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:
61199
Service:
LPD
Call Sign:
W45DX-D
Channel:
13 (High VHF)
File Number:
0000089654
FRN:
0006159552
Eligibility Status:
Eligible
Date Submitted:
11/14/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

VENTANA TELEVISION, INC.

Doing Business As: VENTANA TELEVISION, INC.

Eric Yonkin

1 HSN Drive

St. Petersburg, FL 33729

United States

+1 (727) 872-7443 EASnotice@hsn.net 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

Trey Hanbury

Hogan Lovells US LLP

555 Thirteenth Street, NW

Washington, DC 20004

United States

+1 (202) 637-5534 trey.hanbury@hoganlovells.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 Station must receive new transmitter, antenna, and equipment for modifying transmission line; assemble transmitter; conduct study for current tower; and install new equipment.

Question Response
Sharee Station Facility ID 182024
Call Sign WUEO-LD
Type
Licensee Name DTV AMERICA CORPORATION
Status LICENSED
DTS No
Community of License MACON, GA
Pre-auction RF Channel 11
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 72120
Call Sign WGCL-TV
Type Commercial
Licensee Name MEREDITH CORPORATION
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 19
Post-auction RF Channel 19
Neilsen DMA Atlanta
Network Affiliation
Question Response
Sharee Station Facility ID 168811
Call Sign WTBS-LD
Type
Licensee Name PRISM BROADCASTING NETWORK, INC.
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 30
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 6900
Call Sign WUPA
Type Commercial
Licensee Name ATLANTA TELEVISION STATION WUPA INC.
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 36
Post-auction RF Channel 36
Neilsen DMA Atlanta
Network Affiliation
Question Response
Sharee Station Facility ID 48813
Call Sign WUVG-DT
Type Commercial
Licensee Name UNIVISION ATLANTA LLC
Status LICENSED
DTS No
Community of License ATHENS, GA
Pre-auction RF Channel 18
Post-auction RF Channel 18
Neilsen DMA Atlanta
Network Affiliation
Question Response
Sharee Station Facility ID 147273
Call Sign W266BW
Type
Licensee Name DAVIS BROADCASTING OF ATLANTA, L.L.C.
Status LICENSED
DTS No
Community of License WINDER, GA
Pre-auction RF Channel 266
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 23960
Call Sign WSB-TV
Type Commercial
Licensee Name GEORGIA TELEVISION, LLC
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 39
Post-auction RF Channel 32
Neilsen DMA Atlanta
Network Affiliation
Question Response
Sharee Station Facility ID 183170
Call Sign WLVO-LD
Type
Licensee Name UNITED MEDIA NETWORK, LLC
Status LICENSED
DTS No
Community of License Atlanta, GA
Pre-auction RF Channel 26
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 11275
Call Sign WWPW
Type Commercial
Licensee Name CITICASTERS LICENSES, INC.
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 241
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13805
Call Sign WZGC
Type Commercial
Licensee Name ENTERCOM LICENSE, LLC
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 225
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 125850
Call Sign WBUD-LD
Type
Licensee Name VINIONS, LLC
Status LICENSED
DTS No
Community of License BLAIRSVILLE, GA
Pre-auction RF Channel 36
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 22819
Call Sign WATL
Type Commercial
Licensee Name PACIFIC AND SOUTHERN, LLC
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 25
Post-auction RF Channel 25
Neilsen DMA Atlanta
Network Affiliation
Question Response
Sharee Station Facility ID 11675
Call Sign WCLK
Type Noncommercial Educational
Licensee Name CLARK ATLANTA UNIVERSITY
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 220
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 73161
Call Sign WKHX-FM
Type Commercial
Licensee Name RADIO LICENSE HOLDINGS LLC
Status LICENSED
DTS No
Community of License MARIETTA, GA
Pre-auction RF Channel 268
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 64033
Call Sign WPCH-TV
Type Commercial
Licensee Name MEREDITH CORPORATION
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 31
Post-auction RF Channel 31
Neilsen DMA Atlanta
Network Affiliation
Question Response
Sharee Station Facility ID 158597
Call Sign W250BC
Type
Licensee Name CUMULUS LICENSING LLC
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 250
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 168812
Call Sign WANN-CD
Type
Licensee Name PRISM BROADCASTING NETWORK, INC.
Status LICENSED AND SILENT
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 29
Post-auction RF Channel 20
Neilsen DMA Atlanta
Network Affiliation
Question Response
Sharee Station Facility ID 88937
Call Sign W229AG
Type
Licensee Name DICKEY BROADCASTING COMPANY
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 229
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 54585
Call Sign WRFG
Type Noncommercial Educational
Licensee Name RADIO FREE GEORGIA BROADCASTING FOUNDATION, INC.
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 207
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 125861
Call Sign WDWW-LD
Type
Licensee Name DTV AMERICA CORPORATION
Status LICENSED
DTS No
Community of License CLEVELAND, GA
Pre-auction RF Channel 28
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 148550
Call Sign W255CJ
Type
Licensee Name CUMULUS LICENSING LLC
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 255
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 69785
Call Sign WUVM-LP
Type
Licensee Name HC2 STATION GROUP, INC
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 4
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 73345
Call Sign WWWQ
Type Commercial
Licensee Name RADIO LICENSE HOLDING SRC LLC
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 259
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 29735
Call Sign WUBL
Type Commercial
Licensee Name CITICASTERS LICENSES, INC.
Status LICENSED
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 235
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 190105
Call Sign WAGC-LD
Type
Licensee Name NEW YORK SPECTRUM HOLDING COMPANY, LLC
Status LICENSED AND SILENT
DTS No
Community of License ATLANTA, GA
Pre-auction RF Channel 14
Post-auction RF Channel
Neilsen DMA
Network Affiliation

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 TXUD1000MA
Year 2011
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.0 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 LPTV-5000-1000V3
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.0 kW
Justification for New Transmitter The existing transmitter will not work on post-repack channel. (Pre-auction channel was UHF, post-auction channel is VHF.)

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 No
HVAC Service Does the replacement transmitter require HVAC Service? No
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

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)
Ownership Owned
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? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ALP16L2-HSW
Year 2011

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? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 1
Lower Limit 174.00 MHz
Upper Limit 217.00 MHz
Design power capacity in use 10.0 %
ERP: 500.0 W
Manufacturer
Model JHD-HV2
Year 2020
Justification for New Antenna The existing antenna for the pre-auction channel is specific-channel, UHF-only and will not work on the new, post-repack VHF frequency.

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? 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? No
Power Dividers Does the panel antenna require power dividers? No
Cable Harness Does the panel antenna require cable harness? No

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 Utilize Existing
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 Andrew/CommScope
Type Flexible Air
Diameter 4 inches
Number of parallel runs 1
Length 634 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Jumper

New antenna requires jumper from previous antenna bottom feed point to new antenna center feed point.

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)
Ownership Leased
Is this tower consider Complex? Candelabra
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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1223132
Coordinates (NAD83) Latitude (NAD83) 33° 48' 26.4" N-
Longitude (NAD83) 084° 20' 21.5" W-
Overall Structure Height 1182.07 feet
Support Structure Height 1056.09 feet
Ground Elevation Above Mean Sea Level (AMSL) 867.12 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers LLC
Date Constructed 03/27/2002

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
147273 W266BW FX
72120 WGCL-TV DTV
22819 WATL DTV
73345 WWWQ FM
125861 WDWW-LD LPD
158597 W250BC FX
73161 WKHX-FM FM
11675 WCLK FM
6900 WUPA DTV
125850 WBUD-LD LPD
69785 WUVM-LP LPA
168812 WANN-CD DTV
54585 WRFG FM
183170 WLVO-LD LPD
168811 WTBS-LD LPD
29735 WUBL FM
88937 W229AG FX
13805 WZGC FM
11275 WWPW FM
23960 WSB-TV DTV
190105 WAGC-LD LPD
64033 WPCH-TV DTV
48813 WUVG-DT DTV
182024 WUEO-LD LPD
148550 W255CJ FX

Other Types of Users

Users
Cell Providers

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Tower mapping and report for structural engineer
Tower Reinforcements Please select whether tower reinforcements are needed: Serious Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Candelabra
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? No
Outside RF consulting Engineering Services Perform engineering study for displacement application No
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 No
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 No
Prepare and file Form FCC License to Cover Application No
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 Yes
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

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
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

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 $40,000.00 $40,000.00 N/A $0.00 N/A
Total for all systems $108,947.50 $108,947.50 N/A $0.00 N/A
Primary Transmitter LPTV-5000-1000V3 $40,000.00 $40,000.00 $0.00
Transmitter Building Site Survey/Installation $10,000.00 $10,000.00 N/A N/A N/A
High VHF - Air Cooled Solid State Transmitter 400 - 1000 Watts $30,000.00 $30,000.00 N/A N/A N/A

Components

Information not provided.

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 $1,550.00 $1,550.00 N/A $0.00 N/A
Total for all systems $108,947.50 $108,947.50 N/A $0.00 N/A
Primary Antenna JHD-HV2 $1,550.00 $1,550.00 $0.00
High VHF-Low Power, Side Mount, Broadband Panel, 1 bay, 500.0watt input, Circular $1,550.00 $1,550.00 N/A N/A N/A

Components

Information not provided.

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 $750.00 $750.00 N/A $0.00 N/A
Total for all systems $108,947.50 $108,947.50 N/A $0.00 N/A
Primary Transmission Line $750.00 $750.00 $0.00
Jumper $750.00 $750.00 N/A N/A N/A

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 $61,000.00 $61,000.00 N/A $0.00 N/A
Total for all systems $108,947.50 $108,947.50 N/A $0.00 N/A
Primary Tower GTOWER $61,000.00 $61,000.00 $0.00
Tower mapping and report for structural engineer $21,000.00 $21,000.00 N/A N/A N/A
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $25,000.00 $25,000.00 N/A N/A N/A
Serious tower reinforcement/modifications $15,000.00 $15,000.00 N/A N/A N/A

Components

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 $5,312.50 $5,312.50 N/A $0.00 N/A
Total for all systems $108,947.50 $108,947.50 N/A $0.00 N/A
Outside Professional Services $5,312.50 $5,312.50 $0.00
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Form 399 assistance or other Program Management costs $1,500.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 Included consultation on antenna design. N/A N/A

Components

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 $335.00 $335.00 N/A $0.00 N/A
Total for all systems $108,947.50 $108,947.50 N/A $0.00 N/A
Other Expenses $335.00 $335.00 $0.00
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $108,947.50 $108,947.50 $0.00

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel.
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.

Eric Yonkin

Reimbursement Representative


11/14/2019

Attachments

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Information not provided.