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:
72041
Service:
DTV
Call Sign:
WEVV-TV
Channel:
28 (UHF)
File Number:
0000026507
FRN:
0027266139
Date Submitted:
04/22/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ALLEN MEDIA BROADCASTING, LLC

Doing Business As: WEVV-TV

Eric Stremming

477 CARPENTER STREET

EVANSVILLE, IN 47708

United States

+1 (812) 464-4444 support@wevv.com Limited Liability Company

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

Thomas F. Bardo

Attorney

Nelson Mullins Riley & Scarborough LLP

101 Constitution Avenue, NW

Suite 1000

Washington, DC 20001

United States

+1 (202) 689-2817 tom.bardo@nelsonmullins.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 We will take WEVV ch 45 off the air for the installation of RF equipment. During that time we will operate our ch 21 WEEV LP transmitter for over the air service to our viewers providing both CBS and FOX programming.

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 AI-QXD1
Year 1999
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 30 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 HPTV-PRLX-U16
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 27.5 kW
Justification for New Transmitter Acrodyne no longer supports channel change for IOT transmitters such as ours

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 3 inches
Length 120.0 feet
Other Electrical Service No
Description N/A
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

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? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
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: 340.0 kW
Manufacturer
Model ATW27H5-HTOL-44S
Year 1999

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? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top 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: 243.0 kW
Manufacturer
Model ATW23H3-ETO-28H
Year 2018
Justification for New Antenna CH45 antenna cannot be tuned to channel 28. The new antenna will be 20% vertical polarity. The additional cost for vertical will not be included in the reimbursement request.

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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
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

retuning antenna filter

add new cost line for retuning antenna filter

tower rigging

rig tower and gin pole. Remove ch45 antenna replace with ch 28. Make up elbow complex. plumb and tension tower. Sweep line and antenna

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Lease New
Ownership Leased
Owner ERI
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 Type Class Full Power
Mounting Side 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: 7.5 kW
Manufacturer
Model ETU-P3H1-1451
Year 2019
Justification for New Antenna interim antenna required for transition

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 6 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Interim 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? No

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 Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) No
Others Types of Users Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1030890
Coordinates (NAD83) Latitude (NAD83) 37° 53' 17.2" N-
Longitude (NAD83) 087° 32' 37.0" W-
Overall Structure Height 1016.06 feet
Support Structure Height 967.84 feet
Ground Elevation Above Mean Sea Level (AMSL) 413.05 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Pinnacle Towers LLC
Date Constructed 11/08/1993


Other Types of Users

Users
W220DV9
W243CU
WEEV

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 undocumented/poorly 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 N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Antenna Installation helicopter lift

expenses for antenna installation helicopter lift

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 595
Explanation reimbursement filing, expense tracking, vendor coordination, progress reporting, budget creation, budget review, budget tracking, daisy-chain monitoring and all other activities
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 Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

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 No
BLM or NFS Coordination Yes
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
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? 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

Name Description

Hitachi

WEVV Transmitter & Antenna Invoice

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 $953,240.00 $777,298.02 N/A $771,298.02 N/A
Total for all systems $2,052,221.00 $1,974,929.33 N/A $1,163,937.33 N/A
Primary Transmitter HPTV-PRLX-U16 $953,240.00 $777,298.02 $771,298.02
3" Rigid Conduit and Wiring (Cost per foot) $6,240.00 $6,000.00 N/A $0.00 0.00
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $771,298.02 Comark Proposal 3732R6 Parallax U16; extra costs incurred per invoices $771,298.02 The project required additional electrical work which is reflected in the Boyd Electric Invoice 7965. The Boyd Electric Quote for Invoice 7965 is attached.

Components

Actual Information Description File Name
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter and antenna installation
Amount:
$265,800.16

Component Description:
Transmitter and installation and deinstallation
Amount:
$37,971.45

Component Description:
Transmitter labor and materials
Amount:
$11,869.00

Component Description:
WEVV, SYSTEM PRLX U16 D28
Amount:
$455,657.41

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 $455,471.00 $564,021.31 N/A $331,259.31 N/A
Total for all systems $2,052,221.00 $1,974,929.33 N/A $1,163,937.33 N/A
Interim Antenna ETU-P3H1-1451 $26,918.00 $26,918.00 $13,218.00
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $13,700.00 add for filing purposes N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 8 kW input, horizontally polarized $13,218.00 $13,218.00 reenter here for side mount correction $13,218.00 N/A
Primary Antenna ATW23H3-ETO-28H $428,553.00 $537,103.31 $318,041.31
tower rigging $118,573.00 $118,573.00 Includes plumb and tension to ANSI/TIA-222-G ERI states that labor costs have increased substantially since their original quote. Also rigging plans had to be reviewed by a certified engineer. $118,573.00 N/A
retuning antenna filter $1,450.00 $1,450.00 Estimated cost is actual cost $1,450.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $7,821.00 N/A $7,821.14 This is 14 cent de minimis difference between actual and estimated cost
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $403,009.31 Estimated cost adjusted per additional invoices; estimated cost adjusted at the direction of staff to enable processing of 399 $183,947.17 This invoice contains line items that will be accounted for in other sections
Sweep test of existing antenna $6,730.00 $6,250.00 N/A $6,250.00 This invoice contains multiple items that will be entered in the appropriate section

Components

Actual Information Description File Name
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 8 kW input, horizontally polarized

Component Description:
interim tower component
Amount:
$6,465.00

Component Description:
cost to install and remove antenna
Amount:
$6,753.00
tower rigging

Component Description:
Down payment on tower rigging and installation of antenna
Amount:
$59,286.50

Component Description:
tower rigging reimbursement
Amount:
$59,286.50
retuning antenna filter

Component Description:
retuning antenna filter
Amount:
$1,450.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
down payment on the elbow complex for antenna installation
Amount:
$3,910.57

Component Description:
elbow complex
Amount:
$3,910.57
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Deposit on the new channel 28 full power antenna, minus $15,500 for an antenna upgrade that is not eligible for reimbursement
Amount:
$84,955.00

Component Description:
Second antenna payment
Amount:
$84,955.00

Component Description:
OHM standard inner connector per change order
Amount:
$205.00

Component Description:
freight
Amount:
$460.00

Component Description:
impedance transformer per change order
Amount:
$1,613.00

Component Description:
sales tax
Amount:
$11,732.17

Component Description:
elbow complex
Amount:
N/A

Component Description:
hardware kit per change order
Amount:
$27.00

Component Description:
system sweep
Amount:
N/A

Component Description:
antenna installation
Amount:
N/A

Component Description:
retuning antenna filter
Amount:
N/A

Component Description:
Cost to install and remove rental antenna
Amount:
N/A

Component Description:
antenna installation helicopter lifts
Amount:
N/A

Component Description:
install and remove rental antenna
Amount:
N/A
Sweep test of existing antenna

Component Description:
Down payment on system sweep invoice
Amount:
$3,125.00

Component Description:
system sweep
Amount:
$3,125.00

Cost Information

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Transmission Line

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 $451,050.00 $440,350.00 N/A $56,250.00 N/A
Total for all systems $2,052,221.00 $1,974,929.33 N/A $1,163,937.33 N/A
Primary Tower TOWER $451,050.00 $440,350.00 $56,250.00
Antenna Installation helicopter lift $56,250.00 $56,250.00 cost for antenna installation helicopter lift $56,250.00 N/A
Minor tower reinforcement/modifications $158,000.00 $153,500.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,600.00 N/A N/A N/A
Tall Tower (greater than 500') $210,500.00 $205,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Antenna Installation helicopter lift

Component Description:
antenna installation helicopter lift
Amount:
$56,250.00
Minor tower reinforcement/modifications Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study Information not provided.
Tall Tower (greater than 500') 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 $171,020.00 $172,425.00 N/A $0.00 N/A
Total for all systems $2,052,221.00 $1,974,929.33 N/A $1,163,937.33 N/A
Outside Professional Services $171,020.00 $172,425.00 $0.00
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 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 - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A 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 N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $94,010.00 $99,675.00 Per Widelity Strategic Quote 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 $21,440.00 $20,835.00 N/A $5,130.00 N/A
Total for all systems $2,052,221.00 $1,974,929.33 N/A $1,163,937.33 N/A
Other Expenses $21,440.00 $20,835.00 $5,130.00
Hitachi $0.00 $0.00 N/A N/A N/A
MVPD Notification of Channel Change $2,150.00 $2,150.00 certified letter campaign $2,150.00 The original estimate was inaccurate
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 announcement campaign on other local media N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $500.00 $500.00 final cleanup after tower rigging removes their debris N/A N/A
BLM or NFS Coordination $500.00 $500.00 certified letter campaign N/A N/A
Local Zoning $100.00 $100.00 This should be a simple local construction permit N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 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 $11,000.00 N/A $2,980.00 N/A

Components

Actual Information Description File Name
Hitachi Information not provided.
MVPD Notification of Channel Change

Component Description:
MVPD Notification
Amount:
$2,150.00
Develop and air announcement of upcoming channel change Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
BLM or NFS Coordination Information not provided.
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request 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:
Notification to medical facilities
Amount:
$2,980.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,052,221.00 $1,974,929.33 $1,163,937.33

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.

Eric Stremming

Station Manager


04/22/2020

Attachments

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