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:
73389
Service:
LPA
Call Sign:
WDFM-LP
Channel:
35 (UHF)
File Number:
0000086433
FRN:
0004378071
Eligibility Status:
Eligible
Date Submitted:
10/14/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

American Christian Television Services, Inc.

Kevin Bowers

1844 Baty Rd.

Lima, OH 45807

United States

+1 (419) 339-4444 kbowers@wtlw.com Corporation

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

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan In October, 2019, WNHO will begin transmitting at tower site ASR 1285569 in Sherwood, Ohio. The plan calls for a used transmitter building to be installed in addition to the antenna, transmission line and transmitter.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model TLU/1KSE
Year 1992
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model UAXTE-4R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.4 kW
Justification for New Transmitter Current transmitter cannot meet the requirements for the new construction permit and channel change.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service Yes
Description Complete electrical service installation for transmitter and building.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size Other
Other Size 6 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Building

Concrete Transmitter Shelter 10 ft x 12 ft

Grounding Installation

Grounding Installation and Labor

Transmitter Building Foundation and Pad

Concrete foundation and pad for 10 ft x 12 ft transmitter building

Transmitter Installation

Installation and commissioning

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)
Ownership Owned
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
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type Unknown
ERP: 7.5 kW
Manufacturer
Model SL-8
Year 1992

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model TLP-16A/VP
Year 2019
Justification for New Antenna The current antenna cannot support the requirements of our construction permit or channel change.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Reducer

Reducer

Flex 3 in Hanger Butterfly

10 pack butterfly hangers, Qty 3

Antenna Freight Charge

Delivery of antenna

VPOL Components

VPOL Components

Hangers Buttlerfly

Qty 4 flex butterfly hangers

Freight and Shipping

Parts shipping UPS

FedEx Shipping

Part shipping FedEx

Antenna Storage

Dielectric storage charge

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 600 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 3 inches
Number of parallel runs 1
Length 340 feet per run
Justification for New Transmission Line Current feed line will not meet requirements of the construction permit.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Nitrogen Helium Inlet Outlet

Transmission Line Gas

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 Move Equipment
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
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 1285569
Coordinates (NAD83) Latitude (NAD83) 41° 17' 32.7" N-
Longitude (NAD83) 084° 32' 01.7" W-
Overall Structure Height 337.92 feet
Support Structure Height 330.05 feet
Ground Elevation Above Mean Sea Level (AMSL) 711.93 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Towers LLC
Date Constructed 03/07/2013


Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Antenna and Transmission Line Removal

The prior antenna and transmission line from previous tower is to be removed.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Outside RF consulting Engineering Services Perform engineering study for displacement application 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
Prepare Form 601 No
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

PE Engineer Building Plan Review

Review of transmitter building drawings as per Ohio code,

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Name Description

Tower Structural Analysis

Tower Analysis

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 $176,528.00 $181,246.30 N/A $168,978.30 N/A
Total for all systems $335,566.69 $316,420.45 N/A $287,114.95 N/A
Primary Transmitter UAXTE-4R37 $176,528.00 $181,246.30 $168,978.30
Transmitter Installation $12,268.00 $12,268.00 N/A N/A N/A
Transmitter Building Foundation and Pad $17,010.00 $17,010.00 N/A $17,010.00 N/A
Grounding Installation $12,150.00 $12,150.00 N/A $12,150.00 N/A
Other Electrical Service: Complete electrical service installation for transmitter and building. $12,150.00 $12,150.00 N/A $12,150.00 N/A
Other -- HVAC Service Type: C Size:6 (Other) $7,500.00 $7,500.00 N/A $7,500.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $13,990.00 Installed according to tower owner requirements and Ohio code. Includes crane rental at $6700. $13,990.00 N/A
Transmitter Building $21,450.00 $21,450.00 N/A $21,450.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $84,728.30 Includes installation and proof, mask filter, shipping, electrical and equipment racks. $84,728.30 N/A

Components

Actual Information Description File Name
Transmitter Installation Information not provided.
Transmitter Building Foundation and Pad

Component Description:
Concrete poured foundation and pad for concrete transmitter building.
Amount:
$17,010.00
Grounding Installation

Component Description:
Electrical Grounding
Amount:
$12,150.00
Other Electrical Service: Complete electrical service installation for transmitter and building.

Component Description:
Electrical Install and Labor
Amount:
$12,150.00
Other -- HVAC Service Type: C Size:6 (Other)

Component Description:
Qty 2 HVAC 3 ton New Mavair Install included
Amount:
$7,500.00
Transmitter Building Site Survey/Installation

Component Description:
Transmitter building installation labor, materials and lift crane.
Amount:
$13,990.00
Transmitter Building

Component Description:
Transmitter Building - Final Payment, HVAC cost deducted
Amount:
$10,725.00

Component Description:
Downpayment transmitter building. Separated HVAC cost.
Amount:
$10,725.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Transmitter Quote and Purchase Order
Amount:
$84,728.30

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 $56,061.78 $63,366.78 N/A $57,581.78 N/A
Total for all systems $335,566.69 $316,420.45 N/A $287,114.95 N/A
Primary Antenna TLP-16A/VP $56,061.78 $63,366.78 $57,581.78
Antenna Storage $2,500.00 $2,500.00 N/A $2,445.00 N/A
FedEx Shipping $214.64 $214.64 N/A $214.64 N/A
Freight and Shipping $20.34 $20.34 N/A $20.34 N/A
VPOL Components $5,966.00 $5,966.00 N/A $5,966.00 N/A
Antenna Freight Charge $2,835.00 $2,835.00 N/A $2,835.00 N/A
Flex 3 in Hanger Butterfly $237.60 $237.60 N/A $237.60 N/A
Side Mount antenna brackets $4,625.00 $11,930.00 Custom made brackets to fit tower frame $11,930.00 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical $33,208.00 $33,208.00 N/A $33,208.00 N/A
Reducer $426.00 $426.00 N/A $426.00 N/A
Hangers Buttlerfly $299.20 $299.20 N/A $299.20 N/A

Components

Actual Information Description File Name
Antenna Storage

Component Description:
Antenna Storage at Dielectric
Amount:
$2,445.00
FedEx Shipping

Component Description:
Parts shipping
Amount:
$214.64
Freight and Shipping

Component Description:
Shipping
Amount:
$20.34
VPOL Components

Component Description:
VPOL Components
Amount:
$5,966.00
Antenna Freight Charge

Component Description:
Antenna delivery
Amount:
$2,835.00
Flex 3 in Hanger Butterfly

Component Description:
Flex 3inch hangar Qty 3 10pk
Amount:
$237.60
Side Mount antenna brackets

Component Description:
Custom made brackets for tower legs.
Amount:
$11,930.00
Sweep test of transmission line and antenna Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical

Component Description:
UHF Antenna
Amount:
$33,208.00
Reducer

Component Description:
Reducer
Amount:
$426.00
Hangers Buttlerfly

Component Description:
butterfly hangars Qty 4 10pk
Amount:
$299.20

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 $20,704.41 $16,807.37 N/A $16,807.37 N/A
Total for all systems $335,566.69 $316,420.45 N/A $287,114.95 N/A
Primary Transmission Line $20,704.41 $16,807.37 $16,807.37
Nitrogen Helium Inlet Outlet $644.41 $644.41 Gas regulator for transission line includes brass inlet and outlet. $644.41 N/A
Flexible Air Transmission Line - dielectric, 3" $20,060.00 $16,162.96 N/A $16,162.96 N/A

Components

Actual Information Description File Name
Nitrogen Helium Inlet Outlet

Component Description:
Regulator gas inlet and outlet
Amount:
$644.41
Flexible Air Transmission Line - dielectric, 3"

Component Description:
Flexible Transmission Line
Amount:
$16,162.96

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 $63,270.00 $38,360.00 N/A $31,280.00 N/A
Total for all systems $335,566.69 $316,420.45 N/A $287,114.95 N/A
Primary Tower LTOWER $63,270.00 $38,360.00 $31,280.00
Antenna and Transmission Line Removal $7,080.00 $7,080.00 Removal of antenna and transmission line from previous tower. N/A N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $31,280.00 N/A $31,280.00 N/A

Components

Actual Information Description File Name
Antenna and Transmission Line Removal Information not provided.
Tower Rigging Short Tower (less than 500')

Component Description:
Install of antenna, transmission line and bridge.
Amount:
$31,280.00

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 $14,267.50 $12,240.00 N/A $8,067.50 N/A
Total for all systems $335,566.69 $316,420.45 N/A $287,114.95 N/A
Outside Professional Services $14,267.50 $12,240.00 $8,067.50
PE Engineer Building Plan Review $3,000.00 $3,000.00 N/A $3,000.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A $2,978.75 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $875.00 N/A $875.00 N/A
Perform engineering study for displacement application $1,800.00 $1,000.00 N/A $1,000.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A $213.75 N/A

Components

Actual Information Description File Name
PE Engineer Building Plan Review

Component Description:
PE Engineering review of site plan.
Amount:
$3,000.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Minor modification for CP
Amount:
$372.50

Component Description:
CP application
Amount:
$427.50

Component Description:
displacement work
Amount:
$1,565.00

Component Description:
Eve Reed .25 hours
Amount:
$198.75

Component Description:
displacement application
Amount:
$415.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering for CP
Amount:
$875.00
Perform engineering study for displacement application

Component Description:
Engineering study displacement application.
Amount:
$1,000.00
Prepare/ Review 399 reimbursement form

Component Description:
Form 399 work.
Amount:
$213.75

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 $4,735.00 $4,400.00 N/A $4,400.00 N/A
Total for all systems $335,566.69 $316,420.45 N/A $287,114.95 N/A
Other Expenses $4,735.00 $4,400.00 $4,400.00
Tower Structural Analysis $4,400.00 $4,400.00 N/A $4,400.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower Structural Analysis

Component Description:
Structural analysis to determine if tower can support antenna
Amount:
$4,400.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $335,566.69 $316,420.45 $287,114.95

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.

Kevin Bowers

President


10/14/2019

Certification

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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.

Kevin Bowers , Bowers .

President


10/14/2019

Attachments

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