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:
36607
Service:
DTV
Call Sign:
KJZZ-TV
Channel:
19 (UHF)
File Number:
0000028798
FRN:
0025502048
Date Submitted:
06/05/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KJZZ LICENSEE, LLC

Doing Business As: KJZZ LICENSEE, LLC

Harvey Arnold

10706 Beaver Dam Road

Cockeysville, MD 21030

United States

+1 (410) 568-1500 harnold@sbgtv.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

Paul A Cicelski

Lerman Senter PLLC

Paul Cicelski

2001 L Street, NW

Suite 400

Washington, DC 20036

United States

+1 (202) 429-8970 pcicelski@lermansenter.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. Yes
Briefly describe transition plan See Exhibit A.

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 DHD45P2
Year 2001
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 10.5 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 THU9evo-16
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25.5 kW
Justification for New Transmitter Per the manufacturer, the current transmitter cannot be retuned. See Exhibit B.

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) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 800.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 50 tons
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.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model ULXTE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12 kW
Justification for New Transmitter This interim transmitter cost will be shared by the eight stations that are collocated on this tower, and will aid all of the stations in transitioning to their new channels considering the terrain and phase time constraints.

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 800.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 50 tons
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
Inside RF System Is an additional interior RF system required to support this interim transmitter? Yes

Interim 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? 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? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 8
Number of Panels 48
Design power capacity in use 77.0 %
Lower Limit 773.00 MHz
Upper Limit 928.00 MHz
Other Antenna Type N/A
ERP: 200.0 kW
Manufacturer
Model 773 928
Year 1999

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

Facility ID Call Sign
69396 KUED
69582 KUEN
1136 KUCW
35823 KUTV
6359 KSL-TV
6823 KBYU-TV
68889 KTVX

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? Yes
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 Bottom
Polarization Circular
Type Broadband Panel
Number of Stations Supported 8
Number of Panels/Bays 48
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 90.0 %
Other Antenna Type N/A
ERP: 114.0 kW
Manufacturer
Model 759 25063
Year 2017
Justification for New Antenna FROM MANUFACTURER. These panel antennas are finely tuned to a specific band, but the new repacked channels are not within the specific band, so the current antenna cannot be used for the new repack channel.

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 8
Frequencies of channels supported Upper and lower frequency
Frequency 470.0 MHz - 608.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? Yes
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 6 1/8 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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Other Costs

Other Costs

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 Utilize Existing
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? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 230 feet per run

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

Facility ID Call Sign
68889 KTVX
1136 KUCW
35823 KUTV
6359 KSL-TV
6823 KBYU-TV
69396 KUED
69582 KUEN

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 Owned
Is this tower consider Complex? Terrain Constrained
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 Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1062408
Coordinates (NAD83) Latitude (NAD83) 40° 39' 33.0" N-
Longitude (NAD83) 112° 12' 10.0" W-
Overall Structure Height 308.40 feet
Support Structure Height 308.40 feet
Ground Elevation Above Mean Sea Level (AMSL) 9035.32 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner DTV UTAH, LC
Date Constructed 10/28/1999

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
69582 KUEN DTV
6359 KSL-TV DTV
35823 KUTV DTV
69396 KUED DTV
68889 KTVX DTV
6823 KBYU-TV DTV
1136 KUCW DTV

Other Types of Users

Users
KPNZ - Telev
Go Go Air

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 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 Terrain constrained
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

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 800
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution. See Exhibit K.
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 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 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 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 Yes
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? 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 Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Transportation Services

Snow cat and helicopter to move equipment and personnel to remote mountaintop site during winter season. See Exhibit R.

DTV Utah Operating Agreement Equity Equalization

Per Operating Agreement signed July 1998. See Exhibit M.

KSTU Mask Filter

Needed for KSTU (channel 28) to protect KUED (channel 27). See Exhibit N.

Road Maintenance

Snow plowing, grading, and repairs to existing road to remote mountaintop site. See Exhibit R.

Temporary Sanitation

For onsite workers. See Exhibit S.

Temporary Storage

For tools and equipment onsite and staging area off-site. See Exhibit P.

Garbage Disposal

Remove general garbage from mountaintop site (does not include equipment removal). Billed as used.

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 $2,312,600.00 $1,306,147.91 N/A $272,261.27 N/A
Total for all systems $4,316,248.95 $2,585,891.37 N/A $1,009,392.36 N/A
Interim Transmitter ULXTE-20 $1,003,800.00 $262,847.91 $170,413.15
UHF inside RF system including switching $147,500.00 $17,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $4,944.63 N/A
50 Ton system $266,000.00 $96,392.50 Updated cost estimate per FCC guidelines. Check quote for CCI and Quote for WHW. 1/6 share of the entire quotes added including added scope. $64,774.63 The old entry of "$2,400.00" can be deleted. The old entry of "$933.33" can also be deleted.
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $2,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $4,375.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $4,537.50 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $3,645.79 N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $137,542.91 This cost is shared with all DTV Utah stations and represents 1/6 of the cost of this item. $97,048.10 N/A
Primary Transmitter THU9evo-16 $1,308,800.00 $1,043,300.00 $101,848.12
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $922,000.00 N/A $101,848.12 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $20,000.00 N/A N/A N/A
50 Ton system $266,000.00 $30,000.00 This cost is shared with eight stations, six of which are repacked, and we estimate $180,000 total for the cost of this HVAC service. $0.00 N/A

Components

Actual Information Description File Name
UHF inside RF system including switching

Component Description:
1/6 share of interim transmitter related cost. #268011
Amount:
$6.06

Component Description:
1/6 share of interim transmitter related cost. #267999
Amount:
$2,589.33

Component Description:
1/6 share for 25% of Transmitter related cost. #GTIA-1010
Amount:
$201.09

Component Description:
1/6 share of interim transmitter related cost. #266916
Amount:
$1,236.39

Component Description:
1/6 share of interim transmitter related cost. #GTIA-1024
Amount:
$308.50

Component Description:
1/6 share of interim transmitter cost. #GTIA-1018
Amount:
$603.26
50 Ton system

Component Description:
1/6 share of transmitter related cost. #170701
Amount:
$2,400.00

Component Description:
Updated 1/6 share of transmitter related cost. #171552
Amount:
$933.33

Component Description:
1/6 share of the cost of transmitter HVAC project. #170701
Amount:
$2,400.00

Component Description:
1/6 share of cost for transmitter HVAC project. #171552
Amount:
$933.33

Component Description:
1/6 cost of HVAC project. #171551
Amount:
$7,466.66

Component Description:
1/6 cost of HVAC project payment 1. #141941
Amount:
$16,416.66

Component Description:
1/6 share of costs for HVAC project, payment 4. #147696
Amount:
$8,627.50

Component Description:
1/6 share of cost for HVAC project, payment 2. #143250
Amount:
$11,163.83

Component Description:
1/6 share of the cost of the transmitter HVAC project. Payment 2. #170702
Amount:
$266.66

Component Description:
1/6 share of cost for HVAC work. #145734
Amount:
$14,166.66
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp

Component Description:
1/6 share of switchgear related cost for transmitter. #17470
Amount:
$3,149.19

Component Description:
1/6 share of transmitter switchgear related cost. #17051
Amount:
$496.60
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
1/6 share of cost for interim transmitter. #US0310264
Amount:
$21,682.94

Component Description:
Install station specific transmitter electrical equipment. #717-100
Amount:
$15,222.00

Component Description:
Transmitter downpayment. #9500074989
Amount:
$40,494.81

Component Description:
1/6 share of costs for interim transmitter. #US0311663
Amount:
$5,412.88

Component Description:
1/6 share of cost for interim transmitter. #JW30003982-DP
Amount:
$27,365.14

Component Description:
1/6 share of cost for interim transmitter. #JW30003982-BS
Amount:
$27,365.14
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter cost. #9500074989
Amount:
$101,848.12
Switchgear - industrial 800 amp Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
50 Ton system

Component Description:
1/6 share of costs for HVAC system. #141941
Amount:
$16,416.66

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 $531,503.70 $663,523.21 N/A $630,027.45 N/A
Total for all systems $4,316,248.95 $2,585,891.37 N/A $1,009,392.36 N/A
Primary Antenna 759 25063 $531,503.70 $663,523.21 $630,027.45
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $13,000.00 N/A $4,794.94 N/A
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $120,000.00 The station now has an invoice with this cost separated as a line item, and is entering it in the 399 as such. $0.00 N/A
Other Costs $50,873.70 $50,873.70 ***System Notice: Estimate adjusted and locked because line has been superseded.***Updated estimated amount per FCC's requirement. $50,873.70 N/A
Sweep test of existing antenna $6,730.00 $6,000.00 N/A $3,157.24 N/A
New combiner, cost per channel (without antenna) $84,200.00 $223,649.51 As per the request of the FCC $343,773.90 The share of the cost is greater than expected because the FCC requested to use 1/6 share as opposed to 1/8 share of the cost. Please delete the old entries as the new ones are updated.
UHF - High Power Top Mount Eight Station broadband panel antenna elliptically or circularly polarized $250,000.00 $250,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit D. $227,427.67 N/A

Components

Actual Information Description File Name
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
1/6 share of cost for antenna installation related cost. #GTIA-1050
Amount:
$4,794.94
Combiner output splitting/switching for dual feed lines, if applicable Information not provided.
Other Costs

Component Description:
1/6 share of antenna installation. #GTIA-1021
Amount:
$798.45

Component Description:
1/6 share of antenna installation cost. #GTIA-1011
Amount:
$1,748.05

Component Description:
1/6 share of remainder antenna installation cost. #GTIA-1055
Amount:
$11,754.09

Component Description:
1/6 share of cost for antenna installation. #GTIA-1012
Amount:
$1,310.83

Component Description:
1/6 share of cost for antenna installation. #GTIA-1036
Amount:
$23,508.19

Component Description:
1/6 share of antenna installation. #GTIA-1004
Amount:
$11,754.09
Sweep test of existing antenna

Component Description:
1/6 share of cost for antenna sweep test. #GTIA-1001
Amount:
$329.16

Component Description:
1/6 share of cost for antenna sweep test. #GTIA-1000
Amount:
$2,828.08
New combiner, cost per channel (without antenna)

Component Description:
Updated 1/6 share of antenna related cost. #GTIA-1086
Amount:
$6,727.52

Component Description:
Updated 1/6 share of antenna related cost.
Amount:
$113,396.87

Component Description:
1/6 share of new combiner cost last balance due. #00068513-3
Amount:
$2,561.53

Component Description:
1/6 share of costs for interim transmitter. #US0311888
Amount:
$3,320.18

Component Description:
1/6 share of antenna related reduced cost. #23001
Amount:
$90,717.50

Component Description:
1/6 share of the second payment that is due for the associated new combiner cost. #00068513-2
Amount:
$5,123.06

Component Description:
1/6 share of new combiner cost. #GTIA-1086
Amount:
$6,727.52

Component Description:
1/6 share of cost for the construction of a new combiner and monitor system. #00068513
Amount:
$5,123.06

Component Description:
1/6 share of cost for the construction for a new combiner and monitor system. #00068513
Amount:
$5,123.06

Component Description:
1/6 of antenna related reduced cost. #CLE 068 RevD-DP
Amount:
$22,679.35

Component Description:
1/6 share of antenna related reduced cost. #25008
Amount:
$90,717.49
UHF - High Power Top Mount Eight Station broadband panel antenna elliptically or circularly polarized

Component Description:
1/6 share of final 25% invoiced for antenna related cost. #GTIA-1056
Amount:
$7,710.92

Component Description:
1/6 share of high power antenna cost. #STS87757-1
Amount:
$4,160.41

Component Description:
1/6 share of progress payment for high power antenna related cost. #GTIA-1049
Amount:
$6,400.09

Component Description:
1/6 share for 25% of antenna related cost. #GTIA-1005
Amount:
$47,876.97

Component Description:
1/6 share for 25% down payment for Antenna related costs. #GTIA-1003
Amount:
$7,710.92

Component Description:
1/6 share of cost for antenna installation. #GTIA-1057
Amount:
$4,794.94

Component Description:
1/6 share of final invoice for antenna related cost. #GTIA-1054
Amount:
$9,575.39

Component Description:
1/6 share of cost for antenna installation. #GTIA-1002
Amount:
$5,142.50

Component Description:
1/6 share for second incremental invoice (25% of total) of High Power antenna installation. #GTIA-1035
Amount:
$47,876.97

Component Description:
1/6 share of progress payment for high power antenna cost. #GTIA-1048
Amount:
$86,178.56

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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $4,316,248.95 $2,585,891.37 N/A $1,009,392.36 N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

Information not provided.

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 $854,600.00 $101,500.00 N/A $2,413.47 N/A
Total for all systems $4,316,248.95 $2,585,891.37 N/A $1,009,392.36 N/A
Primary Tower TOWER $854,600.00 $101,500.00 $2,413.47
Structural engineering tower load study for well documented tower $12,600.00 $1,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $898.32 N/A
Major tower reinforcement/modifications $421,000.00 $50,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $1,515.15 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $50,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit L for partial cost. N/A N/A

Components

Actual Information Description File Name
Structural engineering tower load study for well documented tower

Component Description:
1/6 Share of cost for tower engineering study. #GTIA-1025
Amount:
$671.66

Component Description:
1/6 share of cost for one month of structural engineering & design services. #8895
Amount:
$226.66
Major tower reinforcement/modifications

Component Description:
1/6 share of tower related cost. #GTIA-1087
Amount:
$1,515.15
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) 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 $276,510.00 $174,250.00 N/A $84,563.37 N/A
Total for all systems $4,316,248.95 $2,585,891.37 N/A $1,009,392.36 N/A
Outside Professional Services $276,510.00 $174,250.00 $84,563.37
RF Exposure Measurements $21,050.00 $2,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $10,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
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 $7,360.00 $7,000.00 N/A $1,318.90 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $3,043.64 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,418.10 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $0.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $375.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,360.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,385.00 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
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $221.92 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
Project management of the transition $126,400.00 $120,000.00 N/A $68,440.81 N/A

Components

Actual Information Description File Name
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Updated 1/6 share of special temporary authorization cost. #18-032A
Amount:
$659.45

Component Description:
1/6 share of professional legal service cost. #18-032A
Amount:
$659.45
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
1/6 share of legal service cost. #842108
Amount:
$165.91

Component Description:
1/6 share of legal service cost. #844167
Amount:
$501.40

Component Description:
1/6 share of legal cost. #856027
Amount:
$415.83

Component Description:
1/6 share of legal service cost. #857095
Amount:
$68.00

Component Description:
1/6 share of legal service cost. #843151
Amount:
$1,960.50

Component Description:
1/6 share of legal service cost. #854957
Amount:
$357.00
Prepare and or review reimbursement form

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$1,311.48

Component Description:
Legal services cost. #461804
Amount:
$85.31

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$152.01

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$869.30
Prepare request for Special Temporary Authorization Information not provided.
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Legal services cost.
Amount:
$375.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting engineering cost. #858-64-0001
Amount:
$3,705.00

Component Description:
Consulting engineering services. #878-74-0001
Amount:
$2,655.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Consulting engineering cost. #878-74-0001
Amount:
$2,385.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$99.92

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$122.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Project management of the transition

Component Description:
updated 1/6 share of outside consulting services. #17-0036
Amount:
$916.62

Component Description:
1/6 share of outside consulting cost. #18-00039
Amount:
$17.82

Component Description:
1/6 share of outside consulting service cost. #17-00137
Amount:
$699.66

Component Description:
Updated 1/6 share of outside consulting cost. #18-00056
Amount:
$1,046.00

Component Description:
Updated outside consulting services. #1080
Amount:
$4,032.00

Component Description:
updated 1/6 share of outside consulting cost. #17-000137
Amount:
$699.66

Component Description:
Outside Consulting Cost. #1080
Amount:
$4,032.00

Component Description:
1/6 share of outside consulting services. #18-00056
Amount:
$1,046.00

Component Description:
1/6 share of outside consulting cost. #17-0036
Amount:
$916.62

Component Description:
Legal Service Cost. #467387
Amount:
$209.07

Component Description:
1/6 share of outside consulting service cost. #17-0021
Amount:
$1,102.36

Component Description:
1/6 share of outside consulting service cost. #17-0049
Amount:
$703.95

Component Description:
1/6 share of outside consulting service cost. #17-0053
Amount:
$445.45

Component Description:
1/6 share of outside consulting cost. #18-00005
Amount:
$742.45

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1032
Amount:
$43.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1078
Amount:
$215.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1045
Amount:
$185.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465001
Amount:
$596.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1055
Amount:
$243.38

Component Description:
1/6 share of outside consulting cost. #18-00008
Amount:
$545.14

Component Description:
1/6 share of outside consulting cost. #18-00037
Amount:
$837.25

Component Description:
Legal Service Cost. #466699
Amount:
$1,760.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$91.50

Component Description:
Legal Service Cost. #467497
Amount:
$564.20

Component Description:
1/6 share of outside consulting services. #18-00065
Amount:
$1,497.06

Component Description:
Legal services cost. #460941
Amount:
$765.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1012
Amount:
$20.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #1086
Amount:
$275.35

Component Description:
1/6 share of outside consulting services. #18-00043
Amount:
$1,215.74

Component Description:
Legal Service Cost. #467895
Amount:
$318.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1072
Amount:
$237.64

Component Description:
1/6 share of costs for engineering consulting cost. #GTIA-1038
Amount:
$1,750.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453972
Amount:
$716.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467378
Amount:
$576.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1051
Amount:
$105.97

Component Description:
1/6 share of outside consulting cost. #18-00031
Amount:
$521.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #464321
Amount:
$683.07

Component Description:
1/6 share of outside consulting cost. #18-00061
Amount:
$2,803.83

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026
Amount:
$801.57

Component Description:
1/6 share of outside consulting cost. #17-0059
Amount:
$696.62

Component Description:
1/6 share of consulting cost. #18-00027
Amount:
$525.66

Component Description:
1/6 share of outside consulting services. #GTIA-1007
Amount:
$2,763.54

Component Description:
Legal services cost. #463575
Amount:
$250.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1022
Amount:
$32.35

Component Description:
Legal Service Cost. #467841
Amount:
$1,988.40

Component Description:
Legal Service Cost. #465184
Amount:
$4,462.50

Component Description:
1/6 share of outside consulting cost. #18-00017
Amount:
$359.67

Component Description:
Legal service cost. #457856
Amount:
$3,745.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #450412
Amount:
$999.04

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1079
Amount:
$177.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1058
Amount:
$187.24

Component Description:
Legal services cost. #464259
Amount:
$575.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1063
Amount:
$262.29

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457331
Amount:
$836.44

Component Description:
1/6 share of outside consulting cost. #18-00023
Amount:
$358.38

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1029
Amount:
$20.91

Component Description:
1/6 share of cost for engineering consulting costs. #GTIA-1007
Amount:
$2,763.54

Component Description:
Legal services cost. #463022
Amount:
$5,586.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465173
Amount:
$654.26

Component Description:
1/6 share of outside consulting cost. #191
Amount:
$1,200.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1010
Amount:
$86.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$29.98

Component Description:
Legal Service Cost. #468747
Amount:
$2,552.90

Component Description:
Legal services cost. #464356
Amount:
$1,250.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463567
Amount:
$566.48

Component Description:
1/6 share of outside consulting service cost. #17-0026
Amount:
$916.41

Component Description:
Consulting cost. #1800032
Amount:
$101.15

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453686
Amount:
$943.95

Component Description:
Legal Service Cost. #468722
Amount:
$57.50

Component Description:
Legal services cost. #453970
Amount:
$172.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #466690
Amount:
$446.87

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457851
Amount:
$818.59

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1069
Amount:
$246.68

Component Description:
Legal services cost. #464698
Amount:
$240.00

Component Description:
1/6 share of outside consulting service cost. #17-0042
Amount:
$891.87

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1039
Amount:
$30.47

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 $341,035.25 $340,470.25 N/A $20,126.80 N/A
Total for all systems $4,316,248.95 $2,585,891.37 N/A $1,009,392.36 N/A
Other Expenses $341,035.25 $340,470.25 $20,126.80
Garbage Disposal $1,500.00 $1,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. Billed as used, but the estimate is based on past experience at this site. $1,212.50 N/A
Temporary Sanitation $3,000.00 $3,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit S. Estimate is based on past experience at this site. $0.00 N/A
Road Maintenance $10,000.00 $10,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit R. N/A N/A
Equipment Storage $4,000.00 $4,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit Q. $3,489.66 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Non-zoning permits $1,875.00 $1,875.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $28,566.00 $28,566.00 See Exhibit U. $0.00 N/A
Develop and air announcement of upcoming channel change $28,050.00 $28,050.00 See Exhibit T. N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Transportation Services $5,000.00 $5,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. To be used during inclement weather. $1,654.99 N/A
DTV Utah Operating Agreement Equity Equalization $223,083.00 $223,083.00 See Exhibit M. N/A N/A
KSTU Mask Filter $6,756.25 $6,756.25 Mask filter to remedy adjacent channel problem with KSTU. This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit N. N/A N/A
Equipment Delivery and Handling Charges $8,125.00 $8,125.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit P. $5,365.65 N/A
Temporary Storage $4,000.00 $4,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit P. $3,855.00 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $4,549.00 N/A

Components

Actual Information Description File Name
Garbage Disposal

Component Description:
1/6 share of garbage disposal cost. #10723
Amount:
$225.00

Component Description:
1/6 share of garbage disposal cost. #10786
Amount:
$150.00

Component Description:
Garbage disposal. #10184
Amount:
$312.50

Component Description:
1/6 share of garbage disposal cost. #10660
Amount:
$225.00

Component Description:
1/6 share of garbage disposal cost. #10581
Amount:
$300.00
Temporary Sanitation Information not provided.
Road Maintenance Information not provided.
Equipment Storage

Component Description:
1/6 share of equipment storage cost. #0029220-IN
Amount:
$308.33

Component Description:
1/6 share of cost for equipment storage. #0029207-IN
Amount:
$308.33

Component Description:
1/6 share of cost for equipment storage. #0029058-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029246-IN
Amount:
$308.33

Component Description:
1/6 share of cost for equipment storage. #002901-IN
Amount:
$120.83

Component Description:
1/6 share of equipment storage cost. #9568587381
Amount:
$139.68

Component Description:
1/6 share of equipment storage cost. #0029104-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029188-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029234-IN
Amount:
$308.33

Component Description:
1/6 share of equipment storage cost. #0029086
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029104-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029169-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029122-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029262-IN
Amount:
$308.33

Component Description:
1/6 share of equipment storage cost. #0029141-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. 0029156-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029067-In
Amount:
$187.50
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Non-zoning permits Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
MVPD Notification of Channel Change Information not provided.
Transportation Services

Component Description:
1/6 share of transportation service cost. #1783
Amount:
$108.33

Component Description:
1/6 share of cost for transportation service. #932
Amount:
$362.50

Component Description:
1/6 share of costs for transportation service. #900
Amount:
$507.50

Component Description:
1/6 share of cost for transportation service. #905
Amount:
$676.66

Component Description:
1/6 Share of cost for transportation service. #932
Amount:
$362.50
DTV Utah Operating Agreement Equity Equalization Information not provided.
KSTU Mask Filter Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Updated 1/6 share of cost for equipment delivery and handling.
Amount:
$264.97

Component Description:
1/6 share of equipment delivery and handling cost. #189065
Amount:
$265.99

Component Description:
1/6 share of cost for equipment handling and transportation service. #0029097-IN
Amount:
$77.91

Component Description:
Freight cost. #239058A
Amount:
$450.00

Component Description:
1/6 share of equipment delivery/handling cost. #244363A
Amount:
$62.50

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029115-IN
Amount:
$55.66

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029150-IN
Amount:
$14.16

Component Description:
1/6 share of equipment delivery and handling cost. #239584A
Amount:
$68.75

Component Description:
1/6 share of equipment delivery and handling cost. #239583A
Amount:
$68.75

Component Description:
1/6 share of cost for equipment and delivery. #189068-2
Amount:
$385.58

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029199-IN
Amount:
$28.33

Component Description:
1/6 share of equipment delivery and handling cost. #239940A
Amount:
$100.00

Component Description:
1/6 share of cost for equipment rental and delivery. #179518
Amount:
$503.82

Component Description:
1/6 share of equipment delivery and handling. #189067
Amount:
$176.98

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029132-IN
Amount:
$42.50

Component Description:
1/6 share of cost for equipment handling and transportation service. #0029079-IN
Amount:
$70.83

Component Description:
1/6 share of equipment delivery and handling cost. #189068
Amount:
$1,020.24

Component Description:
1/6 share of equipment delivery and handling cost. #9450
Amount:
$1,553.69

Component Description:
1/6 share of equipment delivery and handling cost. #0029166-AD
Amount:
$14.16

Component Description:
1/6 share of equipment delivery and handling cost. #228748A
Amount:
$100.00

Component Description:
1/6 share of equipment delivery and handling cost. #100
Amount:
$40.83
Temporary Storage

Component Description:
Updated 1/6 share of temporary storage cost. #5-1-2017
Amount:
$1,927.50

Component Description:
Temporary storage unit cost. #5-1-2017
Amount:
$1,927.50
DTV Medical Facility Notification

Component Description:
1/6 share of DTV Medical Facility Notification. #INV-001827
Amount:
$2,164.00

Component Description:
1/6 share of DTV Notification Service cost. #INV-001775
Amount:
$2,385.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,316,248.95 $2,585,891.37 $1,009,392.36

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.

Lucy Rutishauser

CFO


06/05/2019

Attachments

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