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:
57274
Service:
DTV
Call Sign:
WXXI-TV
Channel:
22 (UHF)
File Number:
0000028556
FRN:
0003410362
Date Submitted:
04/01/2019

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WXXI PUBLIC BROADCASTING COUNCIL

Doing Business As: WXXI-TV

SUSAN M. ROGERS

PO Box 30021

ROCHESTER, NY 14603

United States

+1 (585) 258-0213 srogers@wxxi.org Not-for-Profit

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

Kent Stephen Hatfield

VP Technology & Operations - Retired

WXXI Public Broadcasting Council

Kent Hatfield

2709 Clay Top Lane

Knoxville, TN 37912

United States

+1 (585) 303-1816 khatfield@wxxi.org

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 WXXI will now utilize its new transmitter on channel 16, up to the transition to channel 22. We will utilize our auxiliary channel 16 antenna during the replacement of our primary antenna. We will replace our transmitter as it is no longer supported

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 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 Ultimate
Year 2003
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 8.0 kW

Primary Transmitter

Back to Top

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-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12.9 kW
Justification for New Transmitter As per attachment, the Thales Ultimate series is no longer supported and can not be rechanneled. Note that the power rating for the replacement transmitter is the true power out of the transmitter and is not the power out from the associated mask filter.

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 40.0 feet
Other Electrical Service Yes
Description See attached documentation
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

Back to Top

Other Transmitter Cost Not Listed

Name Description

Removal of Thales Transmitter

Decommissioning and removal of existing Thales Ultimate transmitter

Antennas

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

Auxiliary Antenna

Back to Top

Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Aux-Lower Power
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this 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 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: 200.0 kW
Manufacturer
Model TFU-16DSB
Year 2003

Auxiliary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Auxillary for Top Mounted Main Antenna
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types 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: 200.0 kW
Manufacturer
Model ALP Series II
Year 2019
Justification for New Antenna The existing channel 16 side-mounted, auxiliary antenna is not retunable.

Auxiliary 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? 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

Auxiliary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Auxiliary Antenna Test

Test and verify the integrity of the channel 16 auxiliary antenna and line

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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 236.6 kW
Manufacturer
Model ATW25H3-ETC170-16H
Year 2013

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 Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 273.0 kW
Manufacturer
Model ATW25H3-ETC170-22H
Year 2019
Justification for New Antenna Existing antenna cannot be retuned

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? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

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? No
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1003958
Coordinates (NAD83) Latitude (NAD83) 43° 08' 07.0" N-
Longitude (NAD83) 077° 35' 02.0" W-
Overall Structure Height 344.48 feet
Support Structure Height 275.59 feet
Ground Elevation Above Mean Sea Level (AMSL) 672.56 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WXXI PUBLIC BROADCASTING COUNCIL INC
Date Constructed 01/31/1980

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
74218 WXXI-FM FM
69138 WRUR-FM FM

Primary Tower

Back to Top

Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No 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

Rotation of Auxiliary Antenna

Rotation of the existing channel 16 side-mounted auxiliary antenna power lobe from 210 degrees to 180 degrees to match current pattern

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 30
Explanation Staff is not available 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 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations 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 Yes
Number of Days 1
Justification Verify that adjacent channel 21 is protected from the new channel 22 by correctly tuned mask filters

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Basic Site Survey

Survey to verify facility site for implementation of new channel 22 operation

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 No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
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

Back to Top

Other Expenses Not Listed

Name Description

WXXI Staff

WXXI Staff is involved in the migration from channel 16 to 22 and required filings

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 $558,953.00 $549,896.62 N/A $186,651.21 N/A
Total for all systems $1,252,609.00 $1,165,277.62 N/A $191,897.27 N/A
Primary Transmitter ULXTE-20 $558,953.00 $549,896.62 $186,651.21
Removal of Thales Transmitter $25,213.00 $25,213.00 Decommission and removal of the Thales transmitter from the 2nd floor of the WXXI transmission facility. N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,040.00 $0.00 Price contained within the electrical Proposal N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $507,048.62 DTV Transmitter system with a redundant exciter, coax switching, station load, delivery, installation, and testing. $169,016.21 Costs included Shipping and Installation
Switchgear - industrial 800 amp $38,200.00 $17,635.00 Price Contained within the Electrical Proposal $17,635.00 Original estimated cost did not include major switchgear. After the full evaluation of the panelboard, the plan was revised to install a new sub-main panel, to comply with NEC.
Other Electrical Service: See attached documentation $0.00 $0.00 Installation requires the installation of a new breaker installed in the main power distribution system, after normal hours. Also, involves building a new frame to support the new power distribution panel. N/A N/A

Components

Actual Information Description File Name
Removal of Thales Transmitter Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
First Invoice 1/3 of total Purchase Agreement
Amount:
$169,016.21

Component Description:
Second Payment of 1/3 Prior to Shipping
Amount:
$169,016.21

Component Description:
Final Payment - GatesAir Transmitter, Shipping & Installation
Amount:
$169,153.03
Switchgear - industrial 800 amp

Component Description:
Please reimburse the total value $17635 of the Invoice as all amounts have been paid.
Amount:
$17,635.00
Other Electrical Service: See attached documentation 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 $498,860.00 $511,660.00 N/A $766.06 N/A
Total for all systems $1,252,609.00 $1,165,277.62 N/A $191,897.27 N/A
Primary Antenna ATW25H3-ETC170-22H $296,230.00 $318,860.00 $0.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $0.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $312,460.00 Includes removal of channel 16 and installation of channel 22 antennas N/A N/A
Auxiliary Antenna ALP Series II $202,630.00 $192,800.00 $766.06
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $766.06 N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $180,000.00 N/A N/A N/A
Auxiliary Antenna Test $6,400.00 $6,400.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Reimbursement of $774.45 for services relating to teh testing of teh WXXI auxiliary antenna and line
Amount:
$774.45
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized Information not provided.
Sweep test of existing antenna

Component Description:
Sweep of Current CH 21 Aux Antenna. Corrected for compliance with Mileage Costs.
Amount:
$766.06

Component Description:
Sweep Existing Auxiliary Antenna for use during transition.
Amount:
$766.06
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized Information not provided.
Auxiliary Antenna Test Information not provided.

Cost Information

Back to Top

Transmission Line

Information not provided.

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 $92,200.00 $8,000.00 N/A $0.00 N/A
Total for all systems $1,252,609.00 $1,165,277.62 N/A $191,897.27 N/A
Primary Tower TOWER $92,200.00 $8,000.00 $0.00
Rotation of Auxiliary Antenna $8,000.00 $8,000.00 After Hours tower work N/A N/A
Short Tower (less than 500') $84,200.00 $0.00 N/A N/A N/A

Components

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 $57,546.00 $56,221.00 N/A $4,480.00 N/A
Total for all systems $1,252,609.00 $1,165,277.62 N/A $191,897.27 N/A
Outside Professional Services $57,546.00 $56,221.00 $4,480.00
Basic Site Survey $6,471.00 $6,471.00 Review facilities and site for implementation of channel 22 operation N/A N/A
Additional Field Engineering Service, 1 Days $2,000.00 $2,000.00 Verification of correct adjacent channel operation N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A $0.00 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
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 $7,000.00 N/A $4,480.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $5,000.00 See Attachment: Justification for Additional Time Needed to Prepare Engineering Section of Form 2100.docx $0.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
Project management of the transition $4,740.00 $4,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Basic Site Survey Information not provided.
Additional Field Engineering Service, 1 Days 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 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

Component Description:
Reimbursement for Engineering Expenses related to Spectrum Repack
Amount:
$1,840.00

Component Description:
Reimbursement of Engineering Expense Related to Spectrum Repack
Amount:
$400.00

Component Description:
Refund of Engineering Costs Related to Spectrum Repack
Amount:
$2,240.00
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.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Project management of the transition Information not provided.
Prepare and or review reimbursement form 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 $45,050.00 $39,500.00 N/A $0.00 N/A
Total for all systems $1,252,609.00 $1,165,277.62 N/A $191,897.27 N/A
Other Expenses $45,050.00 $39,500.00 $0.00
Develop and air announcement of upcoming channel change $3,000.00 $3,000.00 Develop and produce on-air spots for all DTV Channels N/A N/A
WXXI Staff $10,000.00 $10,000.00 WXXI staff will be required to develop and support the transition plan from channel 16 to 22 N/A N/A
DTV Medical Facility Notification $11,550.00 $6,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 Electronic Waste Disposal N/A N/A
Equipment Delivery and Handling Charges $10,000.00 $10,000.00 Estimated Freight costs and delivery services for the new antenna N/A N/A
MVPD Notification of Channel Change $500.00 $500.00 Memo to cable ad Satellite Providers N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,252,609.00 $1,165,277.62 $191,897.27

Reimbursement Status

Back to Top
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

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.

Kent Stephen Hatfield , Hatfield .

VP Technology & Operations - Retired


04/01/2019

Attachments

Back to Top