed Line Size | 6 1/8 inches | |
| Side Mount Brackets | Do you require the separate purchase of side mount brackets for an antenna? | No |
| Pattern Scatter Analysis | Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? | No |
| Sweep Test | Do you require the sweep testing of transmission line and antenna? | Yes |
| 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 | Utilize Existing |
| Use | Primary (Main) | |
| Description of Use | N/A | |
| Ownership | Leased | |
| Owner | American Tower | |
| Site | N/A | |
| Is the existing transmission line shared with another station or stations? | Yes | |
| Is Transmission Line in operating condition? | Yes | |
| Existing Transmission Line Manufacturer and Type | Manufacturer | Dielectric |
| Type | Rigid | |
| Diameter | 8 3/16 inches | |
| Other Diameter | N/A | |
| Segment Length | Broadband | |
| Other Segment Length | N/A | |
| Number of parallel runs | 2 | |
| Length | 1514 feet per run |
| Facility ID | Call Sign |
|---|---|
| 71082 | WATE-TV |
| 19200 | WTNZ |
| Name | Description |
|---|---|
Sweep existing transmission line |
Sweep existing transmission line |
| 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) | Yes | |
| Others Types of Users | No | |
| Is tower documented for structural analysis? | Unknown | |
| Is tower compliant with Rev G? | No | |
| Existing Tower Structure Registration | Do you have a tower registration number? | Yes |
| ASR Number | 1052156 | |
| Coordinates (NAD83) | Latitude (NAD83) | 36° 00' 12.8" N- |
| Longitude (NAD83) | 083° 56' 34.0" W- | |
| Overall Structure Height | 1456.02 feet | |
| Support Structure Height | 1332.99 feet | |
| Ground Elevation Above Mean Sea Level (AMSL) | 1393.03 feet | |
| Structure Type | GTOWER - Guyed Structure Used for Communication Purposes | |
| Tower Owner | SpectraSite Communications, LLC. through American Towers, LLC. | |
| Date Constructed | 01/01/1955 |
| Facility ID | Call Sign | Service |
|---|---|---|
| 19200 | WTNZ | DTV |
| 71082 | WATE-TV | DTV |
| 22014 | WOFM | FM |
| 81317 | WYLV | FM |
| 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: | Major 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 | 58 | |
| Explanation | Required by Landlord, see attached AT Exhibit | |
| Outside RF consulting Engineering Services | Perform engineering study for new channel assignment and antenna development | Yes |
| Prepare engineering section of Form FCC Construction Permit Application | Yes | |
| For Auxiliary Facility | No | |
| For Main Facility | Yes | |
| Prepare engineering section of Form FCC License to Cover Application | Yes | |
| For Auxiliary Facility | No | |
| For Main Facility | Yes | |
| Prepare request for Special Temporary Authority | Yes | |
| Quantity | 1 | |
| Do you have Distributed Transmission System engineering services? | N/A | |
| Critical Facility | N/A | |
| Terrain-Shielded Facility | N/A | |
| Attorney and Other Outside Consulting Services | Prepare and file Form FCC Construction Permit Application | Yes |
| For Auxiliary Facility | No | |
| For Main Facility | Yes | |
| Prepare and file Form FCC License to Cover Application | Yes | |
| For Auxiliary Facility | No | |
| For Main Facility | Yes | |
| Prepare request for Special Temporary Authority | Yes | |
| Quantity | 1 | |
| NEPA Section 106 environmental review | Yes | |
| Environmental Assessment | Yes | |
| 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 |
| 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 | Yes | |
| BLM or NFS Coordination | Yes | |
| FCC Construction Permit Minor Change | No | |
| 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? | 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 |
| Name | Description |
|---|---|
Obtain building permits from local zoning authorities |
Obtain building permits from local zoning authorities (cost of preparation, submission, and prosecution of necessary forms or applications per customer)(See Services agreement)(if needed) |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $1,591,650.00 | $1,106,980.00 | N/A | $793,384.00 | N/A |
| Total for all systems | $2,729,354.00 | $1,912,612.00 | N/A | $819,751.99 | N/A |
| Primary Transmitter HPTV-PRLX-U30 | $1,591,650.00 | $1,106,980.00 | $793,384.00 | ||
| UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW | $1,473,000.00 | $991,730.00 | See attached Hitachi Comark Quote #P3473PRLXU30-011818-R2. | $793,384.00 | N/A |
| RF Interconnect | $25,000.00 | $25,000.00 | N/A | N/A | N/A |
| Removal of Existing Equipment | $25,000.00 | $25,000.00 | N/A | N/A | N/A |
| 5 Ton system | $20,250.00 | $19,250.00 | N/A | N/A | N/A |
| Transformer 3 phase/480v - 500 KVA | $48,400.00 | $46,000.00 | N/A | N/A | N/A |
| Actual Information Description | File Name |
|---|---|
| UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW | |
| RF Interconnect | Information not provided. |
| Removal of Existing Equipment | Information not provided. |
| 5 Ton system | Information not provided. |
| Transformer 3 phase/480v - 500 KVA | Information not provided. |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $193,710.00 | $144,760.00 | N/A | $0.00 | N/A |
| Total for all systems | $2,729,354.00 | $1,912,612.00 | N/A | $819,751.99 | N/A |
| Interim Antenna TFU-WB-16 | $76,680.00 | $68,375.00 | $0.00 | ||
| Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) | $13,700.00 | $8,125.00 | N/A | N/A | N/A |
| Sweep test of existing antenna | $6,730.00 | $4,000.00 | N/A | N/A | N/A |
| UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 250 kW input, directional,, horizontally polarized | $56,250.00 | $56,250.00 | N/A | N/A | N/A |
| Primary Antenna TUDO5-16/80H-2-B | $117,030.00 | $76,385.00 | $0.00 | ||
| Combiner installation | $26,100.00 | $26,100.00 | See AT Exhibits for more information. | N/A | N/A |
| New combiner, cost per channel (without antenna) | $84,200.00 | $46,285.00 | See AT Exhibits for more information. | N/A | N/A |
| Sweep test of existing antenna | $6,730.00 | $4,000.00 | N/A | N/A | N/A |
| UHF - High Power Top Mount Three Station broadband panel antenna horizontally polarized | $0.00 | $0.00 | N/A | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $6,400.00 | $6,400.00 | N/A | $0.00 | N/A |
| Total for all systems | $2,729,354.00 | $1,912,612.00 | N/A | $819,751.99 | N/A |
| Primary Transmission Line | $6,400.00 | $6,400.00 | $0.00 | ||
| Sweep existing transmission line | $6,400.00 | $6,400.00 | N/A | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $657,800.00 | $394,422.00 | N/A | $20,000.00 | N/A |
| Total for all systems | $2,729,354.00 | $1,912,612.00 | N/A | $819,751.99 | N/A |
| Primary Tower GTOWER | $657,800.00 | $394,422.00 | $20,000.00 | ||
| Tall Tower (greater than 500') | $210,500.00 | $125,000.00 | See AT Exhibit for more information. | $20,000.00 | N/A |
| Major tower reinforcement/modifications | $421,000.00 | $250,000.00 | See AT Exhibit for more information. | N/A | N/A |
| Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | $26,300.00 | $19,422.00 | See AT Exhibit for more information. | $0.00 | N/A |
| Actual Information Description | File Name |
|---|---|
| Tall Tower (greater than 500') | |
| Major tower reinforcement/modifications | Information not provided. |
| Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | Information not provided. |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $166,164.00 | $155,485.00 | N/A | $6,367.99 | N/A |
| Total for all systems | $2,729,354.00 | $1,912,612.00 | N/A | $819,751.99 | N/A |
| Outside Professional Services | $166,164.00 | $155,485.00 | $6,367.99 | ||
| 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 |
| Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet | $10,520.00 | $10,000.00 | N/A | N/A | N/A |
| NEPA Section 106 environmental review, if needed | $6,310.00 | $6,000.00 | N/A | N/A | N/A |
| Attorney Fees - Prepare and File request for Special Temporary Authorization | $3,680.00 | $3,500.00 | N/A | N/A | N/A |
| Attorney Fees - Negotiation of lease and other matters for shared locations | $4,210.00 | $4,000.00 | 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 |
| Perform engineering study for new channel assignment and antenna development | $7,360.00 | $5,000.00 | See AT Exhibits for more information. | $125.00 | N/A |
| Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | $1,500.00 | 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 request for Special Temporary Authorization | $2,050.00 | $1,500.00 | 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 | $4,742.99 | 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 |
| Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | $0.00 | N/A |
| Project management of the transition | $9,164.00 | $8,735.00 | See AT Exhibits for more information. | N/A | N/A |
| Actual Information Description | File Name |
|---|---|
| RF Exposure Measurements | Information not provided. |
| Comprehensive coverage verification via field study, if needed | Information not provided. |
| Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet | Information not provided. |
| NEPA Section 106 environmental review, 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. |
| Address transition timing and coordination issues w/ other stations and wireless | Information not provided. |
| Perform engineering study for new channel assignment and antenna development | |
| Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | |
| Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
| Prepare request for Special Temporary Authorization | Information not provided. |
| Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | |
| Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | Information not provided. |
| Prepare and or review reimbursement form | Information not provided. |
| Project management of the transition | Information not provided. |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $113,630.00 | $104,565.00 | N/A | $0.00 | N/A |
| Total for all systems | $2,729,354.00 | $1,912,612.00 | N/A | $819,751.99 | N/A |
| Other Expenses | $113,630.00 | $104,565.00 | $0.00 | ||
| MVPD Notification of Channel Change | $800.00 | $800.00 | N/A | N/A | N/A |
| Develop and air announcement of upcoming channel change | $0.00 | $0.00 | The amount is yet to be determined (TBD) and ION will submit on-air announcement costs when finalized. | N/A | N/A |
| Equipment Storage | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
| Equipment Delivery and Handling Charges | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
| Disposal Costs (for equipment and other waste, net of any salvage value) | $15,000.00 | $15,000.00 | N/A | N/A | N/A |
| BLM or NFS Coordination | $25,000.00 | $25,000.00 | N/A | N/A | N/A |
| Non-zoning permits | $15,000.00 | $15,000.00 | N/A | N/A | N/A |
| Local Zoning | $25,000.00 | $25,000.00 | N/A | N/A | N/A |
| FCC Filing Fees - Special Temporary Authorization request | $195.00 | $190.00 | 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 | $2,500.00 | N/A | N/A | N/A |
| Obtain building permits from local zoning authorities | $750.00 | $750.00 | See AT Exhibits for more information. | N/A | N/A |
| Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
|---|---|---|---|
| Total for all systems | $2,729,354.00 | $1,912,612.00 | $819,751.99 |
| 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. | Mario Vasquez Vice President - Finance, Operations 09/21/2018 |
