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:
57292
Service:
DTV
Call Sign:
WAAY-TV
Channel:
17 (UHF)
File Number:
0000027628
FRN:
0025852393
Date Submitted:
03/25/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ALABAMA TV LICENSE COMPANY, LLC

3282 NORTHSIDE PARKWAY

SUITE 275

ATLANTA, GA 30327

United States

+1 (470) 355-1944 jburgett@wileyrein.com 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 WAAY (post ch. 17, Phase 2) & WZDX (pre ch. 41/post ch. 18, Phase 8) to re-use shared antenna. WAAY to install new transmitter & constant impedance mask filter for shared 17/41 operations until Phase 8, then will implement shared 17/18 operations.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup
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 Ranger
Year 2003
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity .5 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE1
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity .6 kW
Justification for New Transmitter Existing aux/backup transmitter cannot be re-channeled to meet repack channel assignment and is no longer supported by manufacturer.

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 1.5 inches
Length 1000.0 feet
Other Electrical Service Yes
Description Connect power panel to Aux transmitter
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 Quantum
Year 2002
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 30 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? No
Manufacturer
Model ULXTE-16
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 10.8 kW
Justification for New Transmitter Primary transmitter cannot be re-channeled to meet repack channel assignment and is no longer supported by manufacturer.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 1.5 inches
Length 1000.0 feet
Other Electrical Service Yes
Description Connecting power panel to new transmitter
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 Retune Existing
Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner American Tower
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Bottom
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 70
Design power capacity in use 50.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Other Antenna Type N/A
ERP: 700.0 kW
Manufacturer Dielectric
Model TUD-S5B-14/70H-1-T
Year 2001

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
57292 WAAY-TV
28119 WZDX

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

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? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
17
18

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Installation

Cost to install the new channel 17 combiner module in existing broadband combiner system

Combiner Interconnects

6-1/8", 3-1/8", & 4-1/16" combiner interconnects required to connect new channel 17 combiner module

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

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? No

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 37
Explanation Manage combiner ordering, shipping, installation, and testing
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations 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 No
RF exposure measurements No
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

Name Description

RF System Test

Testing of the combiner to ensure all frequencies are tuned for optimal patterns.

Attorney Fees and Other Matters

Professional Fees Outside 2100 Permit Applications

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 No
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 No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

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 $602,413.60 $577,913.60 N/A $480,319.13 N/A
Total for all systems $1,052,899.60 $870,313.60 N/A $640,993.88 N/A
Primary Transmitter ULXTE-16 $512,456.25 $487,956.25 $408,412.02
Other Electrical Service: Connecting power panel to new transmitter $14,956.25 $14,956.25 ACW Electric Estimate 3346 $14,956.25 N/A
1.5" Rigid Conduit and Wiring $3,000.00 $3,000.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $470,000.00 N/A $393,455.77 N/A
Auxiliary Transmitter UAXTE1 $89,957.35 $89,957.35 $71,907.11
UHF - Air Cooled Solid State Transmitter .6 kW $83,957.35 $83,957.35 See Attachment "WAAY - Gates Air UAXTE 1 Auxiliary Transmitter Invoice and Quote.pdf" showing total with estimated shipping and taxes included. $71,907.11 N/A
1.5" Rigid Conduit and Wiring $3,000.00 $3,000.00 N/A N/A N/A
Other Electrical Service: Connect power panel to Aux transmitter $3,000.00 $3,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Other Electrical Service: Connecting power panel to new transmitter

Component Description:
Power package / Required equipment for 480 volt connection
Amount:
$14,956.25
1.5" Rigid Conduit and Wiring Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
WAAY-Primary Transmitter (ULXTE-16). Request does not include cost for shipping and taxes, which will be requested when these expenses are incurred. See Attachment "WAAY-GatesAir ULXTE-16 Primary Transmitter Invoice and Quote (submitted 4.23.2018).pdf."
Amount:
$393,455.77
UHF - Air Cooled Solid State Transmitter .6 kW

Component Description:
WAAY - Auxiliary Transmitter (UAXTE-1R37). Request does not include estimated costs for shipping and taxes, which will be requested with a separate invoice when these expenses are incurred.
Amount:
$71,907.11
1.5" Rigid Conduit and Wiring Information not provided.
Other Electrical Service: Connect power panel to Aux transmitter Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $372,525.00 $94,595.00 N/A $94,595.00 N/A
Total for all systems $1,052,899.60 $870,313.60 N/A $640,993.88 N/A
Primary Antenna TUD-S5B-14/70H-1-T $372,525.00 $94,595.00 $94,595.00
Combiner Interconnects $24,305.00 $24,305.00 Estimated cost shown is WAAY-TV's total cost for shared American Tower project. See Attachment "American Tower Invoice for Shared Project (revised)." $24,305.00 N/A
Combiner Installation $10,290.00 $10,290.00 Estimated cost shown is WAAY-TV's total cost for shared American Tower project. See Attachment "American Tower Invoice for Shared Project (revised)." $10,290.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $55,000.00 Estimated cost shown is WAAY-TV's total cost for shared American Tower project. See Attachment "American Tower Invoice for Shared Project (revised)." $55,000.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized $247,000.00 $0.00 N/A $0.00 N/A
Sweep test of existing antenna $6,730.00 $5,000.00 Estimated cost shown is WAAY-TV's total cost for shared American Tower project. See Attachment "American Tower Invoice for Shared Project (revised)." $5,000.00 N/A

Components

Actual Information Description File Name
Combiner Interconnects

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See "American Tower Invoice for Shared Project (revised)."
Amount:
$24,305.00
Combiner Installation

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See"American Tower Invoice for Shared Project (revised)."
Amount:
$10,290.00
New combiner, cost per channel (without antenna)

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See "American Tower Invoice for Shared Project (revised)."
Amount:
$55,000.00
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized Information not provided.
Sweep test of existing antenna

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See "American Tower Invoice for Shared Project (revised)."
Amount:
$5,000.00

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $46,076.00 $166,480.00 N/A $60,262.75 N/A
Total for all systems $1,052,899.60 $870,313.60 N/A $640,993.88 N/A
Outside Professional Services $46,076.00 $166,480.00 $60,262.75
Attorney Fees and Other Matters $10,250.00 $10,250.00 Wiley Rein Invoices including #1467358, #1471191, #1441810, #1445757, #1457860, #1453829, and #1478863 $10,250.00 N/A
RF System Test $5,000.00 $5,000.00 Estimated cost shown is WAAY-TV's total cost for shared American Tower project. See Attachment "American Tower Invoice for Shared Project (revised)." $5,000.00 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 - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 Estimated cost shown is WAAY-TV's total cost for shared American Tower project. See Attachment "American Tower Invoice for Shared Project (revised)." $2,500.00 N/A
Prepare and or review reimbursement form $2,630.00 $24,805.00 See Wiley Rein Invoices including #1461819, #1467358, #1457860, #1441810, #1445757, #1449756 $24,805.00 N/A
Project management of the transition $5,846.00 $105,175.00 See Widelity Strategic Support Services Quote; Estimated cost shown is WAAY-TV's total cost for shared American Tower project. See Attachment "American Tower Invoice for Shared Project (revised)." $12,707.75 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $5,000.00 N/A

Components

Actual Information Description File Name
Attorney Fees and Other Matters

Component Description:
Professional services
Amount:
$1,640.00

Component Description:
Professional legal services
Amount:
$1,435.00

Component Description:
Total Professional Services, Total Disbursements
Amount:
$1,640.00

Component Description:
Professional services
Amount:
$820.00

Component Description:
WAAY-550-Attorney - Other Matters
Amount:
$1,435.00

Component Description:
Professional services
Amount:
$1,640.00

Component Description:
WAAY-550-Attorney - Other Matters
Amount:
$820.00

Component Description:
For professional services rendered through November 30, 2018
Amount:
$615.00

Component Description:
WAAY-550-Attorney - Other Matters
Amount:
$205.00
RF System Test

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See "American Tower Invoice for Shared Project (revised)."
Amount:
$5,000.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See "American Tower Invoice for Shared Project (revised)."
Amount:
$2,500.00
Prepare and or review reimbursement form

Component Description:
WAAY-590-Prepare and/or Review Reimbursement Form
Amount:
$4,305.00

Component Description:
Professional services
Amount:
$1,435.00

Component Description:
WAAY-590-Prepare and/or Review Reimbursement Form
Amount:
$1,640.00

Component Description:
Professional services
Amount:
$6,560.00

Component Description:
Professional services
Amount:
$2,460.00

Component Description:
Professional legal services
Amount:
$2,460.00

Component Description:
TC w/K. Laguatan re: revisions to Form 399 repack reimbursement; prepare Form 399 re: change in transition plan
Amount:
$4,305.00

Component Description:
Review construction and equipment costs for channel reassignment, etc.; Research, draft and file receive-only earth station registration; Analyze potential acquisition of WHNT, etc.
Amount:
$1,640.00
Project management of the transition

Component Description:
Project Management
Amount:
$1,924.50

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See "American Tower Invoice for Shared Project (revised)."
Amount:
$5,500.00

Component Description:
Project Management
Amount:
$2,552.30

Component Description:
Project Management
Amount:
$2,730.95
Perform engineering study for new channel assignment and antenna development

Component Description:
Actual Cost requested is WAAY-TV's total cost for shared American Tower project. See "American Tower Invoice for Shared Project (revised)."
Amount:
$5,000.00

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 $31,885.00 $31,325.00 N/A $5,817.00 N/A
Total for all systems $1,052,899.60 $870,313.60 N/A $640,993.88 N/A
Other Expenses $31,885.00 $31,325.00 $5,817.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A $2,634.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,183.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
Notification of Cable and Satellite MVPD Providers of new RF Channel
Amount:
$1,814.00

Component Description:
WAAY MVPD Notifications
Amount:
$820.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
DTV Medical Facility Notification

Component Description:
Notification of Medical Facilities, Transmitter Medical Facility Notification per proposal
Amount:
$3,183.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,052,899.60 $870,313.60 $640,993.88

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.

Robert S. Prather , Jr .

CEO


03/25/2019

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.

Robert S. Prather , Jr .

CEO


03/25/2019

Attachments

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