| Applicant | Address | Phone | Applicant Type | |
|---|---|---|---|---|
|
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY Doing Business As: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
Gregory Petrowich PO Box 62708 MAILCODE 6602 CARBONDALE, IL 62901 United States |
+1 (618) 453-6181 | GREG.PETROWICH@WSIU.ORG | Not-for-Profit |
| Applicant | Address | Phone | |
|---|---|---|---|
|
[Confidential] |
|
|
|
| Applicant | Address | Phone | |
|---|---|---|---|
|
Greg Best Consulting Engineer Greg Best Consulting, Inc. |
16100 Outlook Avenue Stilwell, KS 66085 United States |
+1 (816) 792-2913 | gbconsulting54@gmail.com |
| 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 | WSEC requires a new tower. Existing tower will be shortened to allow installation of interim antenna. A xmtr will be purchased to replicate coverage. Final xmtr facility will be constructed with new tower & antenna. See attached Transition plan document. |
| Section | Question | Response |
|---|---|---|
| Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
| Section | Question | Response |
|---|---|---|
| Existing Transmitter Description | Type of change | Purchase New |
| Use | Primary (Main) | |
| Description of Use | N/A | |
| Ownership | Owned | |
| Owner | N/A | |
| Site | N/A | |
| Is this transmitter currently shared with another station? | No | |
| Is this transmitter currently in operating condition? | Yes | |
| Existing Transmitter Manufacturer and Type | Manufacturer | |
| Model | DCD20PL1 | |
| Year | 2001 | |
| Type | Solid State | |
| Solid State Cooling | Air Cooled | |
| Solid State Power Capacity | 5 kW |
| Section | Question | Response |
|---|---|---|
| New Transmitter | Use | Primary (Main) |
| Change Type | Purchase New | |
| Is this a request for upgraded equipment? | No | |
| Manufacturer | ||
| Model | ULXTE-50 | |
| Transmitter Type | Solid State | |
| Solid State Cooling | Liquid Cooled | |
| Solid State Power capacity | 31.7 kW | |
| Justification for New Transmitter | Existing Harris DiamondCD transmitter is not supported for new channel of operation. New xmtr will be needed to meet contour replication during the interim operation time. See transition plan document. |
| Section | Question | Response |
|---|---|---|
| Electrical Service | Service Entrance (3 phases 800A 208V) | Yes |
| Switchgear (industrial 800 amp) | No | |
| Transformer (480V) | No | |
| Power | N/A | |
| Rigid Conduit and Wiring | Yes | |
| Size | 3 inches | |
| Length | 50.0 feet | |
| Other Electrical Service | Yes | |
| Description | Install new circuit breaker(s) as required and install wiring to transmitter's physical location within the building. Site needs 3 phase power. See separate estimate for 3 phase power service to the site. | |
| 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? | Yes |
| Size | 100.0 square feet | |
| 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 |
| Section | Question | Response |
|---|---|---|
| Antenna Related Expenses | Do you have antenna related expenses? | Yes |
| 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 this antenna currently shared with any other stations? | No | |
| Is this antenna directional? | No | |
| 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 | Horizontal | |
| Type | Other | |
| 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 | Slot Antenna - single channel tuned | |
| ERP: | 75.0 kW | |
| Manufacturer | ||
| Model | TFU-24GTH-R O4 | |
| Year | 2002 |
| 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? | No | |
| Will antenna be located on or in close proximity to an antenna farm? | No | |
| 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: | 80.8 kW | |
| Manufacturer | ||
| Model | ATW28HSO-18 | |
| Year | 2019 | |
| Justification for New Antenna | Existing antenna will not function on the assigned frequency. |
| Section | Question | Response |
|---|---|---|
| Combiner for Shared Antenna | Do you need a Combiner for a Shared Antenna? | No |
| Type | ||
| Number of channels supported | N/A | |
| Frequencies of channels supported | N/A | |
| Frequency | N/A | |
| Do you need a combiner output splitter/switcher for dual feed lines? | N/A | |
| Elbow Complex | Do you require the separate purchase of the Elbow Complex? | Yes |
| Broadband or Single Channel? | Single Channel | |
| Feed Line Size | 4 1/16 inches inches | |
| 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 |
| Section | Question | Response |
|---|---|---|
| Transmission Line Related Expenses | Do you have transmission line related expenses? | Yes |
| Section | Question | Response |
|---|---|---|
| Existing Transmission Line Description | Type of change | 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 | Rigid | |
| Diameter | 4 1/16 inches | |
| Other Diameter | N/A | |
| Segment Length | 20 inches | |
| Other Segment Length | N/A | |
| Number of parallel runs | 1 | |
| Length | 1000 feet per run |
| 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 | Rigid | |
| Diameter | 4 1/16 inches | |
| Other Diameter | N/A | |
| Segment Length | 20 inches | |
| Other Segment Length | N/A | |
| Number of parallel runs | 1 | |
| Length | 1000 feet per run | |
| Justification for New Transmission Line | Structure analyses found need for tower replacement. New tower will require transmission line be in place at the time transmission begins on new tower. |
| Section | Question | Response |
|---|---|---|
| Tower Equipment or Rigging Costs Changes | Do you have tower equipment or rigging costs changes? | Yes |
| Section | Question | Response |
|---|---|---|
| Existing Tower Description | Type of change | Construct New |
| 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) | No | |
| Others Types of Users | Yes | |
| 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 | 1221865 | |
| Coordinates (NAD83) | Latitude (NAD83) | 39° 36' 09.2" N- |
| Longitude (NAD83) | 090° 02' 47.4" W- | |
| Overall Structure Height | 976.04 feet | |
| Support Structure Height | 915.67 feet | |
| Ground Elevation Above Mean Sea Level (AMSL) | 672.89 feet | |
| Structure Type | TOWER - Free Standing or Guyed Structure | |
| Tower Owner | West Central Illinois Educational Telecommunications Corporation | |
| Date Constructed | 09/23/2002 |
| Users |
|---|
| W40CV-D |
| Section | Question | Response |
|---|---|---|
| Construct New Tower | Use | Primary (Main) |
| Description of Use | N/A | |
| Is this a request for upgraded equipment? | No | |
| Height | 912.00 feet | |
| Justification for New Tower | Two structural analyses were conducted and both found that the existing structure and foundation do not meet ANSI/TIA - G Code. See attachment: WSEC Documentation for new tower.pdf (attached). |
| Section | Question | Response |
|---|---|---|
| Tower Rigging Costs | Complex Tower | N/A |
| Helicopter Services Required | Are helicopter services required? | No |
| Name | Description |
|---|---|
STL-TSL Equipment |
Please refer to file - WSEC-Microwave Justification.PDF This tower is the 2nd in a string of 7 towers sending programming, transmitter control & telemetry between master control and our three broadcast stations. |
Interim tower mods |
Please refer to ERI quotation 20190314-958 that creates adapter and mounts antenna for interim operation. |
| Section | Question | Response |
|---|---|---|
| Outside Project Management Services | Do you require outside project management services? | Yes |
| Number of Hours | 120 | |
| Explanation | Forms review; onsite supervision during transmitter, antenna & tower work; coordination of involved entities in 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 | No | |
| For Main Facility | Yes | |
| Prepare engineering section of Form FCC License to Cover Application | Yes | |
| For Auxiliary Facility | No | |
| For Main Facility | Yes | |
| Prepare request for Special Temporary Authority | Yes | |
| Quantity | 1 | |
| Do you have Distributed Transmission System engineering services? | N/A | |
| Critical Facility | N/A | |
| Terrain-Shielded Facility | N/A | |
| Attorney and Other Outside Consulting Services | Prepare and file Form FCC Construction Permit Application | Yes |
| For Auxiliary Facility | No | |
| For Main Facility | Yes | |
| Prepare and file Form FCC License to Cover Application | Yes | |
| For Auxiliary Facility | No | |
| For Main Facility | Yes | |
| Prepare request for Special Temporary Authority | Yes | |
| Quantity | 1 | |
| NEPA Section 106 environmental review | No | |
| Environmental Assessment | No | |
| ASR Modification | Yes | |
| 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 |
| 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? | 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 |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $998,500.00 | $998,050.00 | N/A | $0.00 | N/A |
| Total for all systems | $4,103,478.31 | $3,858,048.36 | N/A | $1,524,133.81 | N/A |
| Primary Transmitter ULXTE-50 | $998,500.00 | $998,050.00 | $0.00 | ||
| UHF - Liquid Cooled Solid State Transmitter 31.7 kW | $900,000.00 | $900,000.00 | N/A | N/A | N/A |
| Service entrance 3 phase/800 amp/208 volt | $14,400.00 | $14,050.00 | N/A | N/A | N/A |
| 3" Rigid Conduit and Wiring (Cost per foot) | $2,600.00 | $2,500.00 | N/A | N/A | N/A |
| Other -- Building Addition Size: 100.0 | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
| Other Electrical Service: Install new circuit breaker(s) as required and install wiring to transmitter's physical location within the building. Site needs 3 phase power. See separate estimate for 3 phase power service to the site. | $71,500.00 | $71,500.00 | See separate estimate for 3 phase service to the site. | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $552,800.00 | $346,020.00 | N/A | $94,325.00 | N/A |
| Total for all systems | $4,103,478.31 | $3,858,048.36 | N/A | $1,524,133.81 | N/A |
| Primary Antenna ATW28HSO-18 | $552,800.00 | $346,020.00 | $94,325.00 | ||
| Sweep test of existing antenna | $6,730.00 | $6,250.00 | Sweep test of new line and antenna. See ERI Proposal 20190207-592 Rev A | $4,375.00 | N/A |
| Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) | $9,570.00 | $9,320.00 | N/A | N/A | N/A |
| UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized | $289,500.00 | $240,500.00 | N/A | N/A | N/A |
| UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized | $247,000.00 | $89,950.00 | ***System Notice: Estimate adjusted and locked because line has been superseded.***ERI Proposal 20190207-592 Rev A- Attached. Price above indicates deduction for Hpol version. | $89,950.00 | N/A |
| Actual Information Description | File Name |
|---|---|
| Sweep test of existing antenna | |
| Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) | Information not provided. |
| UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized | Information not provided. |
| UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $142,000.00 | $97,405.05 | N/A | $68,183.53 | N/A |
| Total for all systems | $4,103,478.31 | $3,858,048.36 | N/A | $1,524,133.81 | N/A |
| Primary Transmission Line | $142,000.00 | $97,405.05 | $68,183.53 | ||
| Rigid Transmission Line - copper, 4 1/16" | $142,000.00 | $97,405.05 | See ERI proposal 20190207-592 Rev A. This quote includes transmission line and air dryer | $68,183.53 | N/A |
| Actual Information Description | File Name |
|---|---|
| Rigid Transmission Line - copper, 4 1/16" |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $2,315,353.31 | $2,298,953.31 | N/A | $1,322,391.47 | N/A |
| Total for all systems | $4,103,478.31 | $3,858,048.36 | N/A | $1,524,133.81 | N/A |
| Primary Tower TOWER | $0.00 | $0.00 | $0.00 | ||
| Primary Tower | $2,315,353.31 | $2,298,953.31 | $1,322,391.47 | ||
| STL-TSL Equipment | $65,061.36 | $65,061.36 | Please refer to file - WSEC - Microwave Justification ... and per quote from Heartland Video Systems - see file - WSEC - HVS Commscope Antennas Gear.PDF | N/A | N/A |
| Tall Tower (greater than 500') | $210,500.00 | $200,000.00 | Replacement antennae and waveguide for microwave on new tower plus rigging to remove old antennae and replaced tower structure once new structure is complete and online. | $3,200.00 | N/A |
| Interim tower mods | $184,722.95 | $184,722.95 | See ERI quote Quote #20190314-958. | N/A | N/A |
| New tower | $1,842,469.00 | $1,842,469.00 | See ERI Proposal 20190207-592. Manufacture (discounted), construct and equip replacement 912' tower and decommission existing tower. | $1,312,491.47 | N/A |
| Structural engineering tower load study for well documented tower | $12,600.00 | $6,700.00 | ***System Notice: Estimate adjusted and locked because line has been superseded.*** | $6,700.00 | N/A |
| Actual Information Description | File Name |
|---|---|
| STL-TSL Equipment | Information not provided. |
| Tall Tower (greater than 500') | |
| Interim tower mods | Information not provided. |
| New tower | |
| Structural engineering tower load study for well documented tower |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $51,775.00 | $76,120.00 | N/A | $39,233.81 | N/A |
| Total for all systems | $4,103,478.31 | $3,858,048.36 | N/A | $1,524,133.81 | N/A |
| Outside Professional Services | $51,775.00 | $76,120.00 | $39,233.81 | ||
| ASR modification (prepare FCC Form 854) | $2,105.00 | $2,000.00 | N/A | N/A | N/A |
| Attorney Fees - Prepare and File request for Special Temporary Authorization | $3,680.00 | $3,585.00 | N/A | N/A | N/A |
| Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $4,500.00 | Please refer to uploaded file "WSEC Legal Counsel Budget.PDF" -- Additional legal counsel costs incurred due to unanticipated need for a new tower at this site. | $2,416.50 | Additional legal counsel required due to problems with 'saving' the 399 schedule without losing tower work dollar amounts. Received numerous errors on "saving & exiting'. Required repeated contact with FCC I.T. personnel (Raphael) to rectify. |
| Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $30,000.00 | Additional amount added to budget for legal counsel expenses due to legal complexities associated with unanticipated construction of a new tower at this site. | $25,398.81 | Additional legal fees due to unanticipated need to replace tower. |
| Project management of the transition | $18,960.00 | $18,000.00 | N/A | $9,075.00 | N/A |
| Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | 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 | N/A | N/A |
| Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | $2,343.50 | N/A |
| Prepare engineering section of FCC Form 2100 (main), License to Cover Application | $1,580.00 | $1,500.00 | N/A | N/A | N/A |
| Prepare request for Special Temporary Authorization | $2,050.00 | $1,535.00 | N/A | N/A | N/A |
| Actual Information Description | File Name |
|---|---|
| ASR modification (prepare FCC Form 854) | 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 | |
| Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | |
| Project management of the transition | |
| Prepare and or review reimbursement form | 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 | Information not provided. |
| Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | |
| Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
| Prepare request for Special Temporary Authorization | Information not provided. |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $43,050.00 | $41,500.00 | N/A | $0.00 | N/A |
| Total for all systems | $4,103,478.31 | $3,858,048.36 | N/A | $1,524,133.81 | N/A |
| Other Expenses | $43,050.00 | $41,500.00 | $0.00 | ||
| Develop and air announcement of upcoming channel change | $5,000.00 | $5,000.00 | N/A | N/A | N/A |
| MVPD Notification of Channel Change | $5,000.00 | $5,000.00 | N/A | N/A | N/A |
| Equipment Storage | $2,500.00 | $2,500.00 | N/A | N/A | N/A |
| DTV Medical Facility Notification | $11,550.00 | $10,000.00 | N/A | N/A | N/A |
| Disposal Costs (for equipment and other waste, net of any salvage value) | $4,000.00 | $4,000.00 | Antenna, transmitter, packaging materials. | N/A | N/A |
| Equipment Delivery and Handling Charges | $15,000.00 | $15,000.00 | Tx @ 5400 Antenna @ 7700 Misc @ 1900 | N/A | N/A |
| Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
|---|---|---|---|
| Total for all systems | $4,103,478.31 | $3,858,048.36 | $1,524,133.81 |
| Question | Response |
|---|---|
| The facility has ceased operating on its pre-auction channel. | No |
| Construction of final facilities or all necessary modifications are complete. | No |
| All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. | No |
| Section | Question | Response |
|---|---|---|
| Submission of Estimated Expenses Statements | WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT. |
|
| I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | J Kevin Dorsey Interim President, Southern Illinois University 05/03/2019 |
| 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). |
|
| I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | J Kevin Dorsey Interim President, Southern Illinois University 05/03/2019 |
