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:
3032
Service:
DCA
Call Sign:
WVUP-CD
Channel:
30 (UHF)
File Number:
0000027779
FRN:
0005935499
Date Submitted:
11/15/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CHRISTIAN TELEVISION of Tallahassee, INC.

Doing Business As: CHRISTIAN TELEVISION of Tallahassee, INC.

Chris Mavros

3494 Weems Rd.

#B-2

Tallahassee, FL 32317

United States

+1 (850) 402-1116 clmavros@yahoo.com Not-for-Profit

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

Joseph C. Chautin III

Hardy, Carey, Chautin & Balkin, LLP

1080 West Causeway Approach

Mandeville, LA 70471

United States

+1 (985) 629-0777 jchautin@hardycarey.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. No
Briefly describe transition plan Temporary antenna & transmission line to be installed. Existing transmitter will then feed temporary antenna. Existing antenna & line to be removed. New antenna, line, and transmitter to be installed.

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 AT71K0
Year 2009
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 EC702-HP-BB
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.7 kW
Justification for New Transmitter Manufacturer has discontinued this model of transmitter and will not support the re-channeling of it.

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 No
Size N/A
Length N/A
Other Electrical Service Yes
Description additional breakers in panel, EMT or flexible metal conduit, misc wiring
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

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Other Transmitter Cost Not Listed

Name Description

other electrical

interconnect needed from existing electrical service to new transmitter components

interiorTRANSMISSION LINE

interconnect transmission line components within transmitter building

from Comark - shipping

transmitter shipping costs from Comark

from Comark - factory training

training of staff for new Comark transmitter

from Comark - 4 way motorized switch

needed to rout transmitter output into station load

heavy equipment rental

heavy lifting equipment rental needed for removal of old equipment and installation of new equipment

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? 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 Slotted Coaxial
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 N/A
ERP: 15.0 kW
Manufacturer
Model ATW25H5-HTOL-45H
Year 2004

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? No
Ownership Owned
Owner N/A
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 Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
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: 11.2 kW
Manufacturer
Model TFU 14ETT-R-04
Year 2017
Justification for New Antenna Existing antenna cannot be re tuned to the new channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
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?
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

Top Mount Adapter

An adapter for the top-mounted antenna to interface with top of the tower.

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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 900 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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 900 feet per run
Justification for New Transmission Line Existing line section length is not compatible with new channel frequency.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Temporary Transmission Line

1 5/8" Heliax needed to feed temporary antenna which will keep WVUP on the air during modification of facility

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)
Description of Use N/A
Ownership Leased
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1031203
Coordinates (NAD83) Latitude (NAD83) 30° 34' 28.0" N-
Longitude (NAD83) 084° 12' 09.0" W-
Overall Structure Height 898.94 feet
Support Structure Height 833.32 feet
Ground Elevation Above Mean Sea Level (AMSL) 144.36 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Gray Television Group, Inc.
Date Constructed 01/01/1973


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

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 605
Explanation Project management (Invoice processing, progress reporting, daisy chain monitoring and analysis, program management, and site visits as required)
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
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 No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 2
Justification optimization of new transmission line to operated on new channel

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Attorney - Other Services

Attorney - Other Matters

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? 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 $174,236.00 $168,236.00 N/A $64,580.40 N/A
Total for all systems $1,022,623.00 $890,203.63 N/A $335,600.29 N/A
Primary Transmitter EC702-HP-BB $174,236.00 $168,236.00 $64,580.40
from Comark - shipping $11,013.00 $11,013.00 N/A $9,307.80 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $120,000.00 N/A $55,272.60 N/A
Other Electrical Service: additional breakers in panel, EMT or flexible metal conduit, misc wiring $7,000.00 $7,000.00 N/A N/A N/A
from Comark - factory training $4,500.00 $4,500.00 N/A N/A N/A
from Comark - 4 way motorized switch $8,723.00 $8,723.00 N/A N/A N/A
other electrical $7,000.00 $7,000.00 N/A N/A N/A
heavy equipment rental $5,000.00 $5,000.00 N/A N/A N/A
interiorTRANSMISSION LINE $5,000.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
from Comark - shipping

Component Description:
Shipping
Amount:
$9,307.80
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
TRANSMITTER, UHF DOHERTY BROADBAND
Amount:
$55,272.60
Other Electrical Service: additional breakers in panel, EMT or flexible metal conduit, misc wiring Information not provided.
from Comark - factory training Information not provided.
from Comark - 4 way motorized switch Information not provided.
other electrical Information not provided.
heavy equipment rental Information not provided.
interiorTRANSMISSION LINE 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 $273,250.00 $164,630.63 N/A $148,167.56 N/A
Total for all systems $1,022,623.00 $890,203.63 N/A $335,600.29 N/A
Primary Antenna TFU 14ETT-R-04 $273,250.00 $164,630.63 $148,167.56
Top Mount Adapter $19,520.00 $19,520.00 Please see DTVPros Quote DTVPros JEHQ1242-03 WVUP REPACK-D $17,568.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,760.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized $247,000.00 $138,710.63 Please see DTVPros Quote DTVPros JEHQ1242-03 WVUP REPACK-D $124,839.56 N/A

Components

Actual Information Description File Name
Top Mount Adapter

Component Description:
WVUP-210-Primary Antenna - Top Mount Adapter
Amount:
$8,784.00

Component Description:
WVUP-210-Primary Antenna - Top Mount Adapter
Amount:
$8,784.00
Sweep test of existing antenna

Component Description:
WVUP-210-Primary Antenna - Sweep Test
Amount:
$2,880.00

Component Description:
WVUP-210-Primary Antenna - Sweep Test
Amount:
$2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized

Component Description:
UHF - High power top mount
Amount:
$62,419.78

Component Description:
UHF - High power top mount
Amount:
$62,419.78

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 $196,800.00 $187,800.00 N/A $90,455.08 N/A
Total for all systems $1,022,623.00 $890,203.63 N/A $335,600.29 N/A
Primary Transmission Line $196,800.00 $187,800.00 $90,455.08
Temporary Transmission Line $15,000.00 $15,000.00 N/A N/A N/A
Rigid Transmission Line - copper, 6 1/8" $181,800.00 $172,800.00 N/A $90,455.08 N/A

Components

Actual Information Description File Name
Temporary Transmission Line

Component Description:
WVUP-310-Primary Transmission Line - Temporary Transmission Line
Amount:
$666.00

Component Description:
WVUP-310-Primary Transmission Line - Temporary Transmission Line
Amount:
$666.00
Rigid Transmission Line - copper, 6 1/8"

Component Description:
WVUP-310-Primary Transmission Line - Rigid, Copper, 6 1/8"
Amount:
$45,227.54

Component Description:
WVUP-310-Primary Transmission Line - Rigid, Copper, 6 1/8"
Amount:
$45,227.54

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 $210,500.00 $200,000.00 N/A $0.00 N/A
Total for all systems $1,022,623.00 $890,203.63 N/A $335,600.29 N/A
Primary Tower GTOWER $210,500.00 $200,000.00 $0.00
Tall Tower (greater than 500') $210,500.00 $200,000.00 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 $128,192.00 $130,447.00 N/A $31,065.25 N/A
Total for all systems $1,022,623.00 $890,203.63 N/A $335,600.29 N/A
Outside Professional Services $128,192.00 $130,447.00 $31,065.25
Attorney - Other Services $522.00 $522.00 Please see the Estimated Cost Justification WVUP-590-Attorney - Other matters v0 $442.00 N/A
Additional Field Engineering Service, 2 Days $4,000.00 $4,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 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 FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $628.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,000.00 N/A
Project management of the transition $95,590.00 $99,675.00 Justifying Quote - WVUP-CD Strategic support quote $27,342.75 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $340.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $312.50 N/A

Components

Actual Information Description File Name
Attorney - Other Services

Component Description:
Legal services
Amount:
$78.00

Component Description:
Legal services
Amount:
$78.00

Component Description:
Review quarterly requires uploads
Amount:
$208.00

Component Description:
WVUP-550-Attorney - Other Matters
Amount:
$78.00
Additional Field Engineering Service, 2 Days Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
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:
WVUP-550-Attorney - Construction Permit Application (Main)
Amount:
$80.00

Component Description:
WVUP-550-Attorney - Construction Permit Application (Main)
Amount:
$80.00

Component Description:
Review, modify and finalize Form 2100
Amount:
$468.00
Prepare request for Special Temporary Authorization Information not provided.
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:
Preparation of the engineering section of FCC Form 2100.
Amount:
$2,000.00
Project management of the transition

Component Description:
Project Management
Amount:
$1,023.10

Component Description:
Project Management
Amount:
$2,534.85

Component Description:
Project Management
Amount:
$1,505.60

Component Description:
Project Management
Amount:
$1,686.95

Component Description:
Project Management
Amount:
$1,803.40

Component Description:
Project Management
Amount:
$1,594.55

Component Description:
Project Management
Amount:
$2,162.90

Component Description:
Project Management
Amount:
$1,575.90

Component Description:
Project Management
Amount:
$1,508.10

Component Description:
Project Management
Amount:
$1,682.70

Component Description:
Project Management
Amount:
$1,470.85

Component Description:
Project Management
Amount:
$2,692.55

Component Description:
Project Management
Amount:
$1,231.60

Component Description:
Project Management
Amount:
$2,141.60

Component Description:
Project Management
Amount:
$1,120.70

Component Description:
Project Management
Amount:
$1,607.40
Prepare and or review reimbursement form

Component Description:
Legal services
Amount:
$80.00

Component Description:
Legal services
Amount:
$260.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering study work for new channel assignment and antenna development. 2. Preparation of the engineering section of FCC Form 2100.
Amount:
$312.50

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 $39,645.00 $39,090.00 N/A $0.00 N/A
Total for all systems $1,022,623.00 $890,203.63 N/A $335,600.29 N/A
Other Expenses $39,645.00 $39,090.00 $0.00
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,000.00 $1,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $400.00 $400.00 N/A N/A N/A
MVPD Notification of Channel Change $1,500.00 $1,500.00 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 $1,022,623.00 $890,203.63 $335,600.29

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.

CHRIS L MAVROS

D.E., Christian Television Network


11/15/2019

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.

CHRIS L MAVROS

D.E., Christian Television Network


11/15/2019

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