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:
70158
Service:
DCA
Call Sign:
WVVH-CD
Channel:
18 (UHF)
File Number:
0000026842
FRN:
0004934246
Date Submitted:
10/07/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Video Voice., Inc.

Doing Business As: WVVH-TV

Ernest Schimizzi

PO Box 769

Wainscott, NY 11975

United States

+1 (917) 559-3323 wvvhtv@aol.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 Remove and replace existing antenna. Install new transmission line and new Main Transmitter.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model AT71-500-10
Year 2011
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.5 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? No
Manufacturer
Model EC710MP-BB
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.0 kW
Justification for New Transmitter Existing Transmitter can not be retuned as per manufacturer COMARK. Their announcement attached "AT Series Transmitter Retuning Options".

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 100.0 feet
Other Electrical Service Yes
Description Conduit and wiring run from switch panel to new transmitter. Lightning Surge Protector.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 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.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type Yagi
ERP: 15.0 kW
Manufacturer
Model AST0607330
Year 2011

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model PSILP8SLVVH-18
Year 2018
Justification for New Antenna Existing antenna can not be retuned

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 7/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 400 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 7/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 400 feet per run
Justification for New Transmission Line Present Transmission Line worn. We are located near the water and environmental conditions and salt water have degraded the present transmission line and needs to be replaced.

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? Located on Building
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? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 40° 57' 20.0" N-
Longitude (NAD83) 072° 15' 14.0" W-
Overall Structure Height 18.30 feet
Support Structure Height 15.20 feet
Ground Elevation Above Mean Sea Level (AMSL) 16.00 feet
Structure Type BTWR - Building with Tower
Tower Owner Video Voice, Inc.
Date Constructed 01/01/2011


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: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Located on Building
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 645
Explanation Please see the attached quote from Widelity; also, the Pattern analysis Antenna Spec Transmitter Spec. Building drawings, installation Supervision Accounting, Internal, Legal.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review 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 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 No
Additional Field Engineering Service Yes
Number of Days 4
Justification Antenna Sweep and transmitter installation and proofing

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 Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
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
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $157,850.00 $110,646.50 N/A $78,068.36 N/A
Total for all systems $1,036,175.00 $642,036.13 N/A $153,601.41 N/A
Primary Transmitter EC710MP-BB $157,850.00 $110,646.50 $78,068.36
5 Ton system $20,250.00 $15,500.00 N/A $0.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $83,746.50 Hungry Wolf Electronics Inv 190325 $74,343.36 N/A
2" Rigid Conduit and Wiring (Cost per foot) $2,600.00 $2,400.00 N/A N/A N/A
Other Electrical Service: Conduit and wiring run from switch panel to new transmitter. Lightning Surge Protector. $9,000.00 $9,000.00 N/A $3,725.00 N/A

Components

Actual Information Description File Name
5 Ton system Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
EC710MP-BB 1000W UHF Air cooled Digital TV Transmitter
Amount:
$62,578.86

Component Description:
Labor to coordinate with customer
Amount:
$11,764.50
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other Electrical Service: Conduit and wiring run from switch panel to new transmitter. Lightning Surge Protector.

Component Description:
Demo cap and kill all hazardous circuits
Amount:
$3,725.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $33,030.00 $39,812.13 N/A $15,572.13 N/A
Total for all systems $1,036,175.00 $642,036.13 N/A $153,601.41 N/A
Primary Antenna PSILP8SLVVH-18 $33,030.00 $39,812.13 $15,572.13
Sweep test of existing antenna $6,730.00 $6,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $33,812.13 Propagation Systems, Inc Invoice $15,572.13 N/A

Components

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

Component Description:
PSILP8SLVVH-18 8-Bay Low Power UHF Slot Antenna for Channel 18
Amount:
$15,572.13

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 $4,400.00 $3,500.00 N/A $2,289.72 N/A
Total for all systems $1,036,175.00 $642,036.13 N/A $153,601.41 N/A
Primary Transmission Line $4,400.00 $3,500.00 $2,289.72
Flexible Foam Transmission Line - dielectric, 7/8" $4,400.00 $3,500.00 N/A $2,289.72 N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 7/8"

Component Description:
7/8" FOAM TRANSMISSION LINE EC5-50-A
Amount:
$2,289.72

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 $591,600.00 $261,500.00 N/A $18,240.00 N/A
Total for all systems $1,036,175.00 $642,036.13 N/A $153,601.41 N/A
Primary Tower BTWR $591,600.00 $261,500.00 $18,240.00
Structural engineering tower load study for well documented tower $12,600.00 $1,500.00 per WVVH-CD ATC Customer Project Estimation N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $120,000.00 N/A $18,240.00 N/A
Minor tower reinforcement/modifications $158,000.00 $140,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Structural engineering tower load study for well documented tower Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
LABOR AND MATERIALS TO ASSEMBLE AND INSTALL PSILP8LVVH-18-CP
Amount:
$18,240.00
Minor tower reinforcement/modifications 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 $221,300.00 $200,182.50 N/A $30,107.20 N/A
Total for all systems $1,036,175.00 $642,036.13 N/A $153,601.41 N/A
Outside Professional Services $221,300.00 $200,182.50 $30,107.20
Additional Field Engineering Service, 4 Days $6,000.00 $6,000.00 N/A $0.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $65,000.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $0.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $0.00 N/A
Project management of the transition $101,910.00 $99,675.00 see WVVH-CD Strategic support quote 4-1-19 $22,120.95 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $4,757.50 Invoice Communications Technologies, Inc 008862 $3,220.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $3,766.25 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
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 4 Days Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Please deny this invoice.
Amount:
N/A
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:
Legal Services
Amount:
$500.00

Component Description:
Legal Professional Services
Amount:
$500.00

Component Description:
Attorney Fees - Prepare and File FCC Form 2100 (main) Construction Permit Application
Amount:
$500.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare and or review reimbursement form

Component Description:
FORM 399 INVOICE REVIEW, UPLOAD AND FIGURE OUT FORM HANDLING
Amount:
$462.44
Project management of the transition

Component Description:
Project Management
Amount:
$6,836.95

Component Description:
Project Management
Amount:
$6,507.90

Component Description:
Project Management
Amount:
$1,976.25

Component Description:
Project Management
Amount:
$2,392.35

Component Description:
Project Management
Amount:
$1,215.00

Component Description:
Project Management
Amount:
$3,192.50
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
FCC FORM 2100 MAIN ENGINEERING DOCUMENTATION AND FORM PREP
Amount:
$1,000.06

Component Description:
Application to modify construction permit
Amount:
$1,757.50

Component Description:
Prepare engineering section of FCC Form 2100 (main) Construction Permit Application
Amount:
$1,462.50
Perform engineering study for new channel assignment and antenna development

Component Description:
N/A
Amount:
N/A

Component Description:
Engineering Study
Amount:
$1,248.75

Component Description:
5.5 HOURS CUSTOM ANTENNA DESIGN WORK. REVIEW SITE LIMITATIONS, INITIAL TVSTUDY ANALYSIS.
Amount:
$2,517.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $27,995.00 $26,395.00 N/A $9,324.00 N/A
Total for all systems $1,036,175.00 $642,036.13 N/A $153,601.41 N/A
Other Expenses $27,995.00 $26,395.00 $9,324.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A $2,866.00 N/A
Non-zoning permits $2,000.00 $2,000.00 N/A N/A N/A
Local Zoning $3,000.00 $3,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $10,000.00 N/A $6,458.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change

Component Description:
Notification of Cable and Satellite MVPD Providers of new RF Channel and Transport Stream Parameters on Repack Channel
Amount:
$2,866.00
Non-zoning permits Information not provided.
Local Zoning Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
Transmitter Medical Facility Notification per proposal.
Amount:
$6,458.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,036,175.00 $642,036.13 $153,601.41

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.

Ernest Joseph Schimizzi

President and General Manager


10/07/2019

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.

Ernest Joseph Schimizzi

President and General Manager


10/07/2019

Attachments

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