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:
23269
Service:
LPD
Call Sign:
KVHF-LD
Channel:
5 (Low VHF)
File Number:
0000086855
FRN:
0024056301
Eligibility Status:
Eligible
Date Submitted:
07/11/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

VENTURA TV VIDEO AND APPLIANCE CENTER, INC.

Applicant

Doing Business As: VENTURA TV VIDEO AND APPLIANCE CENTER, INC.

3619 E. VENTURA AVENUE

FRESNO, CA 93702

United States

+1 (559) 265-4326 vtvgeneral@aol.com Other

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

Scott Barbee

Consultant

Sterling BCG LLC

Scott Barbee

PO Box 306

Clovis, CA 93613

United States

+1 (559) 805-5933 scott@sterlingbcg.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 Station displaced RF 42 to RF 5; ceased transmission in February 2019 (w/T-Mobile approval) while waiting to receive and install a new VHF transmitter, antenna, tx line, etc. Completed install and LTC granted July 12, 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? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model LPTV-8000
Year 2013
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 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 PAS3170
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1 kW
Justification for New Transmitter Station displaced from UHF channel 42 to VHF channel 5 and the existing Comark LPTV-8000 transmitter is not workable on low VHF.

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 1 inches
Length 200.0 feet
Other Electrical Service Yes
Description volt control transformer and associated wiring.
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

Contract Installation

Contract installation costs to install the new VHF 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 Leased
Owner Cocola Broadcasting Companies, LLC
Is the existing antenna shared with another station or stations? Yes
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 3
Number of Panels 16
Design power capacity in use 80.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
ERP: 15.0 kW
Manufacturer
Model K72314
Year 2010

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
68664 KVBC-LP
23276 KBID-LP

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 Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 2
Lower Limit 76.00 MHz
Upper Limit 82.00 MHz
Design power capacity in use 33.0 %
ERP: 1.6 kW
Manufacturer
Model JCPD-2/1(2) LV1
Year 2019
Justification for New Antenna Station displaced from UHF 42 to VHF 5 and the currently UHF antenna will not work on VHF 5.

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? 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
Power Dividers Does the panel antenna require power dividers? Yes
Number of Power Dividers 1
Cable Harness Does the panel antenna require cable harness? Yes
Number of Cable Harnesses 4

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? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Waveguide
Number of parallel runs 1
Length 150 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
68664 KVBC-LP
23276 KBID-LP

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 160 feet per run
Justification for New Transmission Line Station's pre-displaced channel (RF Ch. 42) was combined into an existing UHF antenna and transmission line; the transition to RF Ch. 5 requires new transmission line and antenna.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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)
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
Coordinates (NAD83) Latitude (NAD83) 37° 04' 25.8" N-
Longitude (NAD83) 119° 25' 55.4" W-
Overall Structure Height 135.00 feet
Support Structure Height 135.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 4481.00 feet
Structure Type NNTANN - Antenna Tower Array - 1st N = #
Tower Owner Cocola Broadcasting Companies, LLC
Date Constructed 06/01/2000

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
20559 KJEO-LD LPD
23276 KBID-LP LPD
68664 KVBC-LP LPD

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
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

Phillystran Rope

High performance guy cable with polyethylene jacket to resolve antenna reflection issues

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 175
Explanation Project manage the installation of the new displaced facility, including quotes, pricing, contractor coordination, QC and overall management of project tasks.
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 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 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 Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 5
Justification Onsite engineering and verification of service

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 Yes
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)? 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 No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $36,951.18 $29,951.18 N/A $29,951.18 N/A
Total for all systems $290,601.08 $134,051.45 N/A $105,380.20 N/A
Primary Transmitter PAS3170 $36,951.18 $29,951.18 $29,951.18
Contract Installation $5,000.00 $5,000.00 Contract labor costs to install the new VHF transmitter. $5,000.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $3,000.00 Engineering costs for placement of the new transmitter and associated equipment. $3,000.00 N/A
Other Electrical Service: volt control transformer and associated wiring. $1,763.08 $1,763.08 For other electric services; new service for the new transmitter installation for KVHF. $1,763.08 N/A
1" Rigid Conduit and Wiring $1,678.10 $1,678.10 Electrical conduit and wiring for new transmitter $1,678.10 N/A
Low VHF - Air Cooled Solid State Transmitter 1000.0 Watts $18,510.00 $18,510.00 New Technalogix VHF transmitter with installation. $18,510.00 N/A

Components

Actual Information Description File Name
Contract Installation

Component Description:
New Line Media (Gustavo Luzania) installed the new VHF transmitter.
Amount:
$5,000.00
Transmitter Building Site Survey/Installation

Component Description:
Site survey prior to new transmitter installation and coordination with EMS for electrical work to support.
Amount:
$1,500.00

Component Description:
Site survey with Driggers to review transmitter installation and electrical work prior to installation.
Amount:
$1,500.00
Other Electrical Service: volt control transformer and associated wiring.

Component Description:
Other electrical service to support the installation of the new transmitter.
Amount:
$1,763.08
1" Rigid Conduit and Wiring

Component Description:
Conduit & wiring for new transmitter electrical service
Amount:
$1,678.10
Low VHF - Air Cooled Solid State Transmitter 1000.0 Watts

Component Description:
New transmitter for KVHF RF5 displacement; requesting reimbursement for 500 watt transmitter; will not request balance of this invoice
Amount:
$17,835.00

Component Description:
Components, shipping and handling for the new KVHF RF 5 transmitter.
Amount:
$675.00

Component Description:
New Line Media (Gustavo Luzania) worked with the licensee to install the new VHF transmitter for RF channel 5; this request moved to Other Transmitter Costs.
Amount:
N/A

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 $78,030.00 $23,094.86 N/A $21,794.86 N/A
Total for all systems $290,601.08 $134,051.45 N/A $105,380.20 N/A
Primary Antenna JCPD-2/1(2) LV1 $78,030.00 $23,094.86 $21,794.86
Power Dividers (each, for panel antenna system, if not included in antenna cost) $1,300.00 $1,300.00 Jampro VHF antenna requires a power divider for the panel antenna. N/A N/A
Cable harness (each, for panel antenna system, if not included in antenna cost) $4,000.00 $0.00 N/A N/A N/A
Sweep test of transmission line and antenna $5,730.00 $1,500.00 Cost to perform a full antenna sweep of the new antenna and transmission line. $1,500.00 N/A
Low-VHF, Low Power, Panel antenna (per element), circularly-polarized $67,000.00 $20,294.86 Cost of the Jampro panel antenna for RF channel 5 $20,294.86 N/A

Components

Actual Information Description File Name
Power Dividers (each, for panel antenna system, if not included in antenna cost) Information not provided.
Cable harness (each, for panel antenna system, if not included in antenna cost) Information not provided.
Sweep test of transmission line and antenna

Component Description:
Sweep the new KVHF RF5 antenna
Amount:
$1,500.00
Low-VHF, Low Power, Panel antenna (per element), circularly-polarized

Component Description:
New VHF antenna for KVHF RF 5. Ventura requesting reimbursement for HPOL only; not the CPOL costs as outlined in the supporting memorandum
Amount:
$20,294.86

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 $3,840.00 $3,698.01 N/A $3,698.01 N/A
Total for all systems $290,601.08 $134,051.45 N/A $105,380.20 N/A
Primary Transmission Line $3,840.00 $3,698.01 $3,698.01
Flexible Foam Transmission Line - dielectric, 1 5/8" $3,840.00 $3,698.01 Approximate cost of 160 feet of Cellflex transmission line with connectors. $3,698.01 N/A

Components

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

Component Description:
New transmission line connectors and material.
Amount:
$1,543.01

Component Description:
Transmission line hardware
Amount:
$2,155.00

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 $60,407.40 $26,517.40 N/A $26,517.40 N/A
Total for all systems $290,601.08 $134,051.45 N/A $105,380.20 N/A
Primary Tower NNTANN $60,407.40 $26,517.40 $26,517.40
Phillystran Rope $4,217.40 $4,217.40 Approximate cost of Phillystran rope that will need to be placed on the tower guy wires to eliminate antenna reflection issues. $4,217.40 N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $22,300.00 Place antenna, transmission line and Phillystran for the displaced facility. $22,300.00 N/A
Minor tower reinforcement/modifications $0.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Phillystran Rope

Component Description:
Phillystran rope to eliminate guy wire interference problem for the new KVHF facility.
Amount:
$4,217.40
Tower Rigging Short Tower (less than 500')

Component Description:
Install Phillystran on tower for KVHF RF5 transition and interference mediation.
Amount:
$5,300.00

Component Description:
Antenna and TX line installation for KVHF RF5.
Amount:
$17,000.00
Minor tower reinforcement/modifications 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 $104,772.50 $49,150.00 N/A $23,418.75 N/A
Total for all systems $290,601.08 $134,051.45 N/A $105,380.20 N/A
Outside Professional Services $104,772.50 $49,150.00 $23,418.75
Additional Field Engineering Service, 5 Days $0.00 $0.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $5,000.00 Engineering study post-install of the new facility to confirm minimum coverage requirements. N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $4,470.00 $650.00 Licensee had to file for STA authorization and an extension. $650.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,500.00 Costs to prepare and file the LTC application. N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,000.00 Costs to prepare and file the CP application and modification due to an MX situation. N/A N/A
Prepare request for Special Temporary Authorization $2,560.00 $2,000.00 Costs to prepare STA(s). $2,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,050.00 Cost to prepare the engineering section of the LTC application. N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $1,875.00 Cost to prepare the engineering section of the CP application and mod. $1,875.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $4,000.00 Prepare, revise, submit, resubmit 399 invoices from vendor quotes / invoices and submit for reimbursement. $3,718.75 Additional costs associated with processing 399 invoices for this project. Details provided in these invoices.
Project management of the transition $18,462.50 $18,462.50 Estimated project management costs for the planning and construction of the new displaced facility. $8,562.50 N/A
RF Exposure Measurements $12,100.00 $5,000.00 Post install RF engineering analysis. N/A N/A
Form 399 assistance or other Program Management costs $3,312.50 $3,312.50 Costs to assist in the preparation of the 399 eligibility and reimbursement documents for the displaced channel. $3,312.50 N/A
Perform engineering study for displacement application $1,800.00 $3,300.00 Engineering study to find displacement channel for the new facility. Additional costs due to MX situation causing additional engineering to find suitable displacement channel for the station. $3,300.00 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 5 Days Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Attorney Fees for STA Autho request.
Amount:
$650.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Prepare KVHF STA
Amount:
$2,000.00
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

Component Description:
Prepare Engineering section of CP Permit Application
Amount:
$1,875.00
Prepare/ Review 399 reimbursement form

Component Description:
Review, prepare and submit 399 invoices for the KVHF displacement project.
Amount:
$1,250.00

Component Description:
Prepare, revise, submit, resubmit, memo's for 399 invoices for the displacement project.
Amount:
$656.25

Component Description:
Prepare, Review and submit 399 invoices for the KVHF displacement project
Amount:
$625.00

Component Description:
Prepare, revise, submit 399 displacement invoices for KVHF-LD
Amount:
$500.00

Component Description:
Prepare, revise, submit 399 invoices for the KVHF displacement project.
Amount:
$687.50
Project management of the transition

Component Description:
Various project management tasks, questions for the displacement project.
Amount:
$281.25

Component Description:
various PM tasks and actions for the displacement project
Amount:
$1,656.25

Component Description:
Various project management tasks for the KVHF displacement project.
Amount:
$218.75

Component Description:
Various PM activities associated with the KVHF displacement project.
Amount:
$218.75

Component Description:
Various PM tasks for the displacement project.
Amount:
$93.75

Component Description:
Engineering project management support for the KVHF RF5 transition.
Amount:
$6,000.00

Component Description:
Project management support for KVHF RF5 transition.
Amount:
$93.75
RF Exposure Measurements Information not provided.
Form 399 assistance or other Program Management costs

Component Description:
Prepare 399 Eligibility and Broadcaster Relocation Forms for KVHF RF5 displacement and submit to FCC
Amount:
$2,718.75

Component Description:
Prepare 399 Eligibility and Broadcaster Relocation Form for KVHF RF5 displacement and submit to the FCC.
Amount:
$593.75
Perform engineering study for displacement application

Component Description:
Engineering study for displacement channel given MX situation with initial study.
Amount:
$1,500.00

Component Description:
Engineering study for displacement channel.
Amount:
$1,800.00

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 $6,600.00 $1,640.00 N/A $0.00 N/A
Total for all systems $290,601.08 $134,051.45 N/A $105,380.20 N/A
Other Expenses $6,600.00 $1,640.00 $0.00
Equipment Storage $0.00 $0.00 N/A N/A N/A
Equipment Delivery and Handling Charges $0.00 $0.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 Filing fee for the LTC application N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $0.00 FCC Filing fees for CP application N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 FCC filing fee for the granted STA N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,000.00 $1,000.00 Dispose of boxes, crates and packing material at the transmit site. N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $290,601.08 $134,051.45 $105,380.20

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.

Mark Shirin

President


07/11/2020

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.

Mark Shirin

President


07/11/2020

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