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:
50147
Service:
DTV
Call Sign:
WOUB-TV
Channel:
32 (UHF)
File Number:
0000028541
FRN:
0005012729
Date Submitted:
07/08/2019

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

OHIO UNIVERSITY

Doing Business As: OHIO UNIVERSITY

Stephen Skidmore

WOUB PUBLIC MEDIA

9 SOUTH COLLEGE STREET

ATHENS, OH 45701

United States

+1 (740) 593-4927 SKIDMORE@OHIO.EDU Government Entity

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

Steve Skidmore

Chief Technology Officer

Ohio University / WOUB Public Media

Steve Skidmore

WOUB Public Media

9 South College Street RM 395F

Athens, OH 45701

United States

+1 (740) 593-4927 skidmore@ohio.edu

Broadcaster Information and Transition Plan

Back to Top
Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan See Attachment Exhibit C1 Amendment 2 Submitted 3-21-18 See Attachment Gates Air Submitted 3-21-18 See Attachment Exhibit B1 Amendment 1 submitted 8-2-16 See Attachment "Exhibit A1 WOUB Transition Plan"

Transmitters

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

Primary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model ADC Visionary DT HP50SAW
Year 2001
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 28 kW

Primary Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model ULXTE-40
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25.3 kW
Justification for New Transmitter 3-21-19 The Gates Air Transmitter is a comparable substitute to the Rhode & Schwartz THU9-16 transmitter originally specified and approved. This transmitter was chosen through a competitive bid process required by the State of Ohio and Ohio University.

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 150.0 feet
Other Electrical Service Yes
Description it will require new 220/110 service for the heat exchanger system, and support equipment.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

Back to Top

Other Transmitter Cost Not Listed

Name Description

Structural Reinforcement

The transmitter will be placed on a second story wooden floor. It will require some structural reinforcement to support the weight of the transmitter.

Antennas

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

Primary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Retune Existing
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? 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 Broadband Panel
Number of Stations Supported 1
Number of Panels 40
Design power capacity in use 34.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Other Antenna Type N/A
ERP: 250.0 kW
Manufacturer Dielectric
Model TUF-04-10/40H-SP-1-T
Year 2001

Primary Antenna

Back to Top

Adjustment to Existing Antenna

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

Primary Antenna

Back to Top

Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
27
32

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Transition

61/8 coaxial transition to waveguide to connect to existing waveguide switch

Four Coaxial Elbows

61/8 elbows to connect combiner to Wave Guide switch.

Station Load

Must install a station load to conduct testing of the transmitter before on air transition. QUOTE ATTACHED Exhibit B3

Transmission Line

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

Primary Transmission Line

Back to Top

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? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectrict
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 910 feet per run

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
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 1041734
Coordinates (NAD83) Latitude (NAD83) 39° 18' 52.0" N-
Longitude (NAD83) 082° 08' 59.0" W-
Overall Structure Height 859.57 feet
Support Structure Height 820.53 feet
Ground Elevation Above Mean Sea Level (AMSL) 784.77 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner OHIO UNIVERSITY TELECOM CENTER DBA = WOUB-FM/TV
Date Constructed 01/01/1978


Primary Tower

Back to Top

Tower Modification Costs

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

Primary Tower

Back to Top

Tower Rigging Costs

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

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Atenna and Transmission Line Tunning

WOUB plans to utilize the existing Dielectric antenna and the feed line to minimize costs. This will require physical inspection of antenna and feed line on the tower and will require tower rigging to accomplish the inspection and tuning.

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 100
Explanation University public TV station requires additional project management support for repack work.
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 Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Site Survey

Site survey will determine actual site conditions and determine the materials and components required for system installation/integration for the WOUB site.

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

Back to Top

Other Expenses Not Listed

Name Description

Additional Legal Expenses

Additional legal expenses for small market, University licensee public TV station

Quarterly Progress Reports

FCC-required quarterly progress reports for repacked station

Cost Information

Back to Top

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,012,700.00 $693,573.20 N/A $620,535.02 N/A
Total for all systems $1,549,947.06 $1,001,330.26 N/A $654,295.52 N/A
Primary Transmitter ULXTE-40 $1,012,700.00 $693,573.20 $620,535.02
Structural Reinforcement $5,000.00 $5,000.00 To utilize existing building it will be necessary to reinforce the existing floor to support the weight of the new transmitter. This expense is cost effective compared to adding an addition to the existing building. $30.58 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $629,823.20 Quote Attached Exhibit B2 $620,504.44 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) $3,900.00 $3,750.00 N/A $0.00 N/A
Other Electrical Service: it will require new 220/110 service for the heat exchanger system, and support equipment. $20,000.00 $20,000.00 Additional electrical expenses will be determined after the final transmitter manufacturer is determined and a site analysis is conducted. N/A N/A

Components

Actual Information Description File Name
Structural Reinforcement

Component Description:
Parts needed to make repairs at the WOUB transmitter on a Sunday. 10.1 oz white paint able latex caulking 12 oz spray foam insulation, Hillman linch pin, Hitch pin steel
Amount:
$30.58
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
ULXTE - 40 Transmitter
Amount:
$620,504.44
Transformer 3 phase/480v - 300 KVA Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other Electrical Service: it will require new 220/110 service for the heat exchanger system, and support equipment. Information not provided.

Cost Information

Back to Top

Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $116,305.06 $111,775.06 N/A $0.00 N/A
Total for all systems $1,549,947.06 $1,001,330.26 N/A $654,295.52 N/A
Primary Antenna TUF-04-10/40H-SP-1-T $116,305.06 $111,775.06 $0.00
Station Load $18,707.06 $18,707.06 The new transmitter must be tested off-air before the official testing period begins. A station load is required to do this testing. Quote Attached Exhibit B3 N/A N/A
Four Coaxial Elbows $5,168.00 $5,168.00 Direct Quote from ERI, INC, Attachment A2 N/A N/A
Transition $1,500.00 $1,500.00 Direct quote from ERI, Attachment A3 N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

Back to Top

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 $1,549,947.06 $1,001,330.26 N/A $654,295.52 N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

Information not provided.

Cost Information

Back to Top

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $230,500.00 $20,000.00 N/A $8,316.00 N/A
Total for all systems $1,549,947.06 $1,001,330.26 N/A $654,295.52 N/A
Primary Tower TOWER $230,500.00 $20,000.00 $8,316.00
Atenna and Transmission Line Tunning $20,000.00 $20,000.00 Utilizing the existing system will be cost effective compared to installing a new feed line and antenna. The system was initially optimized for Channels 20 and 27. it needs to be optimized for channel 32 as assigned in the repack. $8,316.00 Field Service WOUB Starting Scope of work. (1) Technician onsite for 2 days to take sweep measurements to the antenna. (2) Dielectric climber for 2 days to inspect transmission line, spring hanger tensions and the antenna.
Tall Tower (greater than 500') $210,500.00 $0.00 We are not building a new tower. The LMS system automatically added in a cost for a new antenna. I spoke with Raphael Sznajder and Cindy Cavell who said to submit it this way. N/A N/A

Components

Actual Information Description File Name
Atenna and Transmission Line Tunning

Component Description:
Field Service WOUB Starting Scope of work. (1) Technician onsite for 2 days to take sweep measurements to the antenna. (2) Dielectric climber for 2 days to inspect transmission line, spring hanger tensions and the antenna.
Amount:
$8,316.00
Tall Tower (greater than 500') Information not provided.

Cost Information

Back to Top

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $145,892.00 $139,482.00 N/A $20,444.50 N/A
Total for all systems $1,549,947.06 $1,001,330.26 N/A $654,295.52 N/A
Outside Professional Services $145,892.00 $139,482.00 $20,444.50
Site Survey $17,232.00 $17,232.00 Quote Attached: Exhibit A5 $17,232.00 WOUB Repack Site Survey
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,962.50 Construction Permit Application. Develop final ERP and parameter for initial CP application. Invoice cover services provided June-July 2017. Consultant Engineer Hourly - 6.25 Hours. Preparation of brief statement to support amendment to application, upl
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 N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 WOUB may need to operate one of the transmitters at a reduced power during the transition/testing phase. Theoretically the existing RF system will support both channels 27 and 32 at full power. This is a precautionary request. N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Project management of the transition $15,800.00 $15,000.00 University licensed public TV station requires additional project management support for repack transition. N/A 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 $1,250.00 Conduct preliminary review of repacked channel assignment and implementation with existing broadband antenna. Determine max ERP to avoid exceeding 1% expansion. Invoice covers services through May 2017. Consulting engineer - hourly 3.2 hour.

Components

Actual Information Description File Name
Site Survey

Component Description:
WOUB Repack Site Survey
Amount:
$17,232.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of brief statement to support amendment to application, upload material and adjust proposed ERP. Invoice Covers services provided throught August 201. Consultant Engineer Hourly - 1.6 hours.
Amount:
$400.00

Component Description:
Construction Permit Application. Develop final ERP and parameter for initial CP application. Invoice cover services provided June-July 2017. Consultant Engineer Hourly - 6.25 Hours.
Amount:
$1,562.50
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 Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Project management of the transition Information not provided.
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

Component Description:
Consulting Engineer - J. Davis - Hourly (@$250/hr)
Amount:
$250.00

Component Description:
Consulting Engineer - J. Davis - Hourly (@ $250/hr)
Amount:
$200.00

Component Description:
Conduct preliminary review of repacked channel assignment and implementation with existing broadband antenna. Determine max ERP to avoid exceeding 1% expansion. Invoice covers services through May 2017. Consulting engineer - hourly 3.2 hour.
Amount:
$800.00

Cost Information

Back to Top

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $44,550.00 $36,500.00 N/A $5,000.00 N/A
Total for all systems $1,549,947.06 $1,001,330.26 N/A $654,295.52 N/A
Other Expenses $44,550.00 $36,500.00 $5,000.00
Develop and air announcement of upcoming channel change $3,000.00 $3,000.00 Conceptional development, CG and video development, and production of 3 60 second spots. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $3,000.00 $3,000.00 Estimate for local refuse removal. N/A N/A
Non-zoning permits $500.00 $500.00 State required electrical permits. N/A N/A
MVPD Notification of Channel Change $1,500.00 $1,500.00 Actual estimate from Joe Davis of Chesapeake RF Consultants. Attached Exhibit A4. $1,250.00 MVPD Notification WOUB FCC ID 50147 MVPD Notification Mailing Complete per FCC Repack
DTV Medical Facility Notification $11,550.00 $3,500.00 Actual estimate from Joe Davis of Chesapeake RF Consultants. Attached Exhibit A4 $3,750.00 . Additionally, the original estimate was from Joe Davis of Chesapeake RF Consultants. When it came time to do the actual work Joe Davis was not available. His schedule was full. The work had to occur on a time table based on the FCC construction cloc
Equipment Delivery and Handling Charges $10,000.00 $10,000.00 N/A N/A N/A
Quarterly Progress Reports $5,000.00 $5,000.00 Assistance with preparation and filing of FCC-required quarterly status reports for repack transition. N/A N/A
Additional Legal Expenses $10,000.00 $10,000.00 Additional legal expenses to advise and support small market University-licensed public TV station with repack transition. N/A N/A

Components

Actual Information Description File Name
Develop and air announcement of upcoming channel change Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits Information not provided.
MVPD Notification of Channel Change

Component Description:
MVPD Notification WOUB FCC ID 50147 MVPD Notification Mailing Complete per FCC Repack
Amount:
$1,250.00
DTV Medical Facility Notification

Component Description:
Medical Notification WOUB FCC ID 50147 Medical Notification Mailing Complete per FCC Repack
Amount:
$3,750.00
Equipment Delivery and Handling Charges Information not provided.
Quarterly Progress Reports Information not provided.
Additional Legal Expenses Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,549,947.06 $1,001,330.26 $654,295.52

Reimbursement Status

Back to Top
Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

Back to Top
Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  3. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

  7. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Cindy Perry

Director Grants Accounting


07/08/2019

Certification

Back to Top
Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

  3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  4. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

  6. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

  8. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  9. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Cindy Perry

Director Grants Accounting


07/08/2019

Attachments

Back to Top