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:
14387
Service:
LPD
Call Sign:
KXUN-LD
Channel:
26 (UHF)
File Number:
0000083932
FRN:
0019028406
Eligibility Status:
Eligible
Date Submitted:
06/11/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TRIBUNE BROADCASTING COMPANY II, LLC

Doing Business As: TRIBUNE BROADCASTING COMPANY II, LLC

LARRY MORTON

PO Box 23808

LITTLE ROCK, AR 72223

United States

+1 (501) 476-1507 equitylem@gmail.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

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan KQRY (now KXUN - see call sign change attached) will share a transmitter building at a leased tower site with KFDF-CD. KQRY is moving off of Channel 48 to Channel 26 and co-locating with KFDF on an adjacent channel. See attached K48FL-D Transition Plan

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 Advanced TV - 140 watt
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 140 W

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 TRN-5XU-24-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1 kW
Justification for New Transmitter The old 140-watt transmitter could not be re-tuned to Channel 26 from channel 48. We are requesting reimbursement for a 140-watt transmitter and paying the difference ourselves. See K48FL_Transmitter_Memo.

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 Yes
Size 2 inches
Length 25.0 feet
Other Electrical Service Yes
Description This is a new site so we need to Install electrical at the location the transmitter will be installed and possibly relocate existing equipment.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size Other
Other Size 1 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 0.0 square feet

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Filter

Channel 26 filter

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? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 4
Design power capacity in use 50.0 %
Lower Limit 476.00 MHz
Upper Limit 608.00 MHz
ERP: 1.0 kW
Manufacturer
Model PRTV Array
Year 2012

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 Horizontal
Type Slotted Coaxial
ERP: 2.0 kW
Manufacturer
Model PSILPD8AERM-26
Year 2018
Justification for New Antenna SEE ATTACHED K48FL_ANTENNA MEMO

Primary 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? Single Channel
Feed Line Size 1 5/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
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

MISCELLANEOUS CONNECTORS

Various connectors and grounding kits as required for installation

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)
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
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 170 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 300 feet per run
Justification for New Transmission Line We purchased the existing line from a prior tenant to minimize costs and to maintain the same tower loading parameters. See attached K48FL_Antenna_Memo.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Hangars

Miscellaneous connectors to fix any loose connections.

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)
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) 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) 35° 26' 51.0" N-
Longitude (NAD83) 094° 21' 54.0" W-
Overall Structure Height 285.10 feet
Support Structure Height 274.93 feet
Ground Elevation Above Mean Sea Level (AMSL) 810.03 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Hash Communications, LLC
Date Constructed 10/26/2001

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
168154 KFDF-CD DTV

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

Tower rigging costs

Cost to hang the antenna and inspect and add additional hangars for the line.

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 80
Explanation We do not have a staff engineer so we have to outsource all engineering work.
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 Yes
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 2
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 2
Negotiation of Lease and other Matter for Shared Locations Yes
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 Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 10
Justification We do not have a staff engineer and have to outsource all engineering work.

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 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? Yes
Does this relocation require Equipment Storage? Yes
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System Yes
New Point to Point Microwave System Yes
Type Unlicensed

Other Expenses

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Other Expenses Not Listed

Name Description

Sales Taxes

State Sales Taxes if applicable

Travel Expenses

Travel, hotels and meal expenses related to the construction

Local Permit

Local Permits if required

Form 399 Assistance

Hourly help to complete the form 399

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 $100,020.00 $26,656.80 N/A $18,216.33 N/A
Total for all systems $303,663.03 $148,929.83 N/A $45,092.61 N/A
Primary Transmitter TRN-5XU-24-C $100,020.00 $26,656.80 $18,216.33
Filter $1,870.00 $1,870.00 N/A $1,870.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $5,000.00 N/A N/A N/A
Other -- Building Addition Size: 0.0 $1,000.00 $1,000.00 We believe the site owner will make the minor modifications we need for the entry to be widened. N/A N/A
Other -- HVAC Service Type: C Size:1 (Other) $500.00 $500.00 Small Air Conditioner to handle the additional heat for a second transmitter. N/A N/A
Other Electrical Service: This is a new site so we need to Install electrical at the location the transmitter will be installed and possibly relocate existing equipment. $2,000.00 $2,000.00 To install conduit and wire for the transmitter at the new site. $559.53 N/A
2" Rigid Conduit and Wiring (Cost per foot) $650.00 $500.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $15,786.80 See K48FL-D Transmitter Memo. $15,330 plus Shipping $456.80 $15,786.80 N/A

Components

Actual Information Description File Name
Filter

Component Description:
We are only requesting reimbursement up to the cost of a 140 watt filter as quoted in the enclosed quote. See attached K48FL-D Transmitter & Filter memo.
Amount:
$1,870.00
Transmitter Building Site Survey/Installation Information not provided.
Other -- Building Addition Size: 0.0 Information not provided.
Other -- HVAC Service Type: C Size:1 (Other) Information not provided.
Other Electrical Service: This is a new site so we need to Install electrical at the location the transmitter will be installed and possibly relocate existing equipment.

Component Description:
Install electrical sub-panel for the transmitter.
Amount:
$559.53
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
See K48FL-D Transmitter and Filter Memo Attached to invoice.
Amount:
$15,786.80

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 $28,421.28 $16,166.28 N/A $10,166.28 N/A
Total for all systems $303,663.03 $148,929.83 N/A $45,092.61 N/A
Primary Antenna PSILPD8AERM-26 $28,421.28 $16,166.28 $10,166.28
MISCELLANEOUS CONNECTORS $1,000.00 $1,000.00 N/A N/A N/A
Side Mount antenna brackets $4,625.00 $0.00 N/A N/A N/A
Elbow complex, single channel, 1 5/8” input (if needed) $6,900.00 $0.00 N/A N/A N/A
Sweep test of transmission line and antenna $5,730.00 $5,000.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Horizontal $0.00 $0.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Horizontal $10,166.28 $10,166.28 ***System Notice: Estimate adjusted and locked because line has been superseded.***This is the amount that was in the Form 399 that was submitted and verified. $10,166.28 N/A

Components

Actual Information Description File Name
MISCELLANEOUS CONNECTORS Information not provided.
Side Mount antenna brackets Information not provided.
Elbow complex, single channel, 1 5/8” input (if needed) Information not provided.
Sweep test of transmission line and antenna Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Horizontal Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Horizontal

Component Description:
SEE K48FL ANTENNA MEMO ATTACHED
Amount:
$10,166.28

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 $9,200.00 $5,600.00 N/A $3,600.00 N/A
Total for all systems $303,663.03 $148,929.83 N/A $45,092.61 N/A
Primary Transmission Line $9,200.00 $5,600.00 $3,600.00
Flexible Foam Transmission Line - dielectric, 1 5/8" $7,200.00 $3,600.00 Purchased used line. 300 feet @ $12/ft $3,600.00 Purchased used line. 300 feet @ $12/ft
Hangars $0.00 $0.00 Replace hangars on the existing line N/A N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $2,000.00 $2,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
N/A
Amount:
$3,600.00
Hangars Information not provided.
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators 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 $56,190.00 $20,000.00 N/A $0.00 N/A
Total for all systems $303,663.03 $148,929.83 N/A $45,092.61 N/A
Primary Tower TOWER $56,190.00 $20,000.00 $0.00
Tower rigging costs $0.00 $0.00 N/A N/A N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $20,000.00 Cost to hang the antenna and replace hangars & connectors and repair line as needed. 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 $91,900.00 $60,880.00 N/A $10,730.00 N/A
Total for all systems $303,663.03 $148,929.83 N/A $45,092.61 N/A
Outside Professional Services $91,900.00 $60,880.00 $10,730.00
Attorney Fees - Prepare and File request for Special Temporary Authorization $4,470.00 $4,470.00 We had to make file 2 STA requests to stay on the air during the transition. See Transition Plan Memo. $4,470.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $3,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,550.00 N/A $1,550.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,000.00 N/A $3,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,100.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,560.00 $4,000.00 We filed two STA requests to stay on the air during the transition period. See Transition Plan Memo. N/A N/A
Perform engineering study for displacement application $1,800.00 $2,500.00 Made a Channel 33 displacement filing and 2 modifications for Ch 19 and then Ch 26 to get a clear channel. See Transition Plan Memo. N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A $1,710.00 N/A
Project management of the transition $8,440.00 $8,250.00 We estimated 55 hours at $150 per hour N/A N/A
Additional Field Engineering Service, 10 Days $9,300.00 $9,300.00 We do not have a staff engineer and rely on contractors to provide these services. We estimated 62 hours at 150 per hour. N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $20,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Legal fees for obtaining the original STA and working on the extension of the STA to keep the station on the air.
Amount:
$4,470.00
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal fees for filing the license. Invoice also covers the costs for the filing fee.
Amount:
$1,550.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal fees for the displacement/construction Permit work.
Amount:
$3,000.00
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 Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Perform engineering study for displacement application Information not provided.
Prepare/ Review 399 reimbursement form

Component Description:
The invoice covers both the Preparing and Reviewing the 399 and the Form 399 Assistance. This payment is for the Preparing and reviewing the Form 399.
Amount:
$1,710.00
Project management of the transition Information not provided.
Additional Field Engineering Service, 10 Days Information not provided.
Comprehensive coverage verification via field study, if needed 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 $17,931.75 $19,626.75 N/A $2,380.00 N/A
Total for all systems $303,663.03 $148,929.83 N/A $45,092.61 N/A
Other Expenses $17,931.75 $19,626.75 $2,380.00
Form 399 Assistance $2,000.00 $2,000.00 We do not have staff and rely on outside contractors for this work. We estimated 40 hours at $50.00 per hour for working on Form 399. $2,000.00 N/A
Local Permit $100.00 $100.00 Amount to cover any zoning or other permits required. N/A N/A
Travel Expenses $2,000.00 $2,000.00 Travel costs incurred during construction N/A N/A
Sales Taxes $5,731.75 $5,731.75 Possible sales taxes if not collected by vendors. N/A N/A
New Point to Point Microwave System: Unlicensed $2,250.00 $3,750.00 Cost to install the STL to the local office. N/A N/A
Point to Point Microwave (STL/ICR): Frequency Coordination for Bi-Direction System $1,100.00 $1,000.00 N/A N/A N/A
Equipment Storage $500.00 $500.00 N/A N/A N/A
Equipment Delivery and Handling Charges $1,500.00 $1,500.00 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
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 $1,100.00 If required N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $610.00 We required 2 STA filings to stay on the air during the transition process. See Transition Plan Memo. $380.00 N/A

Components

Actual Information Description File Name
Form 399 Assistance

Component Description:
The invoice covers both the Preparing and Reviewing the 399 and the Form 399 Assistance. This payment is for the Form 399 Assistance.
Amount:
$2,000.00
Local Permit Information not provided.
Travel Expenses Information not provided.
Sales Taxes Information not provided.
New Point to Point Microwave System: Unlicensed Information not provided.
Point to Point Microwave (STL/ICR): Frequency Coordination for Bi-Direction System Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) 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.
FCC Filing Fees - Special Temporary Authorization request

Component Description:
STA Fees required to maintain operations.
Amount:
$380.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $303,663.03 $148,929.83 $45,092.61

Reimbursement Status

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

LARRY MORTON

MANAGER, KTV MEDIA, LLC


06/11/2020

Attachments

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