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:
0000028569
FRN:
0004343323
Facility ID:
26681
Repack Channel:
14 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
12/03/2018

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TELEVICENTRO OF PUERTO RICO, LLC

Javier Maynulet

P.O. BOX 362050

SAN JUAN, PUERTO RICO 00936-2050

Puerto Rico

7877924444 javier.maynulet@wapa-tv.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

Sally A. Buckman , Esq .

Lerman Senter PLLC

2001 L Street NW

Suite 400

Washington, DC 20036

United States

+1 (202) 416-6762 sbuckman@lermansenter.com

Broadcaster Information and Transition Plan

Back to Top
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 Minor change application for CP, tower modification as needed, transmitter, mask filter and antenna replacement, auxiliary facility, filling for a license.

Transmitters

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

Primary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
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
Model TDU-2
Year 2003
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 10 kw
Other Transmitter Type  

Primary Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Description of Use  
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model Parallax
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 27.5 kw
Other Transmitter Type  
Justification for New Transmitter The manufacturer indicated that channel retuning for the existing transmitter is not supported. Due to additional Ch-14 filter losses additional power is needed to achieve current ERP and coverage.

Primary Transmitter

Back to Top

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 Yes
Size 2 inches
Length 360.0 feet
Other Electrical Service Yes
Description Service disconnect switch and main breaker.
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? Yes
Is a channel 14 Mask Filer needed? Yes
Is additional field engineering time needed? Yes
Number of Days 30

Primary Transmitter

Back to Top

Other Transmitter Cost Not Listed

Name Description

Service Tax

Consulting and services @ 4%

Other Costs

Other Costs associated with the Transmitter

Sales Tax

Equipment @ 11.5%

Interim Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use  
Change Type Purchase
Manufacturer
Model Parallax
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 15.0 kw
Other Transmitter Type  
Justification for New Transmitter See attached WTIN Interim transmitter justification document.

Interim Transmitter

Back to Top

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 Yes
Size 2 inches
Length 150.0 feet
Other Electrical Service Yes
Description Main Breaker, UPS and 300 ft. cable run from existing generator to feed the interim transmitter.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
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? No
Is a channel 14 Mask Filer needed? Yes
Is additional field engineering time needed? No
Number of Days  
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

Back to Top

Other Transmitter Cost Not Listed

Name Description

Local Service Tax

Local and consulting services @ 4%

Other Costs

Other Costs associated with the transmitter

Sales Tax

Equipment @ 11.5%

Antennas

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

Primary Antenna

Back to Top

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 Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 380.20 kW
Manufacturer
Model TLP-24 (C) DC
Year 2003

Primary Antenna

Back to Top

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? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 371.00 kW
Manufacturer
Model TFU-24JSC S180
Year 2017
Justification for New Antenna The existing antenna is single channel, not field tuneable.

Primary Antenna

Back to Top

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? 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

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Sales Tax

Equipment @ 11.5%

Interim Antenna

Back to Top

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? 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 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: 200.00 kW
Manufacturer
Model TLP-24B (C)
Year 2017
Justification for New Antenna To remain on the air while present tower structural upgrades, present antenna removal and new antenna installation are in progress an interim antenna along with an interim transmitter and tower are needed.

Interim Antenna

Back to Top

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? 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

Interim Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Sales Tax

Equipment @ 11.5%

Transmission Line

Back to Top
Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

Back to Top

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 Flexible Air
Diameter 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 175 feet per run

Primary Transmission Line

Back to Top

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 Flexible Air
Diameter 5 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 165 feet per run
Justification for New Transmission Line Current transmission line will not accommodate the new post-repack channel.

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

Back to Top

New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 225 feet per run
Justification for New Transmission Line An interim transmission line, interim transmitter, interim antenna and interim tower are needed to remain on the air while main main tower structural upgrades, present antenna removal and new antenna installation are in progress.

Interim Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Name Description

Sales Tax

Equipment @ 11.5%

Tower Equipment And Rigging Costs

Back to Top
Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 18° 10' 02.85" N-
Longitude (NAD83) 066° 34' 34.6" W-
Overall Structure Height 185.00 feet
Support Structure Height 170.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 4298.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Televicentro of PR, LLC
Date Constructed 05/18/1990

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
39887 WIRS DTV

Primary Tower

Back to Top

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: Major Reinforcements needed

Primary Tower

Back to Top

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Sales Tax

Equipment @ 11.5%

Auxiliary Tower

Back to Top

Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use Interim Tower
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1010731
Coordinates (NAD83) Latitude (NAD83) 18° 10' 04.0" N-
Longitude (NAD83) 066° 34' 37.0" W-
Overall Structure Height 274.93 feet
Support Structure Height 272.31 feet
Ground Elevation Above Mean Sea Level (AMSL) 4268.32 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Televicentro of Puerto Rico, LLC
Date Constructed 07/30/1997


Auxiliary Tower

Back to Top

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: Major Reinforcements needed

Auxiliary Tower

Back to Top

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Auxiliary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Sales Tax

Equipment @ 11.5%

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 1000
Explanation Due to budget constraints the station does not have the necessary personnel to manage the project.
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 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 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 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers 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

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Service Tax

Local Consulting and services @ 4%

Quarterly Progress Reports.

Quarterly Repack Progress Report.

Other Expenses

Back to Top
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 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

Other Expenses

Back to Top

Other Expenses Not Listed

Name Description

Service Tax

Consulting and services @ 4%

Station Employees Time

Station Employee Time

System Design and Site Survey

Main Transmitter System Design and Site Survey, as per Hitachi Comark Proposal.

Motorized Switch

Main transmitter Motorized Switch

Interim Transmitter system Design

Interim Transmitter System Design and Site Survey, as per Hitachi Comark Proposal.

Cost Information

Back to Top

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 $2,302,405.04 $1,793,019.04 N/A $1,208,956.13 N/A
Total for all systems $4,843,751.31 $3,798,613.51 N/A $1,422,055.88 N/A
Interim Transmitter Parallax $1,017,810.04 $827,009.04 $604,023.46
Other Costs $15,000.00 $15,000.00 Other Costs associated with the transmitter $2,146.22 N/A
Other Electrical Service: Main Breaker, UPS and 300 ft. cable run from existing generator to feed the interim transmitter. $35,000.00 $35,000.00 Based on manufacturer UPS pricing consultations, previous experience during the analog to digital transition, the amount of high voltage switches, breakers and other materials needed, site remote location, and difficulty of getting contractors to the site $31,678.23 N/A
2" Rigid Conduit and Wiring (Cost per foot) $3,900.00 $3,750.00 N/A N/A N/A
10 Ton system $37,900.00 $22,908.00 See attached AIr-Con C-17-0411 quote $17,642.91 N/A
Channel 14 Mask Filter $184,500.00 $93,203.00 See Attached Hitachi Kokusai Electric Comark LLC Proposal P#3911PRLXU8-110218 Item 2.3 Part No. NS1 N/A N/A
Local Service Tax $220.00 $220.00 State Service tax 4% N/A N/A
Sales Tax $75,290.04 $75,290.04 State and City Sales Tax 11.5% N/A N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $666,000.00 $581,638.00 See Attached Hitachi Kokusai Electric Comark LLC Proposal P#3911PRLXU8-110218 Less Item 2.3, CH. 14 Mask Filter. $552,556.10 N/A
Primary Transmitter Parallax $1,284,595.00 $966,010.00 $604,932.67
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $922,000.00 $609,795.00 See attached Hitachi Comark Proposal and Invoice $594,895.78 N/A
Sales Tax $76,751.00 $76,751.00 State and City Sales Tax 11.5% N/A N/A
Other Costs $5,000.00 $5,000.00 Other Costs associated with the transmitter. $536.89 N/A
Service Tax $464.00 $464.00 State Service tax 4% N/A N/A
Additional field engineering time, 10-30 days $61,400.00 $60,000.00 N/A N/A N/A
Channel 14 Mask Filter $184,500.00 $180,000.00 N/A $4,500.00 N/A
RF Consulting Engineer $5,120.00 $5,000.00 N/A $5,000.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $9,360.00 $9,000.00 N/A N/A N/A
Other Electrical Service: Service disconnect switch and main breaker. $20,000.00 $20,000.00 As per previous experience, includes transmitters main breakers, safety switches, cooling pumps breakers, Heat Exchange breakers and Safety switches. $0.00 N/A

Components

Actual Information Description File Name
Other Costs

Component Description:
Cutler Hammer Amp Breaker
Amount:
$484.50

Component Description:
Roger Electric Invoice; Including Taxes
Amount:
$646.42

Component Description:
Inv# 1LV37432HU9358136; Amp Circuit breaker. Vendor name will not allow inclusion of "_" symbol
Amount:
$299.99

Component Description:
Roger Electric Invoice #0003503811. Including Taxes.
Amount:
$524.55

Component Description:
Inv# 2B700425DD079671H, Interchangeable trip circuit breaker rating plug. Will not allow use of (&) in Vendor name.
Amount:
$190.76
Other Electrical Service: Main Breaker, UPS and 300 ft. cable run from existing generator to feed the interim transmitter.

Component Description:
WTIN - auxiliary/interim transmitter HVAC work, final payment plus tax. Invoice # 1344, PO # 132144.
Amount:
$19,006.95

Component Description:
WTIN - auxiliary/interim transmitter HVAC work, 40% down payment plus tax. Invoice # 1314, PO # 132144
Amount:
$12,671.28
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
10 Ton system

Component Description:
WTIN - Refricentro - aux/interim transmitter HVAC work plus tax. Invoice # BP-110402, PO # 132568.
Amount:
$109.44

Component Description:
WTIN - Air-Con Inc. - auxiliary/interim transmitter HVAC work plus tax. Invoice # 336865, PO # 132181.
Amount:
$12,854.84

Component Description:
WTIN Universal Air Conditioner Inv# 1773
Amount:
$2,534.00

Component Description:
WTIN Universal Air Conditioner Inv#1790
Amount:
$2,144.63
Channel 14 Mask Filter Information not provided.
Local Service Tax Information not provided.
Sales Tax Information not provided.
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
Comark Inv# 11439A for Interim Transmitter; First 50% payment.
Amount:
$290,819.00

Component Description:
Comark Inv# S10204-2A for Interim Transmitter. Second 45% payment.
Amount:
$261,737.10
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Mays Ochoa Invoice 163322 for Deionized water
Amount:
$345.65

Component Description:
WTIN - Hitachi Comark main transmitter 50% down payment. Invoice # 11434, PO #132263 with proposals and cover letter - REVISED.
Amount:
$235,000.00

Component Description:
WTIN - Hitachi Comark main transmitter 50% down payment. Invoice # 11434, PO #132263 with proposals and cover letter - REVISED.
Amount:
$69,897.50

Component Description:
Comark Invoice# S10209-2, minus maximization costs
Amount:
$289,652.63
Sales Tax Information not provided.
Other Costs

Component Description:
Roger Electric Invoice#0003502729, Including Tax.
Amount:
$304.33

Component Description:
Roger Electric Inv# 0003500014
Amount:
$232.56
Service Tax Information not provided.
Additional field engineering time, 10-30 days Information not provided.
Channel 14 Mask Filter

Component Description:
Mounting Communications Inv. # 1779 for Teleware 400 Bandpass
Amount:
$4,500.00
RF Consulting Engineer

Component Description:
WTIN - Channel 14 land mobile interference study. Invoice # 241619, PO # 132173.
Amount:
$5,000.00
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other Electrical Service: Service disconnect switch and main breaker. Information not provided.

Cost Information

Back to Top

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 $765,145.27 $223,925.05 N/A $109,366.12 N/A
Total for all systems $4,843,751.31 $3,798,613.51 N/A $1,422,055.88 N/A
Interim Antenna TLP-24B (C) $312,465.56 $81,837.46 $48,183.30
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $184,500.00 $36,522.00 See Attached WTIN Interim Antenna Dielectric Quote 8000044CMZ-1, Line 1, Item 11000000077, ANTENNA - UHF SIDE MOUNT ONE STATION HORIZONTAL POLARIZATION. $16,434.90 N/A
Sweep test of existing antenna $6,550.00 $6,400.00 See Attached WTIN Interim Antenna Dielectric Quote 8000044CMZ-1, Line 20, REPACK SWEEP, $5,760.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $10,615.00 See Attached WTIN Interim Antenna Dielectric Quote 8000044CMZ-1, Line 2, Item 11000000077, CUSTOM ANTENNA MOUNTING BRACKETS FOR ITEM 1. $9,553.50 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,120.00 $5,120.00 N/A N/A N/A
Sales Tax $6,745.56 $6,745.56 State and City Sales Tax 11.5% N/A N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $87,000.00 $16,434.90 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $16,434.90 N/A
Primary Antenna TFU-24JSC S180 $452,679.71 $142,087.59 $61,182.82
Sales Tax $12,959.71 $12,959.71 State and City Sales Tax 11.5% N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,120.00 $5,120.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $12,487.50 See Attached WTIN Main Antenna Dielectric Quote 700396CMZ-2, Line 2, Item 11000000077, CUSTOM ANTENNA MOUNTING BRACKETS. $9,553.26 N/A
Sweep test of existing antenna $6,550.00 $6,400.00 See Attached WTIN Main Antenna Dielectric Quote 700396CMZ-2, Line 21, Item REPACK SWEEP $5,760.00 N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $184,500.00 $88,685.60 See Attached WTIN Main Antenna Dielectric Quote 700396cmz-2CMZ-1, Line 1, Item 11000000077, ANTENNA - UHF SIDE MOUNT ONE STATION WITH HORIZONTAL POLARIZATION. $29,434.78 N/A
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized $221,000.00 $16,434.78 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $16,434.78 N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
WTIN - Dielectric - interim/auxiliary antenna, second 45% payment. Invoice # MAN00398, PO #132170.
Amount:
$16,434.90
Sweep test of existing antenna

Component Description:
Portion of the initial WTIN 45% interim antenna invoice attributable to the antenna sweep.
Amount:
$2,880.00

Component Description:
WTIN - Dielectric - interim/auxiliary antenna sweep, second 45% payment. Invoice # MAN00398, PO #132170.
Amount:
$2,880.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Portion of the initial WTIN 45% interim antenna invoice attributable to the brackets.
Amount:
$4,776.75

Component Description:
WTIN - Dielectric - interim/auxiliary antenna brackets, second 45% payment. Invoice # MAN00398, PO #132170.
Amount:
$4,776.75
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Sales Tax Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
Portion of the initial WTIN 45% invoice attributable to the interim antenna.
Amount:
$16,434.90
Sales Tax Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
WTIN - Dielectric, main antenna bracket cost (minus maximization), second 45% payment. Invoice # MAN00407, PO #132182.
Amount:
$4,776.63

Component Description:
Portion of the initial WTIN 45% main antenna invoice attributable to the brackets. Dielectric Invoice # MAN00286, PO #132182 with proposals and cover letter - 2nd REVISED version.
Amount:
$4,776.63
Sweep test of existing antenna

Component Description:
WTIN - Dielectric - main antenna sweep costs (minus maximization), second 45% payment. Invoice # MAN00407, PO # 132182.
Amount:
$2,880.00

Component Description:
Portion of the initial WTIN 45% main antenna invoice attributable to the antenna sweep. Dielectric Invoice # MAN00286, PO #132182 with proposals and cover letter - REVISED version.
Amount:
$2,880.00
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
WTIN - Dielectric - main antenna costs (minus maximization), second 45% payment. Invoice # MAN00407, PO # 132182.
Amount:
$16,434.78

Component Description:
Pegasus Group Inv # 4024 for Antenna work, including tax
Amount:
$13,000.00
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized

Component Description:
Portion of the initial WTIN 45% main antenna invoice attributable to the main antenna. Dielectric Invoice # MAN00286, PO #132182 with proposals and cover letter - 2nd REVISED version.
Amount:
$16,434.78

Cost Information

Back to Top

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 $31,104.00 $50,010.42 N/A $19,212.26 N/A
Total for all systems $4,843,751.31 $3,798,613.51 N/A $1,422,055.88 N/A
Interim Transmission Line $14,274.00 $26,449.00 $19,212.26
Sales Tax $1,449.00 $1,449.00 State and City Sales Tax 11.5% N/A N/A
Flexible Air Transmission Line - dielectric, 3" $12,825.00 $25,000.00 Actual cost is greater than estimated cost. Per instructions estimated cost has been increased. $19,212.26 N/A
Primary Transmission Line $16,830.00 $23,561.42 $0.00
Flexible Air Transmission Line - dielectric, 5" $16,830.00 $23,561.42 See the attached Dielectric invoice and Purchase Order, Inv. # MAN00286, PO #132182. $0.00 N/A

Components

Actual Information Description File Name
Sales Tax Information not provided.
Flexible Air Transmission Line - dielectric, 3"

Component Description:
Portion of the WTIN initial 45% interim antenna invoice attributable to the transmission line.
Amount:
$6,238.63

Component Description:
WTIN - Dielectric - interim/auxiliary transmission line, second 45% payment. Invoice # MAN00398, PO #132170.
Amount:
$6,283.63

Component Description:
WBCPR Invoice 6302018-1 for Interim Transmission line
Amount:
$6,690.00
Flexible Air Transmission Line - dielectric, 5"

Component Description:
The applicant no longer requests reimbursement for this item. Please see the associated cover letter for explanation.
Amount:
N/A

Cost Information

Back to Top

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,062,600.00 $1,039,200.00 N/A $12,447.27 N/A
Total for all systems $4,843,751.31 $3,798,613.51 N/A $1,422,055.88 N/A
Auxiliary Tower TOWER $531,300.00 $519,600.00 $0.00
Major tower reinforcement/modifications $409,500.00 $400,000.00 N/A $0.00 N/A
Structural engineering tower load study for well documented tower $12,300.00 $12,000.00 N/A N/A N/A
Sales Tax $27,600.00 $27,600.00 State and City Sales Tax 11.5% N/A N/A
Short Tower (less than 500') $81,900.00 $80,000.00 N/A N/A N/A
Primary Tower TOWER $531,300.00 $519,600.00 $12,447.27
Structural engineering tower load study for well documented tower $12,300.00 $12,000.00 N/A $5,447.27 N/A
Major tower reinforcement/modifications $409,500.00 $400,000.00 N/A $7,000.00 N/A
Short Tower (less than 500') $81,900.00 $80,000.00 N/A N/A N/A
Sales Tax $27,600.00 $27,600.00 State and City Sales Tax 11.5% N/A N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications Information not provided.
Structural engineering tower load study for well documented tower Information not provided.
Sales Tax Information not provided.
Short Tower (less than 500') Information not provided.
Structural engineering tower load study for well documented tower

Component Description:
WTIN - Malouf Engineering - tower structural analysis. Invoice # 1803640V0, PO # 132000.
Amount:
$3,500.00

Component Description:
WTIN - Office Depot receipt - scan of tower analysis costs with tax, January 26, 2018. Receipt # 2684-5-9417-787776-17.9.2.
Amount:
$75.27

Component Description:
WTIN - Alejandro Luciano tower mapping. Invoice # 1179, PO # 132288.
Amount:
$1,872.00
Major tower reinforcement/modifications

Component Description:
Malouf Inv#1803640V1, structural modifications.
Amount:
$7,000.00
Short Tower (less than 500') Information not provided.
Sales Tax Information not provided.

Cost Information

Back to Top

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 $301,761.00 $311,986.00 N/A $20,368.50 N/A
Total for all systems $4,843,751.31 $3,798,613.51 N/A $1,422,055.88 N/A
Outside Professional Services $301,761.00 $311,986.00 $20,368.50
Prepare and or review reimbursement form $2,560.00 $20,000.00 The actual cost exceeded the estimated costs, so we were instructed to increase the estimate. $12,776.50 N/A
Quarterly Progress Reports. $2,150.00 $2,150.00 Quarterly repack progress report documents preparation and filling based on previous experience with FCC filings $312.00 N/A
Service Tax $6,086.00 $6,086.00 State Service Tax 4% N/A N/A
RF Exposure Measurements $20,500.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $81,900.00 $80,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,585.00 $3,500.00 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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,100.00 $4,000.00 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 $1,500.00 N/A
Prepare request for Special Temporary Authorization $1,535.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,535.00 $1,500.00 N/A N/A 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
Address transition timing and coordination issues w/ other stations and wireless $2,560.00 $2,500.00 N/A N/A N/A
Project management of the transition $154,000.00 $150,000.00 N/A $3,003.00 N/A
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A $2,777.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $3,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,050.00 $2,000.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Prepare and or review reimbursement form

Component Description:
LS Invoice 467118 for legal services
Amount:
$443.00

Component Description:
LS Invoice 455664 for legal services
Amount:
$752.50

Component Description:
LS invoice 457440 for legal services
Amount:
$1,541.50

Component Description:
LS invoice 461692 for legal services
Amount:
$134.00

Component Description:
LS invoice 467305 for legal services
Amount:
$962.50

Component Description:
LS invoice 464476 for legal services
Amount:
$536.00

Component Description:
LS Invoice 460680 for legal services.
Amount:
$2,479.00

Component Description:
WTIN - Alejandro Luciano outside services, 399 preparation and review. Invoice # 1167, PO # 132294 - Revised.
Amount:
$1,248.00

Component Description:
WTIN - Alejandro Luciano outside services, 399 preparation and review. Invoice # 1173, PO # 132291 - Revised.
Amount:
$2,184.00

Component Description:
WTIN - Alejandro Luciano outside services, 399 preparation and review. Invoice # 1161, PO # 132299 - Revised.
Amount:
$1,092.00

Component Description:
WTIN - Alejandro Luciano outside services, 399 preparation and review. Invoice # 1159, PO # 132298 - Revised.
Amount:
$1,404.00
Quarterly Progress Reports.

Component Description:
WTIN - Luciano Invoice # 1175, PO # 132494 - repack progress reports, plus tax.
Amount:
$312.00
Service Tax Information not provided.
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 -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

Component Description:
du Treil invoice# 240855; Services engineering portion of 2100 construction permit
Amount:
$1,500.00
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.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
WTIN - Luciano Invoice # 1157, PO # 132490 - repack project management plus tax.
Amount:
$39.00

Component Description:
WTIN - Luciano Invoice # 1171, PO # 132492 - repack project management plus tax.
Amount:
$312.00

Component Description:
WTIN - Luciano Invoice # 1151, PO # 132487 - repack project management plus tax.
Amount:
$936.00

Component Description:
WTIN - Luciano Invoice # 1153, PO # 132488 - repack project management plus tax.
Amount:
$780.00

Component Description:
WTIN - Luciano Invoice # 1155, PO # 132489 - repack project management plus tax.
Amount:
$468.00

Component Description:
WTIN - Luciano Invoice # 1177, PO # 132493 - repack project management plus tax. Revised
Amount:
$468.00
Perform engineering study for new channel assignment and antenna development

Component Description:
WTIN - Alejandro Luciano channel studies for main and aux antennas. Invoice # 1169, PO # 132292 - Revised.
Amount:
$2,652.00

Component Description:
du Treil Inv#240855; Engineering study for new channel.
Amount:
$125.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.

Cost Information

Back to Top

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 $380,736.00 $380,473.00 N/A $51,705.60 N/A
Total for all systems $4,843,751.31 $3,798,613.51 N/A $1,422,055.88 N/A
Other Expenses $380,736.00 $380,473.00 $51,705.60
Interim Transmitter system Design $15,300.00 $15,300.00 Interim Transmitter System Design and Site Survey as per attached Hitachi Comark Interim transmitter proposal. Item 2.4 P/N S34 N/A N/A
Motorized Switch $4,835.00 $4,835.00 Existing system has motorized switch for antenna to test load transfer. See attached Hitachi Comark Main Transmitter Proposal Item 2.1 P/N T5 N/A N/A
System Design and Site Survey $15,300.00 $15,300.00 Transmitter System Design and Site Survey as per attached Hitachi Comark Main Transmitter Proposal Item 2.4 P/N S34 N/A N/A
Station Employees Time $216,963.00 $216,963.00 Estimated based on internal calculations for station employees repack dedicates time. See attached Exhibit 1. 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 $333.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,250.00 $11,000.00 N/A $3,980.60 N/A
Service Tax $3,060.00 $3,060.00 4% State Service Tax N/A N/A
Local Zoning $10,000.00 $10,000.00 Based on previous experience during analog to digital transition. Local authority estimated fees for tower work permits. $500.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $4,500.00 $4,500.00 Estimate based on previous experience during the analog to digital transition, the site remote location and difficult accessibility. $450.00 N/A
Equipment Delivery and Handling Charges $65,000.00 $65,000.00 See Attached Relocation Fund Administrator Request for Additional Information Document $46,775.00 N/A
Equipment Storage $7,000.00 $7,000.00 Estimate based on previous experience during the analog to digital transition. N/A N/A
Develop and air announcement of upcoming channel change $20,000.00 $20,000.00 N/A N/A N/A
MVPD Notification of Channel Change $7,000.00 $7,000.00 Estimate based on previous experience during the analog to digital transition. N/A N/A

Components

Actual Information Description File Name
Interim Transmitter system Design Information not provided.
Motorized Switch Information not provided.
System Design and Site Survey Information not provided.
Station Employees Time Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
DTVNotification Inv#001834, Medical facility notification.
Amount:
$3,980.60
Service Tax Information not provided.
Local Zoning

Component Description:
WTIN local zoning permit for construction. March 2018. Receipt #2018004706.
Amount:
$250.00

Component Description:
WTIN - Secretary of Hacienda, Government of Puerto Rico zoning permit cost. Receipt # 2018004707.
Amount:
$250.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Transporte Rolon Inv# 2018-43; Removal and Disposal Costs of transfer switch
Amount:
$450.00
Equipment Delivery and Handling Charges

Component Description:
Transportes Rolon invoice 2018-49 for shipping costs
Amount:
$1,800.00

Component Description:
DB Schenker Inv #201080787, for antenna transport to WTIN
Amount:
$9,970.00

Component Description:
Transportes Rolon Invoice # 2018-51 for shipping and handling charges.
Amount:
$740.00

Component Description:
DB Schenker Inv#201092064, delivery and unloading charges.
Amount:
$12,390.00

Component Description:
WTIN - Transportes Rolon, equipment delivery charges. Invoice # 2018-35, PO # 132566.
Amount:
$600.00

Component Description:
Transportes Rolon invoice 2018-93 for shipping costs
Amount:
$350.00

Component Description:
WTIN DB Schenker Inv# 201087403, for delivery and unloading charges
Amount:
$295.00

Component Description:
Transportes Rolon Invoice 2018-57 for shipping costs
Amount:
$650.00

Component Description:
WTIN - Transportes Rolon, equipment delivery charges. Invoice # 2018-28, PO # 132567. Note, UPS refers to Unit Power Supply.
Amount:
$800.00

Component Description:
Transportes Rolon Invoice # 2018-67 for shipping costs
Amount:
$800.00

Component Description:
Transportes Rolon Invoice 2018-71 for shipping costs
Amount:
$700.00

Component Description:
DB Schenker inv#201085771, delivery charges.
Amount:
$7,895.00

Component Description:
Transportes Rolon invoice 2018-69 for shipping costs
Amount:
$700.00

Component Description:
WTIN DB Schenker Inv #201087576, Unloading and delivery charges.
Amount:
$295.00

Component Description:
Transportes Rolon Invoice 2018-89 for shipping costs
Amount:
$600.00

Component Description:
DB Schenker Invoice# 201087377, unloading and delivery charges.
Amount:
$295.00

Component Description:
DB Schenker Inv# 20185772, Delivery charges.
Amount:
$7,895.00
Equipment Storage Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
MVPD Notification of Channel Change Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,843,751.31 $3,798,613.51 $1,422,055.88

Construction Status

Back to Top
Question Response
Is construction complete? No

Certification

Back to Top
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.

Craig Fischer

Vice President


12/03/2018

Certification

Back to Top
Section Question Response
Submission of Actual Cost Documentation 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material.

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

  3. 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).

  4. 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.

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

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

  7. 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.

Craig Fischer

Vice President


12/03/2018

Attachments

Back to Top