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:
168647
Service:
LPD
Call Sign:
WMYS-LD
Channel:
28 (UHF)
File Number:
0000088976
FRN:
0009562448
Eligibility Status:
Eligible
Date Submitted:
05/11/2020

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WBND-TV LIMITED PARTNERSHIP

Doing Business As: WBND-TV LIMITED PARTNERSHIP

Norman H. Shapiro

26 NORTH HALSTED STREET

CHICAGO, IL 60661

United States

+1 (312) 705-2600 NShapiro@wciu.com Limited Partnership

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

Back to Top
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 Due to displacement, WMYS must transition from ch 39 to ch 33 then to final ch 28. WMYS's transmitter is no longer supported and cannot be retuned. WMYS's antenna does not support ch 33/28, so it is being replaced with a new ch 33/28 antenna.

Question Response
Sharee Station Facility ID 24617
Call Sign WCWW-LD
Type
Licensee Name WCWW-TV LIMITED PARTNERSHIP
Status LICENSED
DTS No
Community of License SOUTH BEND, IN
Pre-auction RF Channel 25
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 71426
Call Sign WBND-LD
Type
Licensee Name WEIGEL BROADCASTING COMPANY
Status LICENSED
DTS No
Community of License SOUTH BEND, IN
Pre-auction RF Channel 34
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Transmitters

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

Primary Transmitter

Back to Top

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 TDU2 3K00 LV
Year 2012
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 3 kW

Primary Transmitter

Back to Top

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 THU9evo-4
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.5 kW
Justification for New Transmitter The current WMYS transmitter is no longer supported. It is not capable of being retuned to channel 33 or 28.

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring Yes
Size 2 inches
Length 60.0 feet
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

Back to Top

Other Transmitter Cost Not Listed

Name Description

RF Switch Control Cable

Control cable so that the Rohde & Schwarz transmitter can control the RF switch.

Initial Channel 33 Installation and Proof

Installation and Proof of the Rohde & Schwarz channel 33 and 28 transmitter.

Channel 28 filter

The Rohde & Schwarz transmitter initially shipped with a ch 33 RF system. A replacement ch 28 filter is required

Channel 28 filter installation and mini-proof

The Rohde & Schwarz transmitter initially shipped as a ch 33 system. The transmitter must be retuned for ch 28.

Antennas

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

Primary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? 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 TLP-12B
Year 2012

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Broadband Slot
Number of Stations Supported 2
Number of Panels/Bays 12
Lower Limit 554.00 MHz
Upper Limit 584.00 MHz
Design power capacity in use 60.0 %
ERP: 15.0 kW
Manufacturer
Model ATC-BCSC412M-V3-U
Year 2019
Justification for New Antenna The current Dielectric TLP-B is cut for channel 39 only. The new Alive antenna will pass channel 33 and 28.

Primary Antenna

Back to Top

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? Yes

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Initial ch 33 slot antenna

WMYS initially cut-over from ch 39 to ch 33 via an Alive Telecom, ATC-BCH412M-33 slot antenna that was for ch 33 only.

Transmission Line

Back to Top
Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

Tower Equipment And Rigging Costs

Back to Top
Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Ownership Owned
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) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? No
Coordinates (NAD83) Latitude (NAD83) 41° 36' 54.9" N-
Longitude (NAD83) 086° 11' 06.6" W-
Overall Structure Height 1076.10 feet
Support Structure Height 1076.10 feet
Ground Elevation Above Mean Sea Level (AMSL) 872.69 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WEIGEL BROADCASTING CO.
Date Constructed 09/25/2002

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
71426 WBND-LD LPD
24617 WCWW-LD LPD

Primary Tower

Back to Top

Tower Rigging Costs

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

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Initial channel 33 slot antenna installation

WMYS initially used a channel 33 slot antenna as part of its STA, as the ultimate channel was not yet known at filing. This is the installation cost of the slot antenna.

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? No
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 3
Prepare Form 601 No
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 3
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Back to Top
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 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
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

Back to Top

Other Expenses Not Listed

Information not provided.

Cost Information

Back to Top

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 $288,071.44 $181,525.16 N/A $33,034.38 N/A
Total for all systems $541,963.94 $307,637.66 N/A $59,484.38 N/A
Primary Transmitter THU9evo-4 $288,071.44 $181,525.16 $33,034.38
Channel 28 filter $7,599.44 $7,599.44 A channel 28 filter is required so that the new Rohde & Schwarz transmitter can move from channel 33 to channel 28. See attachment "MSG4636533_2020, 0409 Dielectric Proposal" $7,102.28 N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,560.00 $7,932.10 The estimate cost of $1,560 is a per foot cost. The total cost of the electrical required for the new Rohde & Schwarz transmitter and RF system was 7932.10. See attachment "MSG4636472_2020, 0409 Martell Electric Invoice 56357" $7,932.10 N/A
Initial Channel 33 Installation and Proof $18,000.00 $18,000.00 This is for the installation and proof of the new Rohde & Schwarz transmitter on channel 33. Channel 33 was the initial STA facility. Channel 28 is the final facility. $18,000.00 N/A
Channel 28 filter installation and mini-proof $5,000.00 $5,000.00 This is work that was performed to retune the transmitter from channel 33 to 28 and to install the channel 28 Dielectric RF filter. N/A N/A
RF Switch Control Cable $912.00 $912.00 This is a control cable for the new Rohde & Schwarz transmitter so that it can control the RF switch N/A N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 - 6.5 kW $255,000.00 $142,081.62 See attachment WMYS Primary Transmitter Proposal $0.00 The total amount of $152,027.34 reflects the new, revised total cost of 142,081.62 plus 7% tax-$9,945.71. See attachment "MSG4634123_2020, 0409 Rohde Schwarz Proposal" for details.

Components

Actual Information Description File Name
Channel 28 filter

Component Description:
Invoice for item and shipping.
Amount:
$7,102.28

Component Description:
Sales tax for invoice 563053
Amount:
$497.16
2" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Final invoice for electrical work for the new Rohde & Schwarz transmitter.
Amount:
$7,932.10
Initial Channel 33 Installation and Proof

Component Description:
Final invoice
Amount:
$18,000.00
Channel 28 filter installation and mini-proof Information not provided.
RF Switch Control Cable Information not provided.
UHF - Liquid Cooled Solid State Transmitter 4.9 - 6.5 kW

Component Description:
This amount reflects a 25% Downpayment for the Rohde & Schwarz transmitter based on a new, revised amount of $142,081.62
Amount:
$35,520.41

Component Description:
This amount reflects 7% tax for the Rohde & Schwarz transmitter based on a new, revised amount of $142,081.62.
Amount:
$9,945.71

Component Description:
This amount reflects 75% final balance of the Rohde & Schwarz transmitter based on a new, revised amount of $142,081.62
Amount:
$106,561.22

Cost Information

Back to Top

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 $51,280.00 $47,300.00 N/A $7,650.00 N/A
Total for all systems $541,963.94 $307,637.66 N/A $59,484.38 N/A
Primary Antenna ATC-BCSC412M-V3-U $51,280.00 $47,300.00 $7,650.00
Sweep test of transmission line and antenna $5,730.00 $1,750.00 See attachment "MSG4635289_2020, 0409 AliveTelecom Invoice 2303" $1,750.00 N/A
Initial ch 33 slot antenna $11,800.00 $11,800.00 This is a channel 33 slot antenna for STA use. See attachment "MSG4790884_2020, 0505 AliveTelecom Proposal" $5,900.00 The original proposal for WMYS's channel 33 antenna was for $11,800 but did not include shipping. Invoice 1962 includes the shipping cost of $750, increasing the total from $11,800 to $12,550.
UHF-Low Power, Side Mount, Broadband Slot, 12 bay, 15.0kW input, Circular $33,750.00 $33,750.00 A new antenna is required that can pass channels 33 and 28. This minimizes the need for a second transmission line and related structural and installation requirements. See attachment "MSG4593189_2020, 0402 AliveTelecom Proposal" $0.00 N/A

Components

Actual Information Description File Name
Sweep test of transmission line and antenna

Component Description:
Antenna and line sweep for the WMYS antenna system. See attachment "MSG4635289_2020, 0409 AliveTelecom Invoice 2303"
Amount:
$1,750.00
Initial ch 33 slot antenna

Component Description:
Final payment for WMYS channel 33 antenna plus shipping.
Amount:
$6,650.00

Component Description:
50% deposit for WMYS channel 33 antenna.
Amount:
$5,900.00
UHF-Low Power, Side Mount, Broadband Slot, 12 bay, 15.0kW input, Circular

Component Description:
Final invoice for the WMYS 33/28 antenna. $4,500 deducted from invoice. V-POL is not eligible for reimbursement.
Amount:
$17,125.00

Component Description:
50% deposit for the WMYS 33/28 antenna. $4,500 deducted from invoice. V-POL is not eligible for reimbursement.
Amount:
$16,625.00

Cost Information

Back to Top

Transmission Line

Information not provided.

Cost Information

Back to Top

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 $176,550.00 $52,750.00 N/A $18,800.00 N/A
Total for all systems $541,963.94 $307,637.66 N/A $59,484.38 N/A
Primary Tower TOWER $176,550.00 $52,750.00 $18,800.00
Tower Rigging Tall Tower (greater than 500') $157,750.00 $33,950.00 See attachment "MSG4587716_2020, 0401 Worldwide Comm Proposal" $0.00 N/A
Initial channel 33 slot antenna installation $18,800.00 $18,800.00 See attachment "MSG4592982_2020, 0402 Worldwide Comm Proposal" $18,800.00 N/A

Components

Actual Information Description File Name
Tower Rigging Tall Tower (greater than 500')

Component Description:
Initial payment. This invoice reflects WMYS and WBND. 50% represents WMYS. See attachment "MSG4587716_2020, 0401 Worldwide Comm Invoice 2350"
Amount:
$25,462.50

Component Description:
Final invoice. This invoice reflects WMYS and WBND. 50% represents WMYS. See attachment "MSG4587716_2020, 0401 Worldwide Comm Invoice 2376"
Amount:
$8,487.50
Initial channel 33 slot antenna installation

Component Description:
Final payment for WMYS channel 33 antenna installation.
Amount:
$18,800.00

Component Description:
Final payment for WMYS channel 33 antenna installation.
Amount:
$18,800.00

Cost Information

Back to Top

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 $21,812.50 $21,812.50 N/A $0.00 N/A
Total for all systems $541,963.94 $307,637.66 N/A $59,484.38 N/A
Outside Professional Services $21,812.50 $21,812.50 $0.00
Attorney Fees - Prepare and File request for Special Temporary Authorization $6,705.00 $6,705.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $3,840.00 $3,840.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $4,250.00 $4,250.00 N/A $0.00 N/A
Total for all systems $541,963.94 $307,637.66 N/A $59,484.38 N/A
Other Expenses $4,250.00 $4,250.00 $0.00
Disposal Costs (for equipment and other waste, net of any salvage value) $2,500.00 $2,500.00 Dumpster removal of channel 39 related transmitter, RF system, and antenna. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $541,963.94 $307,637.66 $59,484.38

Reimbursement Status

Back to Top
Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. Yes
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

Back to Top
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.

Kyle Walker

VP, Technology


05/11/2020

Certification

Back to Top
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.

Kyle Walker

VP, Technology


05/11/2020

Certification

Back to Top
Section Question Response
Submission of Final Allocation or Accounting Information 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

  5. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. 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.

Kyle Walker

VP, Technology


05/11/2020

Attachments

Back to Top