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:
74214
Service:
DCA
Call Sign:
WUTH-CD
Channel:
47 (UHF)
File Number:
0000028353
FRN:
0001529627
Date Submitted:
05/10/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ENTRAVISION HOLDINGS, LLC

Mark Boelke

Suite 6000 West

2425 Olympic Boulevard

Santa Monica, CA 90404

United States

+1 (310) 447-3896 mboelke@entravision.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

Samuel Hariton

Widelity

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

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. No
Briefly describe transition plan The plan is for WUTH-CD is to replace the existing Channel 47 system with a new Channel 22 antenna, new 1-5/8" line, and a new transmitter.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model UAX-2000
Year 2013
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 2.5 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model UAXTE-2R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter New transmitter is necessary because the existing transmitter is not capable of being economically retuned as because doing so requires shipping the transmitter back to the manufacturer, see letter from Gates Air.

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 No
Size N/A
Length N/A
Other Electrical Service Yes
Description The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUTH-CD estimated the electrical work cost.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Class A
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: 15.0 kW
Manufacturer
Model B4UD
Year 2001

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Class A
Mounting Side 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: 15.0 kW
Manufacturer
Model TUL-C4SP-4/7M-1-SM
Year 2017
Justification for New Antenna A new antenna is necessary because the existing antenna cannot be retuned to the new channel and is not capable of broadcasting on channel 22.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? 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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 240 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 240 feet per run
Justification for New Transmission Line Buying new transmission line allows WUTH to install and power the new antenna on the new transmitter without disconnecting the old antenna, which would produce an extended period of time off-air.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) No
Others Types of Users Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1206978
Coordinates (NAD83) Latitude (NAD83) 41° 42' 30.0" N-
Longitude (NAD83) 072° 28' 32.0" W-
Overall Structure Height 232.94 feet
Support Structure Height 219.81 feet
Ground Elevation Above Mean Sea Level (AMSL) 776.57 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner M&R Gassner Family III, LLC
Date Constructed 12/03/1999


Other Types of Users

Users
Sprint
Verizon
CT Public Broad
Marcus Communic
USA Mobility
Lo-Jack
CRCOG

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Structural Analysis

After the mapping is complete, a structural will be necessary.

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 712
Explanation WUTH-CD does not have sufficient resource capacity and expertise inhouse to handle all of the reimbursement filing by the construction deadline for Phase 4 on August 2, 2019. WUTH-CD will hire an outside firm to ensure a timely and well managed transition
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 Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination 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 $146,000.00 $84,723.69 N/A $32,255.59 N/A
Total for all systems $997,091.00 $952,189.69 N/A $244,928.68 N/A
Primary Transmitter UAXTE-2R37 $146,000.00 $84,723.69 $32,255.59
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $64,723.69 Please see like-for-like GatesAir Quote Q-7405, including GatesAir change order Q-78768 $32,255.59 N/A
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUTH-CD estimated the electrical work cost. $20,000.00 $20,000.00 N/A $0.00 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
50% Down payment for New Primary Transmitter
Amount:
$32,255.59
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUTH-CD estimated the electrical work cost. 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 $33,030.00 $50,038.00 N/A $14,142.60 N/A
Total for all systems $997,091.00 $952,189.69 N/A $244,928.68 N/A
Primary Antenna TUL-C4SP-4/7M-1-SM $33,030.00 $50,038.00 $14,142.60
Sweep test of existing antenna $6,730.00 $16,500.00 Based on Quote from Vendor N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $33,538.00 See attached Quote 513323JKT Rev 4 with cover letter explaining like-for-like. 31428-2890(like-for-like delta)+5000(est shipping/taxes)=33538 $14,142.60 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
UHF - Low - Medium Power Side Mount
Amount:
$14,142.60

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $7,920.00 $10,402.00 N/A $2,411.59 N/A
Total for all systems $997,091.00 $952,189.69 N/A $244,928.68 N/A
Primary Transmission Line $7,920.00 $10,402.00 $2,411.59
Flexible Air Transmission Line - dielectric, 1 5/8" $7,920.00 $10,402.00 Based on quote from Manufacturer $2,411.59 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 1 5/8"

Component Description:
Transmission Line
Amount:
$2,411.59

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $543,500.00 $550,901.00 N/A $142,616.50 N/A
Total for all systems $997,091.00 $952,189.69 N/A $244,928.68 N/A
Primary Tower TOWER $543,500.00 $550,901.00 $142,616.50
Short Tower (less than 500') $84,200.00 $113,901.00 Based on quote from Installation Vendor. $57,959.16 N/A
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A $71,333.33 N/A
Structural Analysis $12,000.00 $12,000.00 N/A $0.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A $13,324.01 N/A

Components

Actual Information Description File Name
Short Tower (less than 500')

Component Description:
"For Station WUTH Facility ID 74214 : Per Proposal#062817JS10, 50% upon acceptance. Total contract price $39,985.00"
Amount:
$19,992.50

Component Description:
For Station WUTH
Amount:
$37,966.66
Major tower reinforcement/modifications

Component Description:
For Station WUTH, 1/3 upon acceptance
Amount:
$71,333.33
Structural Analysis

Component Description:
Broadcast tower structural analysis
Amount:
$2,486.11
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Tower mapping and prep of doc necessary for tower load study
Amount:
$13,324.01

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 $179,566.00 $171,050.00 N/A $53,502.40 N/A
Total for all systems $997,091.00 $952,189.69 N/A $244,928.68 N/A
Outside Professional Services $179,566.00 $171,050.00 $53,502.40
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $250.00 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 and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $112,496.00 $106,800.00 N/A $49,314.90 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 $437.50 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,500.00 Change to Dielectric antenna caused RF Engineer to make changes for Form 2100 filing, incurring additional costs. See attached invoice. $3,500.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A

Components

Actual Information Description File Name
RF Exposure Measurements Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Prepare Ch. Share Application
Amount:
$250.00
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 and or review reimbursement form Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$4,005.65

Component Description:
Project Management
Amount:
$2,820.75

Component Description:
Project Management
Amount:
$2,028.00

Component Description:
Project management
Amount:
$1,193.70

Component Description:
Project Management
Amount:
$3,291.70

Component Description:
Project Management
Amount:
$2,289.85

Component Description:
Project Management
Amount:
$1,905.05

Component Description:
Project Management
Amount:
$2,055.05

Component Description:
Project management
Amount:
$1,423.35

Component Description:
Project Management
Amount:
$1,971.60

Component Description:
Project Management
Amount:
$4,350.05

Component Description:
Project management
Amount:
$778.60

Component Description:
Project Management
Amount:
$2,305.65

Component Description:
Project management
Amount:
$1,090.65

Component Description:
Project Management
Amount:
$3,036.15

Component Description:
Project management
Amount:
$2,958.25

Component Description:
Project management
Amount:
$3,540.40

Component Description:
Project management
Amount:
$971.95

Component Description:
Project management of transition
Amount:
$2,082.95

Component Description:
Project management
Amount:
$148.20

Component Description:
Project Management
Amount:
$1,402.15

Component Description:
Project Management
Amount:
$1,881.10

Component Description:
Project Management
Amount:
$1,784.10
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:
Engineering study work for new channel assignment and antenna development
Amount:
$437.50
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of the engineering section of FCC Form 2100
Amount:
$2,250.00

Component Description:
Preparing of engineering section of FCC Form 2100
Amount:
$1,250.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.

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 $87,075.00 $85,075.00 N/A $0.00 N/A
Total for all systems $997,091.00 $952,189.69 N/A $244,928.68 N/A
Other Expenses $87,075.00 $85,075.00 $0.00
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
AM Pattern Disturbance -- Impact study $7,890.00 $7,500.00 N/A N/A N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $13,000.00 $13,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 N/A N/A N/A
MVPD Notification of Channel Change $750.00 $750.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
AM Pattern Disturbance -- Remedy $21,050.00 $20,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $997,091.00 $952,189.69 $244,928.68

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.

Manuel Cavazos , III .

EVP - Director of Technology


05/10/2019

Attachments

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