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:
168413
Service:
LPD
Call Sign:
WBQC-LD
Channel:
28 (UHF)
File Number:
0000089336
FRN:
0029108297
Eligibility Status:
Eligible
Date Submitted:
07/03/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Elliott B. Block

Individual Licensee

Doing Business As: ELLIOTT B. BLOCK

PO Box 37770

CINCINNATI, OH 45222

United States

+1 (513) 631-8825 mgray@wkrp.tv Individual

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

Peter Tannenwald

Legal Counsel

Fletcher Heald and Hildreth PLC

1300 N. 17th St.

11th Floor

Arlington, VA 22209

United States

+1 (703) 812-0404 tannenwald@fhhlaw.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 Terminate operation on Ch 47 after T-Mobile demand to vacate by 8/18/2018. Operate temporarily on Ch 20 with old equipment under STA LMS File No. 0000058280 granted 10/9/2018. Buy new equipment, move to Ch. 28 under LMS 0000088128 Nov. 2019.

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? No
Existing Transmitter Manufacturer and Type Manufacturer
Model TRN-5X-U-46D-C
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 3.0 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 TRN-5X-U-48-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 4.4 kW
Justification for New Transmitter Anywave attached letter said old transmitter was outdated, and cost of power amplifiers, filter, and needed exciter upgrades was too high to justify compared to replacing transmitter. Old transmitter power rating was too low to achieve TPO on new channel.

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? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Pro Service, Inc.

Retune filter, ship filter to transmitter site.

Dielectric

Shipping charges for filter.

Broadcast Engineering Services

Installation and testing of new transmitter.

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? No
Is antenna in operating condition? No
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 Circular
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ERI AL12O-47-PL
Year 2008

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? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ALP8L1-CSOC-28
Year 2019
Justification for New Antenna Old nondirectional antenna could not be converted to new directional pattern.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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? No

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change 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? No
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 3 inches
Number of parallel runs 1
Length 725 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 Air
Diameter 4 inches
Number of parallel runs 1
Length 760 feet per run
Justification for New Transmission Line Old transmission line had leaks, resulting in power loss.
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

Collins Construction and Building

Storage, delivery, and unloading of 6,000 pound spool of new transmission line

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? No
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 1013618
Coordinates (NAD83) Latitude (NAD83) 39° 07' 30.4" N-
Longitude (NAD83) 084° 29' 56.0" W-
Overall Structure Height 865.80 feet
Support Structure Height 791.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 844.15 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner SCRIPPS MEDIA, INC.
Date Constructed 12/16/2010


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? 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 No
Prepare request for Special Temporary Authority Yes
Quantity 1
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 Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Legal Fees

Additional legal expenses in connection with transition

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Name Description

Kentucky Educational TV

Reimbursement of cost of negotiating interference consent for STA.

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 $207,396.54 $60,519.48 N/A $48,936.48 N/A
Total for all systems $472,212.63 $203,632.44 N/A $146,006.07 N/A
Primary Transmitter TRN-5X-U-48-C $207,396.54 $60,519.48 $48,936.48
Broadcast Engineering Services $4,157.21 $4,157.21 N/A $4,157.21 N/A
Dielectric $347.57 $347.57 N/A $347.57 N/A
Pro Service, Inc. $2,141.76 $2,141.76 N/A $2,141.76 N/A
UHF - Air Cooled Solid State Transmitter 4 - 6 kW $200,750.00 $53,872.94 N/A $42,289.94 N/A

Components

Actual Information Description File Name
Broadcast Engineering Services

Component Description:
Transmitter installation
Amount:
$4,157.21
Dielectric

Component Description:
Freight and Shipping
Amount:
$347.57
Pro Service, Inc.

Component Description:
Transmitter retuning/shipping; actual cost incurred.
Amount:
$2,141.76
UHF - Air Cooled Solid State Transmitter 4 - 6 kW

Component Description:
The amount being claimed is only $42,289.94. A new Partial Claim Anywave transmitter invoice exhibit has been uploaded, explaining why the claim is less than the invoice amount.
Amount:
$42,289.94

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 $13,809.25 $10,138.66 N/A $8,766.64 N/A
Total for all systems $472,212.63 $203,632.44 N/A $146,006.07 N/A
Primary Antenna ALP8L1-CSOC-28 $13,809.25 $10,138.66 $8,766.64
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Circular $9,184.25 $9,184.25 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $7,812.23 N/A
Side Mount antenna brackets $4,625.00 $954.41 N/A $954.41 N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Circular

Component Description:
UHF Antenna -- cost for comparable horizontally polarized antenna -- explained in exhibit attached to invoice.
Amount:
$7,812.23
Side Mount antenna brackets

Component Description:
Custom side mounts. Cost calculation including tax and freight explained in exhibit attached to invoice.
Amount:
$954.41

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 $67,427.95 $51,465.41 N/A $11,187.95 N/A
Total for all systems $472,212.63 $203,632.44 N/A $146,006.07 N/A
Primary Transmission Line $67,427.95 $51,465.41 $11,187.95
Collins Construction and Building $7,000.00 $7,000.00 N/A $7,000.00 N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $4,187.95 $4,187.95 N/A $4,187.95 N/A
Flexible Air Transmission Line - dielectric, 4" $56,240.00 $40,277.46 N/A $0.00 N/A

Components

Actual Information Description File Name
Collins Construction and Building

Component Description:
Hauling/Unloading 6000 lb wire spool
Amount:
$7,000.00
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators

Component Description:
Dryline Dehydrator
Amount:
$4,187.95
Flexible Air Transmission Line - dielectric, 4"

Component Description:
Claim for transmission line is being deleted. Exhibit attached to invoice explains.
Amount:
N/A

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 $157,750.00 $44,280.00 N/A $44,280.00 N/A
Total for all systems $472,212.63 $203,632.44 N/A $146,006.07 N/A
Primary Tower TOWER $157,750.00 $44,280.00 $44,280.00
Tower Rigging Tall Tower (greater than 500') $157,750.00 $44,280.00 N/A $44,280.00 N/A

Components

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

Component Description:
Tower rigging services
Amount:
$44,280.00

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 $19,000.00 $30,280.00 N/A $28,575.00 N/A
Total for all systems $472,212.63 $203,632.44 N/A $146,006.07 N/A
Outside Professional Services $19,000.00 $30,280.00 $28,575.00
Prepare/ Review 399 reimbursement form $1,710.00 $14,000.00 Actual invoices detailing legal services of $12,800 have been submitted. FCC asked many questions, required significant claim reductions. Two separate repack contractors asked questions on different dates. Charges are law firm's standard rates. $12,800.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $1,200.00 N/A $800.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $1,500.00 N/A $1,500.00 N/A
Prepare request for Special Temporary Authorization $1,280.00 $3,250.00 Services have been performed. Estimate based on actual cost from consulting engineer. Extra work required because of interference to full power station, need to prepare amendment to STA request, and support for agreement consenting to interference. $3,250.00 N/A
Perform engineering study for displacement application $1,800.00 $2,375.00 Services have been performed. Estimate is actual cost billed by consulting engineer. $2,375.00 N/A
Form 399 assistance or other Program Management costs $0.00 $0.00 This cost has been moved from the Form 399 assistance category to the Prepare and Review Form 399 category. The amount for 399 assistance should be zero to avoid duplicate claim. $0.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $6,705.00 $6,705.00 Required 3 separate filings: original STA plus 2 extensions; also required negotiation of agreement for interference consent from Kentucky Educational Television. Estimate is amount actually billed for services. $6,700.00 N/A
Other Legal Fees $800.00 $800.00 N/A $800.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $450.00 N/A $350.00 N/A

Components

Actual Information Description File Name
Prepare/ Review 399 reimbursement form

Component Description:
Responding to FCC requests for changes in Form 399; preparing and filing Form 399 updates
Amount:
$3,800.00

Component Description:
Continuing to respond to FCC questions; split invoices into separate uploads; reduce claims for transmitter, antenna, transmission line. $50 is for non-reimbursable legal services and is not claimed.
Amount:
$1,800.00

Component Description:
Final filing and updating Form 399 with new invoices.
Amount:
$700.00

Component Description:
Continuation of legal services for preparing and filing Form 399; line items that are claimed are marked on invoice by category.
Amount:
$3,950.00

Component Description:
Filing Form 1876; obtaining information from FCC re which account to use after death of licensee; answer FCC questions about cost items.
Amount:
$1,900.00

Component Description:
Legal services continuing to respond to FCC questions about whether transmitter and antenna were upgrades. $7.00 service charge not claimed.
Amount:
$550.00

Component Description:
Legal Fees for preparation and filing of Form 399
Amount:
$100.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal fees for preparing and filing Form 2100 - Construction Permit/Displacement Application
Amount:
$800.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Displacement Application services
Amount:
$1,500.00
Prepare request for Special Temporary Authorization

Component Description:
Prepare STA interference map to enable settlement with W20CT Kentucky Authority for ETV
Amount:
$250.00

Component Description:
Prepare STA Application
Amount:
$2,500.00

Component Description:
Prepare STA amendment
Amount:
$500.00
Perform engineering study for displacement application

Component Description:
Displacement Channel Search
Amount:
$125.00

Component Description:
Displacement Channel Engineering Search and Study
Amount:
$2,250.00
Form 399 assistance or other Program Management costs

Component Description:
$3950 of this invoice has been claimed under Form 399 preparation and review. The claim under Form 399 assistance is zero to avoid a duplicate claim.
Amount:
N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Legal fees for preparation and filing of request for Special Temporary Authority and Extensions
Amount:
$6,700.00
Other Legal Fees

Component Description:
Other legal fees for advising re displacement and transition from old to new channel -- developing plan for STA and then CP.
Amount:
$800.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal fees for preparing and filing Form 2100 - License to Cover Application
Amount:
$100.00

Component Description:
Legal fees for preparing and filing Form 2100 - License to Cover Application
Amount:
$250.00

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 $6,828.89 $6,948.89 N/A $4,260.00 N/A
Total for all systems $472,212.63 $203,632.44 N/A $146,006.07 N/A
Other Expenses $6,828.89 $6,948.89 $4,260.00
Kentucky Educational TV $3,500.00 $3,500.00 N/A $3,500.00 This amount was actually paid to KYETV. FCC Video Division declined to grant STA to keep station on air without KETV consent.
Equipment Delivery and Handling Charges $2,688.89 $2,688.89 N/A $0.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $170.00 N/A $170.00 N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $590.00 Three filing fees: Initial STA at $190, first extension at $200, second extension at $200. $590.00 N/A

Components

Actual Information Description File Name
Kentucky Educational TV

Component Description:
Fee for consenting to grant of STA Request. FCC Video Division declined to grant STA to keep station on air without KYETV consent.
Amount:
$3,500.00
Equipment Delivery and Handling Charges

Component Description:
Shipping/freight costs have been added to the antenna and side mount costs, so they are covered under other cost categories.
Amount:
N/A
FCC Filing Fees - Form 2100 license to cover application

Component Description:
License to Cover Application Filing Fee
Amount:
$170.00
FCC Filing Fees - Special Temporary Authorization request

Component Description:
STA Filing Fee charged by FCC.
Amount:
$190.00

Component Description:
STA Extension Request Filing Fee charged by FCC.
Amount:
$200.00

Component Description:
STA Extension Request Filing Fee charged by FCC.
Amount:
$200.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $472,212.63 $203,632.44 $146,006.07

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.

Lawrence W. Sheff

Executor of the Estate of Elliott B. Block


07/03/2020

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.

Lawrence W. Sheff

Executor of the Estate of Elliott B. Block


07/03/2020

Attachments

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