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:
26853
Service:
LPD
Call Sign:
WHLZ-LD
Channel:
21 (UHF)
File Number:
0000089510
FRN:
0029125721
Eligibility Status:
Eligible
Date Submitted:
08/26/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ZEBRA MEDIA, LLC

Doing Business As: ZEBRA MEDIA, LLC

813 N. FENWICK STREET

ALLENTOWN, PA 18109

United States

+1 (610) 351-8259 DAN@WBPH.ORG 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

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. No
Briefly describe transition plan Displaced Channel W16CO-D is being changed in channel and location to accommodate spectrum changes as it is a displaced station. Moving to different existing tower, need new transmitter, Transmission line and antenna.

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 ADC-ITS PA1000
Year 1998
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1000 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 TMU9evo-8
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3 kW
Justification for New Transmitter Old transmitter is not tuneable and no longer supported by manufacturer and need upgrade to new.

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 No
Other Electrical Service Yes
Description 100Amp single 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 Rental

Since the Rohde was very delayed, we needed a transmitter rental to meet the cut over date and rescan of consumer TV's.

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 Slotted Coaxial
ERP: 7.0 kW
Manufacturer
Model PSI16bay-CH16
Year 2007

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? No
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 PSILP8OI-21
Year 2019
Justification for New Antenna Old antenna can not be retuned.

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

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? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 0
Length 120 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 0
Length 320 feet per run
Justification for New Transmission Line Old line too expensive to move and reuse. Due to age it is not possible.
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

Name Description

Special Delivery

Delivery of Transmission line to remote location required a contractor suited for this.

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? No
Coordinates (NAD83) Latitude (NAD83) 40° 43' 21.2" N-
Longitude (NAD83) 077° 07' 20.9" W-
Overall Structure Height 124.00 feet
Support Structure Height 124.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 2080.00 feet
Structure Type UTOWER - Unguyed - Free Standing Tower
Tower Owner Kuhn Tower
Date Constructed 06/01/1988


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

Installation of Antenna and line on different tower

Due to displacement, W16CO-d had to change channels and move to a different tower. expenses are for removal of old antenna on old tower and install of new antenna on different tower.

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 110
Explanation Comprehensive Project management from study of available channels, tower searches, tower negotiation, oversee and recommend all purchases, and oversee, schedule and entire installations process.
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 No
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 No
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 Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 45
Justification Hire several transmitter and RF engineer installation individuals to prepare for installation, remove old equipment, site preparation, transmitter install and all related components including proof of performance.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Contract Installation Labor

Hiring of Transmitter installation Engineers to get all things ready and completely install transmitter, RF system, and all related components.

Legal

Legal preparation, Form 399 preparation, general counsel on all things regarding channel displacement

Professional Engineering

Professional Engineering, (PE) Consulting, FCC file preparation, Interference and feasibility studies

Project Management

Project management of all project phases from Channel displacement studies, working with PE professional engineer to find a suitable channel, locating a suitable tower location, negotiating tower rental and overseeing the purchase and install of Equipment

Transmitter Sweep and FCC proof of performance

Transmitter Sweep and FCC proof of performance

Site Survey

Site Survey

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 No
FCC Special Temporary Authority Application No
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? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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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 $129,554.00 $107,604.00 N/A $46,670.28 N/A
Total for all systems $335,489.75 $259,906.25 N/A $104,885.79 N/A
Primary Transmitter TMU9evo-8 $129,554.00 $107,604.00 $46,670.28
Transmitter Rental $13,000.00 $13,000.00 To meet phase deadline and overcome late shipping from Rohde, and to meet consumer rescan dates. we rented a transmitter. $0.00 Delivery costs
Transmitter Building Site Survey/Installation $10,000.00 $15,000.00 Project management of all project phases from Channel displacement studies, working with PE professional engineer to find a suitable channel, locating a suitable tower location, negotiating tower rental and overseeing the purchase and install of Equipment $0.00 Site Survey
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $106,300.00 $79,350.00 N/A $46,416.28 N/A
Other Electrical Service: 100Amp single phase $254.00 $254.00 100 Amp Circuit breaker and associated wiring for connection to Rohde Transmitter. $254.00 N/A

Components

Actual Information Description File Name
Transmitter Rental

Component Description:
Rented Transmitter to meet rescan deadline and phase deadline
Amount:
$13,000.00
Transmitter Building Site Survey/Installation

Component Description:
Site Survey
Amount:
$4,500.00
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Rohde & Schwarz Transmitter
Amount:
$46,416.28
Other Electrical Service: 100Amp single phase

Component Description:
100 Amp Circuit breaker and associated wiring for connection to Rohde Transmitter.
Amount:
$254.00

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 $14,778.25 $11,548.25 N/A $11,548.25 N/A
Total for all systems $335,489.75 $259,906.25 N/A $104,885.79 N/A
Primary Antenna PSILP8OI-21 $14,778.25 $11,548.25 $11,548.25
Sweep test of transmission line and antenna $5,730.00 $2,500.00 Full RF sweep of transmission line, RF mask filter and Antenna including proof of performance. $2,500.00 N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical $9,048.25 $9,048.25 8 bay uhf side mount antenna needed as old antenna is not tunable to new channel. $9,048.25 N/A

Components

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

Component Description:
Full RF sweep of transmission line, RF mask filter and Antenna including proof of performance.
Amount:
$2,500.00
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical

Component Description:
8 bay uhf side mount antenna needed as old antenna is not tunable to new channel.
Amount:
$9,048.25

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 $1,200.00 $10,700.00 N/A $10,700.00 N/A
Total for all systems $335,489.75 $259,906.25 N/A $104,885.79 N/A
Primary Transmission Line $1,200.00 $10,700.00 $10,700.00
Flexible Foam Transmission Line - dielectric, 1 5/8" $0.00 $9,500.00 320 ft of 1 5/8" transmission line, connectors and installation of line. $9,500.00 320 ft of 1 5/8" transmission line, connectors and installation of line.
Special Delivery $1,200.00 $1,200.00 Contractor to deliver transmission Line Antenna to remote tower area. $1,200.00 Contractor to deliver transmission Line Antenna to remote tower area.

Components

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

Component Description:
320 ft of 1 5/8" transmission line, connectors and installation of line.
Amount:
$9,500.00
Special Delivery

Component Description:
Contractor to deliver transmission Line Antenna to remote tower area.
Amount:
$1,200.00

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 $62,222.50 $6,032.50 N/A $6,032.50 N/A
Total for all systems $335,489.75 $259,906.25 N/A $104,885.79 N/A
Primary Tower UTOWER $62,222.50 $6,032.50 $6,032.50
Installation of Antenna and line on different tower $6,032.50 $6,032.50 Installation of new antenna on tower. $6,032.50 Removal of old antenna and transmission line from tower
Tower Rigging Short Tower (less than 500') $56,190.00 $0.00 Rigging included in overall install costs $0.00 Rigging included in overall install costs

Components

Actual Information Description File Name
Installation of Antenna and line on different tower

Component Description:
Installation of new antenna on tower.
Amount:
$3,182.50

Component Description:
Removal of old antenna and transmission line from tower
Amount:
$2,850.00
Tower Rigging Short Tower (less than 500') 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 $127,735.00 $124,021.50 N/A $29,934.76 N/A
Total for all systems $335,489.75 $259,906.25 N/A $104,885.79 N/A
Outside Professional Services $127,735.00 $124,021.50 $29,934.76
Site Survey $4,500.00 $4,500.00 N/A $4,500.00 N/A
Transmitter Sweep and FCC proof of performance $2,500.00 $2,500.00 N/A $0.00 N/A
Project Management $15,000.00 $15,000.00 Project management of all project phases from Channel displacement studies, working with PE professional engineer to find a suitable channel, locating a suitable tower location, negotiating tower rental and overseeing the purchase and install of Equipment $0.00 N/A
Professional Engineering $3,000.00 $3,000.00 N/A $1,757.50 N/A
Legal $5,000.00 $5,000.00 N/A $2,944.00 N/A
Contract Installation Labor $15,000.00 $15,000.00 N/A $10,233.26 N/A
Additional Field Engineering Service, 45 Days $3,500.00 $3,500.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $52,600.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $2,944.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $100.00 N/A N/A N/A
Form 399 assistance or other Program Management costs $500.00 $500.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $500.00 N/A N/A N/A
Project management of the transition $11,605.00 $15,000.00 Sonshine needed a comprehensive management team as Sonshine does not have needed expertise to deal with displacement related issues. $10,500.00 This is a comprehensive project management as Sonshine does not have staff to manage such a project.
Perform engineering study for displacement application $1,800.00 $100.00 Study costs included in Professional Engineering costs already submitted. N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $1,200.00 N/A N/A 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

Components

Actual Information Description File Name
Site Survey

Component Description:
Site Survey
Amount:
$4,500.00
Transmitter Sweep and FCC proof of performance

Component Description:
Engineering RF Sweep of transmitter and RF system including transmission line and antenna. Also proof or performance
Amount:
$2,500.00
Project Management

Component Description:
Project management of all project phases from Channel displacement studies, working with PE professional engineer to find a suitable channel, locating a suitable tower location, negotiating tower rental and overseeing the purchase and install of Equipment
Amount:
$15,000.00
Professional Engineering

Component Description:
Professional Engineering Services related to W16CO-D
Amount:
$1,110.00

Component Description:
Professional Engineering Services related to W16CO-D
Amount:
$185.00

Component Description:
Professional Engineering Services related to W16CO-D
Amount:
$462.50
Legal

Component Description:
Legal Expenses relating to displacement of W16CO-D including relocation and FCC Filings
Amount:
$672.00

Component Description:
Legal Expenses relating to displacement of W16CO-D including relocation and FCC Filings
Amount:
$84.00

Component Description:
Legal Services relating to Displacement of W16CO-d and relocation and licensing
Amount:
$448.00

Component Description:
Legal Expenses relating to displacement of W16CO-D including relocation and FCC Filings
Amount:
$168.00

Component Description:
Legal Expenses relating to displacement of W16CO-D including relocation and FCC Filings
Amount:
$448.00

Component Description:
Legal Expenses relating to displacement of W16CO-D including relocation and FCC Filings
Amount:
$1,124.00
Contract Installation Labor

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$1,906.64

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$3,115.91

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$1,986.25

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$170.32

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$1,879.14

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$1,075.00

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$100.00

Component Description:
Transmitter and RF installation engineering contract labor associated with W16CO-D
Amount:
$350.00
Additional Field Engineering Service, 45 Days Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
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 Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Form 399 assistance or other Program Management costs Information not provided.
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition

Component Description:
Project management of all project phases from Channel displacement studies, working with PE professional engineer to find a suitable channel, locating a suitable tower location, negotiating tower rental and overseeing the purchase and install of Equipment
Amount:
$10,500.00

Component Description:
Comprehensive project management
Amount:
$15,000.00
Perform engineering study for displacement application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application 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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $335,489.75 $259,906.25 N/A $104,885.79 N/A
Other Expenses $0.00 $0.00 $0.00

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $335,489.75 $259,906.25 $104,885.79

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.

Daniel P Huber , Huber .

Vice President


08/26/2020

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.

Daniel P Huber , Huber .

Vice President


08/26/2020

Attachments

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