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:
60822
Service:
LPD
Call Sign:
WQMK-LD
Channel:
29 (UHF)
File Number:
0000081276
FRN:
0016992521
Eligibility Status:
Not Determined
Date Submitted:
09/06/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

BEN JORDAN COMMUNICATIONS CORPORATION

Doing Business As: BEN JORDAN COMMUNICATIONS CORPORATION

BEN JORDAN

828 20th St. Sw.

Lanett, AL 36863

United States

+1 (706) 518-3911 BENRAYJORDAN@YAHOO.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

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 WQMK Plans to install a New Antenna and Transmitter to site, after building a new transmitter building.

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 EC710MP
Year 2015
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 HITACHI
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.1 kW
Justification for New Transmitter OUR PRESENT TRANSMITTER IS LONGER PRODUCED BY COMARK, NOR WILL IT MAKE ENOUGH POWER TO COVER OUR ERP 15 KW PATTER WITH THE GAIN OUR NEW ANTENNA WILL HAVE.

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 OUR BUILDING DOSEN'T HAVE ENOUGH POWER TO COOL AND AND SUPPLY THE TRANSMITTER REQUIRMENTS.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 144.0 square feet

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

INSTALLATION

THE TRANSMITTER BE INSTALLED AND OLD TRANSMITTER REMOVED.

INSTALLATION FILED STUDY

DUE TO OUR BROADCAST REQUIREMENT WITH THE LOCAL CABLE SYSTEM,,, THIS WOULD REQUIRE A STUDY TO DETERMINE HOW WE COULD INSTALL THE NEW EQUIPMENT WITH INTERRUPTIONS.

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? 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 Top
Polarization Circular
Type Other
Other Antenna Type POLAR
ERP: 2.0 kW
Manufacturer
Model AL 8
Year 2011

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 Bottom
Polarization Elliptical
Type Yagi
ERP: 2.0 kW
Manufacturer
Model PSIUHY-6PN
Year 2020
Justification for New Antenna OUR ANTENNA IS 4 SECTIONS OF AL 8 TUNED TO CH 18 AN IS A NON-DIRECTIONAL PATTERN AND THE NEW ANTENNA IS DIRECTIONAL TUNED TO CH 29 NOTE; THERE WOULD 6 OF ANTENNAS ON EACH SIDE THE ANTENNA, TO MAKE UP OUR 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? Yes
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

RF CABLE

THE RF LINE WILL BE TO SHORT FOR THE ANTENNA INSTALLATION THEREFORE NEW LONGER LINE NEEDED

TAKE DOWN REMOVAL

OLD ANTENNA MUST BE REMOVER TO INSTALL NEW ANTENNA

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 Rigid
Diameter 1 5/8 inches
Segment Length Other
Other Segment Length 3 feet
Number of parallel runs 1
Length 220 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 Rigid
Diameter 1 5/8 inches
Segment Length Other
Other Segment Length 3 feet
Number of parallel runs 1
Length 240 feet per run
Justification for New Transmission Line THE OLD RF LINES IS TOO SHORT TO REACH THE NEW ANTENNA ARRAY, THEREFORE REQUIRING REPLACING. THE OLD LINES WILL BE ABOUT 20 FT SHORT OF THE ANTENNA INSTALLATION.
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 Owned
Is this tower consider Complex?
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) 33° 44' 40.0" N-
Longitude (NAD83) 085° 17' 32.0" W-
Overall Structure Height 182.00 feet
Support Structure Height 178.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 814.00 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner 2007
Date Constructed 07/29/2007


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study need for guyed or free-standing tower
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 Other
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

GUYED WIRE MOVED

This is a Roghn 25 tower. the guyed wire supporting the tower is located on both side of the tower to where the directional antennas must be attached

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 16
Explanation with a virtual a total change out of equipment, we need some to over see the project with the understanding of not damaging the equipment injuring any personnel, and more importantly continuing to broadcast to the cable system and local communities
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application No
Prepare engineering section of Form FCC License to Cover Application No
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 No
Prepare or Review FCC Form 399 for Reimbursement No
Form 399 assistance or other program management costs No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 2
Justification there is several complex procedures must be done,for example moving guyed wires while broadcasting.... developing a plan for removal of old antennas and installing the transmitter and lines without cutting service to the local cable systems.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
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? 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

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 $163,050.00 $129,100.00 N/A $111,506.10 N/A
Total for all systems $238,875.50 $206,950.00 N/A $160,793.91 N/A
Primary Transmitter HITACHI $163,050.00 $129,100.00 $111,506.10
5 Ton system $20,250.00 $15,500.00 N/A $8,906.00 N/A
Other -- Building Addition Size: 144.0 $28,800.00 $28,800.00 N/A $27,682.75 N/A
Other Electrical Service: OUR BUILDING DOSEN'T HAVE ENOUGH POWER TO COOL AND AND SUPPLY THE TRANSMITTER REQUIRMENTS. $2,500.00 $2,500.00 N/A $2,255.00 N/A
INSTALLATION $15,000.00 $15,000.00 Installing and testing new transmitter. Technalogix 1.2 KW Digital Air Cool Transmitter $11,400.00 N/A
INSTALLATION FILED STUDY $2,500.00 $2,500.00 N/A $1,000.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $8,800.00 Broadcast Site, is located in Cusseta AL. Industrial park, all construction must meet codes and building requirements for any building or structure to be constructed in the industrial site. All plans and license must be approved by industrial Board, $7,750.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $56,000.00 N/A $52,512.35 N/A

Components

Actual Information Description File Name
5 Ton system

Component Description:
installing new AC unit to accommodate the excessive heat from the 1.2 KW Transmitter
Amount:
$8,906.00
Other -- Building Addition Size: 144.0

Component Description:
12 x 12 building for transmitter
Amount:
$27,682.75
Other Electrical Service: OUR BUILDING DOSEN'T HAVE ENOUGH POWER TO COOL AND AND SUPPLY THE TRANSMITTER REQUIRMENTS.

Component Description:
electrical service for newly constructed transmitter building
Amount:
$2,255.00
INSTALLATION

Component Description:
Installing 1.2 KW Air Cool Technalogix Digital tv transmitter
Amount:
$11,400.00
INSTALLATION FILED STUDY

Component Description:
Field Report to determine equipment and installation requirements for new broadcast equipment consisting of RF Lines, Antennas and Transmitter.
Amount:
$1,000.00
Transmitter Building Site Survey/Installation

Component Description:
Site Survey for recording building on deeds, and getting all permits, licenses, and prep for construction
Amount:
$7,750.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
new transmitter replacement due to repack
Amount:
$52,512.35

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 $26,880.00 $38,000.00 N/A $31,625.56 N/A
Total for all systems $238,875.50 $206,950.00 N/A $160,793.91 N/A
Primary Antenna PSIUHY-6PN $26,880.00 $38,000.00 $31,625.56
TAKE DOWN REMOVAL $8,500.00 $8,500.00 N/A $8,400.00 N/A
RF CABLE $5,700.00 $5,700.00 N/A $6,002.25 when providing the estimate the vendor failed to provide price for the 2 flang connector on each end of the cable and shipping shipping was not included, thus this is the justification for the cost overrun
Pattern scatter analysis for side mount (if not included in antenna base cost) $1,200.00 $1,200.00 N/A N/A N/A
Side Mount antenna brackets $4,625.00 $4,000.00 N/A $3,485.50 N/A
Sweep test of transmission line and antenna $5,730.00 $3,600.00 N/A $3,200.00 N/A
UHF-Lower Power, Yagi/Cross-Dipole/Log Periodic Transmit antenna $1,125.00 $15,000.00 This directional antenna requires 6 antennas on each side of the tower to create the directional patter. This require a total of 12 antennas not 1 antenna $10,537.81 we are having to change channel from Ch 18 to Channel 29, the distance between channels is great therefore,,also we could not re tune our AL 8 ..Antennas therefore we would have to replace them with UHF Broadband Panels to be able to broadcast.

Components

Actual Information Description File Name
TAKE DOWN REMOVAL

Component Description:
Replacing Rf line and Installing new antenna on tower
Amount:
$8,400.00
RF CABLE

Component Description:
250 ft of RF cable for transmitter and antenna connection
Amount:
$6,002.25
Pattern scatter analysis for side mount (if not included in antenna base cost) Information not provided.
Side Mount antenna brackets

Component Description:
bracket for the panel antenna to be mounted on the roghn 23 tower.
Amount:
$3,485.50
Sweep test of transmission line and antenna

Component Description:
RF. Line Sweep before transmitter installation
Amount:
$3,200.00
UHF-Lower Power, Yagi/Cross-Dipole/Log Periodic Transmit antenna

Component Description:
we could not use our Ch 18 antenna to broadcast on Ch 29, the distance between the channels was to great .. nor could the antenna be returned in accordance to the manufacture, therefor that is way we are replacing the our AL8 antennas
Amount:
$10,537.81

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 $12,720.00 $9,500.00 N/A $6,002.25 N/A
Total for all systems $238,875.50 $206,950.00 N/A $160,793.91 N/A
Primary Transmission Line $12,720.00 $9,500.00 $6,002.25
Rigid Transmission Line - copper, 1 5/8” $12,720.00 $9,500.00 N/A $6,002.25 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 1 5/8”

Component Description:
250 ft of required Rf. Cable
Amount:
$6,002.25

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 $24,800.00 $21,400.00 N/A $10,550.00 N/A
Total for all systems $238,875.50 $206,950.00 N/A $160,793.91 N/A
Primary Tower GTOWER $24,800.00 $21,400.00 $10,550.00
Minor tower reinforcement/modifications $6,000.00 $6,000.00 N/A $5,600.00 N/A
Study needed for guyed or free-standing tower $8,700.00 $5,300.00 N/A $4,950.00 N/A
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $5,800.00 $5,800.00 N/A N/A N/A
GUYED WIRE MOVED $4,300.00 $4,300.00 N/A N/A N/A

Components

Actual Information Description File Name
Minor tower reinforcement/modifications

Component Description:
modification to tower to accommodate UHF Panels
Amount:
$5,600.00
Study needed for guyed or free-standing tower

Component Description:
Study for antenna installation and tower capacity and load availability
Amount:
$4,950.00
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) Information not provided.
GUYED WIRE MOVED 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 $9,290.50 $6,850.00 N/A $1,110.00 N/A
Total for all systems $238,875.50 $206,950.00 N/A $160,793.91 N/A
Outside Professional Services $9,290.50 $6,850.00 $1,110.00
Additional Field Engineering Service, 2 Days $1,200.00 $1,200.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $2,400.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $1,100.00 N/A $1,110.00 Additional Cost: There were interference with our Application to another CP therefore we had to add a amendment of acceptance agreement to our application
Project management of the transition $1,688.00 $1,150.00 N/A N/A N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 2 Days 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.
Perform engineering study for displacement application

Component Description:
Engineering Study for new channel. due to displacement
Amount:
$910.00

Component Description:
A amendment has to be added to the application due to interference. This amendment was a acceptance agreement of interference
Amount:
$200.00
Project management of the transition 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 $2,135.00 $2,100.00 N/A $0.00 N/A
Total for all systems $238,875.50 $206,950.00 N/A $160,793.91 N/A
Other Expenses $2,135.00 $2,100.00 $0.00
Equipment Delivery and Handling Charges $1,800.00 $1,800.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $300.00 N/A 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 $238,875.50 $206,950.00 $160,793.91

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.

Ben Ray Jordan , mr. .

Owner


09/06/2020

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.

Ben Ray Jordan , mr. .

owner


09/06/2020

Attachments

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