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:
168497
Service:
LPD
Call Sign:
WCEA-LD
Channel:
36 (UHF)
File Number:
0000089202
FRN:
0020562674
Eligibility Status:
Eligible
Date Submitted:
09/02/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

C&M BROADCASTING CORPORATION

Doing Business As: C&M BROADCASTING CORPORATION

Peter Cuenca

903 ALBANY STREET

BOSTON, MA 02119

United States

+1 (617) 541-2222 wcea2000@aol.com Corporation

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

Clarence M Beverage

Broadcast Engineering Consultant

Communications Technologies, Inc.

Clarence M Beverage

PO Box 1130

Marlton, NJ 08053

United States

+1 (609) 451-5296 cbeverage@commtechrf.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 The station is implementing its displacement facilities at its licensed site on the roof of a building in downtown Boston. Transmission line is in place, The existing antenna will have to be removed and the displacement antenna mounted in its place.

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 AT72
Year 2012
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? No
Manufacturer
Model SLIM5_02_UHF_SD_PCM-LP
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.6 kW
Justification for New Transmitter THE CP ANTENNA PATTERN HAS LESS GAIN REQUIRING HIGHER TRANSMITTER POWER THAN THE LIC. TRANSMITTER IS CAN PRODUCE. SEE REVISED TRANSITION PLAN TPO CALCULATION. NOTE: INVOICE #52 SUBMITTED WHICH SUPERSEDES INVOICE XXX. PLEASE REFER TO INV 52

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 Yes
Description NEW MAIN DISCONNECT FOR HIGHER CURRENT 208 VAC 3 PHASE
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

TRANSMITTER ON SITE PROOF OF PERFORMANCE

TRANSMITTER PROOF

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 Circular
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 6
Design power capacity in use 90.0 %
Lower Limit 38.00 MHz
Upper Limit 45.00 MHz
ERP: 15.0 kW
Manufacturer
Model ATC-BPPCC13S
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? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ATC-BCE66H-VP1-36
Year 2019
Justification for New Antenna REQUIRED TO MEET FCC ANTENNA PATTERN. FURTHER, EXISTING ANTENNA RETURN LOSS BAD AT CH 36.

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? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Modification

Two Piece Requirement Flange Connection for modification of WCEA-LD antenna to fit building elevator

Transmission Line

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

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? Located on Building
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 1005833
Coordinates (NAD83) Latitude (NAD83) 42° 20' 57.0" N-
Longitude (NAD83) 071° 04' 29.0" W-
Overall Structure Height 852.02 feet
Support Structure Height 787.06 feet
Ground Elevation Above Mean Sea Level (AMSL) 18.04 feet
Structure Type BPOLE - Building with Pole
Tower Owner JOHN HANCOCK MUTUAL LIFE INSURANCE COMPANY
Date Constructed 01/01/1975


Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Located on Building
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? Yes
Number of Hours 80
Explanation TO MINIMIZE DOWN TIME THE ANTENNA REMOVAL AND INSTALL REQUIRE A RIGGING PLAN AS WELL AS TRANSMITTER REMOVAL AND INSTALL COORDINATION. RF SAFETY COORDINATION ON MULTI USE SITE. SUBSTANTIAL EFFORT BY LAW FIRM AND ENGINEER REQUIRED FOR REIMBURSEMENT 399
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 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 1
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 Yes
Additional Field Engineering Service Yes
Number of Days 4
Justification RF EXPOSURE MEASUREMENTS ON BUSY, MULTI-USER ROOF BY HAMPDEN. LOCAL CONTRACT ENGINEER SANDY SHORE INSTALLATION TIME.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Tower Structural Analysis

Tower Structural Analysis

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? 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

Additional Legal Fees

Additional legal fees in connection with advising station regarding displacement and transition to new channel

Additional Engineering Fees

Additional engineering fees in connection with Transition project management time in 2019 and 2020

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 $113,700.00 $55,390.00 N/A $55,390.00 N/A
Total for all systems $356,877.50 $134,912.50 N/A $109,271.25 N/A
Primary Transmitter SLIM5_02_UHF_SD_PCM-LP $113,700.00 $55,390.00 $55,390.00
TRANSMITTER ON SITE PROOF OF PERFORMANCE $5,100.00 $5,100.00 PRICE INCLUDES $5,100 FOR TRAVEL TO AND FROM SITE. INSTALLATION INSPECTION, TURN ON AND COMMISSIONING. THIS COST IS PART OF THE SYES PROPOSAL AND INVOICE TOTALING $53,090.00. SEE UPDATED INVOICE 52. $5,100.00 THE PRE-DETERMINED COST AND THE ACTUAL COST ARE THE SAME. SEE SYES INVOICE 52 AND PROPOSAL
Other Electrical Service: NEW MAIN DISCONNECT FOR HIGHER CURRENT 208 VAC 3 PHASE $2,300.00 $2,300.00 208 VAC 3 PHASE SERVICE INSTALLATION. INVESTIGATION OF THE COST IS ONGOING BUT THIS IS BELIEVED TO BE A REASONABLE TOTAL COST $2,300.00 THE PREDETERMINED COST IS $5,000 AND THE COST SUBMITTED CURRENTLY TOTALS $1,200
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $106,300.00 $47,990.00 N/A $47,990.00 PRE DETERMINED COST IS $106,300.00 WHILE THE ACTUAL COST IS $47,990.00

Components

Actual Information Description File Name
TRANSMITTER ON SITE PROOF OF PERFORMANCE

Component Description:
INSTALLATION CHECKOUT, INSPECTION OF FACILITIES, TURN ON AND COMMISSIONING.
Amount:
$5,100.00
Other Electrical Service: NEW MAIN DISCONNECT FOR HIGHER CURRENT 208 VAC 3 PHASE

Component Description:
Invoice cost identical to quote cost
Amount:
$2,300.00
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
TRANSMITTER REQUIRED FOR DISPLACEMENT
Amount:
$47,990.00

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 $19,105.00 $12,250.00 N/A $10,250.00 N/A
Total for all systems $356,877.50 $134,912.50 N/A $109,271.25 N/A
Primary Antenna ATC-BCE66H-VP1-36 $19,105.00 $12,250.00 $10,250.00
Sweep test of transmission line and antenna $5,730.00 $1,500.00 N/A $1,500.00 The $1,500.00 sub-total is 50% of the $3,000.00 estimated cost
Antenna Modification $650.00 $650.00 N/A $650.00 N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical $8,100.00 $8,100.00 THE ANTENNA COST ITSELF IS WITHIN THE PREDETERMINED COST EVEN WITH MODIFICATION TO FIT INSIDE THE BUILDING. THE OVERAGE IS CAUSED BY THE INCLUSION OF THE $1,690.00 SHIPPING CHARGE. $8,100.00 THIS IS THE TOTAL OF THE ANTENNA COST. THE ANTENNA HAS BEEN MANUFACTURED. THE ESTIMATED COST MUST BE UPDATED TO REFLECT THE ACTUAL COST. SEE NARRATIVE FILED WITH 399.
Side Mount antenna brackets $4,625.00 $2,000.00 N/A N/A N/A

Components

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

Component Description:
Sweep line and then complete antenna system
Amount:
$1,500.00
Antenna Modification

Component Description:
Modification of WCEA-LD to fit building elevator with two piece requirement flange connection
Amount:
$650.00
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical

Component Description:
CHARGE TO DIVIDE ANTENNA INTO TWO HALVES PER PROPOSAL DATED 05082020 AS THE ONLY WAY TO GET THE ANTENNA TO THE ROOF ECONOMICALLY.
Amount:
N/A

Component Description:
ATC-BCE66H-VP1-36 ANTENNA PER PROPOSAL DATED 03052020
Amount:
$8,100.00
Side Mount antenna brackets Information not provided.

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $157,750.00 $12,750.00 N/A $12,750.00 N/A
Total for all systems $356,877.50 $134,912.50 N/A $109,271.25 N/A
Primary Tower BPOLE $157,750.00 $12,750.00 $12,750.00
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $0.00 $0.00 NO COSTS IN THIS CATEGORY N/A N/A
Tower Rigging Tall Tower (greater than 500') $157,750.00 $12,750.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $12,750.00 THE ESTIMATED COST IS $12,750.00. THE ACTUAL COST IS $12,750.00. SEE INVOICE AND QUOTE DATED APRIL 25, 2020.

Components

Actual Information Description File Name
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) Information not provided.
Tower Rigging Tall Tower (greater than 500')

Component Description:
Tower rigging - Identical cost to Quote
Amount:
$12,750.00

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 $50,072.50 $38,272.50 N/A $21,212.50 N/A
Total for all systems $356,877.50 $134,912.50 N/A $109,271.25 N/A
Outside Professional Services $50,072.50 $38,272.50 $21,212.50
Tower Structural Analysis $4,750.00 $4,750.00 N/A $4,750.00 THE TOWER ANALYSIS (STRUCTURAL ANALYSIS) IS EQUAL TO THE PREDETERMINED COST. SEE QUOTE DATED 04252020.
Form 399 assistance or other Program Management costs $4,000.00 $4,000.00 N/A $950.00 N/A
Project management of the transition $8,440.00 $6,000.00 Transition more complex than initially expected $4,727.50 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $3,000.00 Form more complex and time-consuming than initially expected $1,275.00 N/A
Perform engineering study for displacement application $1,800.00 $1,750.00 N/A $1,500.00 N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 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 $750.00 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), Construction Permit Application $3,025.00 $3,025.00 N/A $1,375.00 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
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Additional Field Engineering Service, 4 Days $6,000.00 $6,000.00 THIS IS A BEST CASE ESTIMATE BASED ON KNOWLEDGE OF THE PROJECT AT THIS TIME. $4,385.00 THE BUDGET COST IS $6,000.00 AND THE ACTUAL COST IS $4,385.00. PLEASE SEE PROPOSAL AND INVOICE ATTACHED.
RF Exposure Measurements $12,100.00 $1,500.00 N/A $1,500.00 THE PRE-DETERMINED COST IS $12,100.00 WHILE THE QUOTE AND INVOICE COST IS $1,500.00. SEE PROPOSAL DATED 04252020

Components

Actual Information Description File Name
Tower Structural Analysis

Component Description:
Tower Structural Analysis - Identical to Quote Cost
Amount:
$4,750.00
Form 399 assistance or other Program Management costs

Component Description:
Legal services for WCEA-LD Form 399 assistance or other Program Management costs
Amount:
$950.00
Project management of the transition

Component Description:
Engineering services for project management of the transition
Amount:
$2,173.75

Component Description:
Legal services associated with the project management of WCEA-LD's transition.
Amount:
$750.00

Component Description:
Engineering services for project management of the transition
Amount:
$1,803.75
Prepare/ Review 399 reimbursement form

Component Description:
Legal services for preparation, review, and filing of WCEA-LD Form 399.
Amount:
$1,275.00
Perform engineering study for displacement application

Component Description:
Performance of engineering study for displacement application
Amount:
$1,500.00
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering services performed for Displacement Application
Amount:
$750.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal services for preparation, filing, and prosecution of WCEA-LD displacement application.
Amount:
$1,375.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Additional Field Engineering Service, 4 Days

Component Description:
CONTRACTOR'S INVOICE AS STATED ON PROPOSAL. QUALIFICATIONS SHOULD NOT EXCEED BUDGET TOTAL
Amount:
$4,000.00

Component Description:
TAX
Amount:
$385.00
RF Exposure Measurements

Component Description:
RF Exposure Analysis - Cost identical to Quote
Amount:
$1,500.00

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 $16,250.00 $16,250.00 N/A $9,668.75 N/A
Total for all systems $356,877.50 $134,912.50 N/A $109,271.25 N/A
Other Expenses $16,250.00 $16,250.00 $9,668.75
Additional Engineering Fees $8,000.00 $8,000.00 BASED ON THE ROOFTOP COMPLEXITY AND LEVEL OF REQUIRED COORDINATION WITH STATION CONTRACTORS AND ATC THIS IS BELIEVED TO BE A REASONABLE BUDGET $6,428.75 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A 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
Additional Legal Fees $1,000.00 $1,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $3,500.00 $3,500.00 N/A $3,240.00 N/A

Components

Actual Information Description File Name
Additional Engineering Fees

Component Description:
REPACK ENGINEERING SERVICES - PROJECT MANAGEMENT AS DESCRIBED IN INVOICE.
Amount:
$6,428.75
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Additional Legal Fees Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Transmitter shipping charges
Amount:
$1,550.00

Component Description:
Antenna shipping charges
Amount:
$1,690.00

Component Description:
Transmitter Shipping Charges (See new invoice)
Amount:
N/A

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $356,877.50 $134,912.50 $109,271.25

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.

Peter Cuenca

President


09/02/2020

Attachments

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