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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:
73345
Service:
FM
Call Sign:
WWWQ
File Number:
0000086388
FRN:
0023756331
Eligibility Status:
Eligible
Date Submitted:
01/23/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

RADIO LICENSE HOLDING SRC LLC

Doing Business As: RADIO LICENSE HOLDING SRC LLC

3280 Peachtree Road, NW

Suite 2200

Atlanta, GA 30305

United States

 +1 (404) 949-0700 FCCLicenseManagement@cumulus.com Limited Liability Company

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

Cynthia M. Jacobson , P.E. .

Consulting Engineer

Carl T. Jones Corp.

7901 Yarnwood Court

Springfield, VA 22153

United States

 +1 (703) 569-7704 cjacob@ctjc.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. Yes
Briefly describe transition plan FM AUXILIARY FACILITY for WWWQ-FM (FM Impacted by TV Repack). This is to use an existing community antenna with a new transmitter to maintain analog and HD signals during TV Repack work at MAIN site.

Transmitters

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Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? No
Existing Transmitter Manufacturer and Type Manufacturer
Model No model
Year 2017
Type Solid State
Solid State Cooling Air Cooled
Model Type Hybrid
Solid State Power Capacity 40 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 FAX20KFAX50HD
Transmitter Type Solid State
Solid State Cooling Air Cooled
Model Type Hybrid
Solid State Power capacity 20 kW
Justification for New Transmitter Needed for New Auxiliary FM site to keep WWWQ-FM on the air during the TV Repack with its analog and digital signals.
Does the transmitter require the purchase of a new HD Importer? Yes
Does the transmitter require the purchase of a new HD Exporter? Yes

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs Does the transmitter installation require an Additional Exciter? No
Does the transmitter installation require any additional transmitter installation costs? Yes
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring Yes
Size 2.50 inches
Length 75.0 feet
Other Electrical Service Yes
Description Electrical Entrance Panel and wiring to the transmitter.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Other Transmitter-Related Expenses Does the replacement transmitter require a Remote Control? Yes
Does the replacement transmitter require an RDS Encoder? Yes
Does the replacement transmitter require Audio Processing? Yes
Audio Processing Analog/HD Basic

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Filter

FM Bandpass Filter

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? No

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? No
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1/2 inches
Number of parallel runs 1
Length 10 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 3 inches
Number of parallel runs 1
Length 150 feet per run
Justification for New Transmission Line New line from New transmitter to existing combiner (using existing transmission line to community FM 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? Yes
Does the Installation of the Transmission Line require additional or replacement Inside RF system elbows, fitting, hangers, etc.? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Inside Lline Installation

Inside Line Installation Costs Xmtr to Combiner

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? No

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 250
Explanation Project Management of the transition
Outside RF consulting Engineering Services Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility 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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application No
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 No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Internal Employee Time Costs

Internal Employee Time Costs

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 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
1 pair IP-only Codecs for fiber, internet or IP microwave systems Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Antenna Tune and IM check

ERI Factory 73.317 tests and report, tune and IM report

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 $367,727.83 $353,124.02 N/A $290,924.02 N/A
Total for all systems $452,570.99 $433,403.68 N/A $348,130.19 N/A
Primary Transmitter FAX20KFAX50HD $367,727.83 $353,124.02 $290,924.02
10 Ton system $38,900.00 $38,900.00 N/A $0.00 N/A
Filter $80,163.83 $80,163.83 Total of net package price $73,127.40, sales tax and freight cost. See attached quote from ERI for net package price. $80,163.83 N/A
Audio Processing - Analog/HD basic $4,750.00 $4,750.00 N/A $0.00 N/A
Other Transmitter-Related Expenses RDS Encoder $1,750.00 $1,750.00 N/A $0.00 N/A
Other Transmitter-Related Expenses Remote Control $2,400.00 $2,400.00 N/A $0.00 N/A
Transmitter Installation $70,500.00 $59,057.10 N/A $59,057.10 N/A
HD Exporter $2,550.00 $7,619.18 Please see attached invoice and quote from GatesAir. $7,619.18 N/A
HD Importer $2,550.00 $6,856.88 Please see attached invoice and quote from GatesAir. $6,856.88 N/A
Air Cooled Solid State FM Transmitter 15 - 20 kW Hybrid $104,200.00 $91,663.03 See Gates Air quote. $91,663.03 N/A
Other Electrical Service: Electrical Entrance Panel and wiring to the transmitter. $43,905.00 $43,905.00 Total of the attached JR Electrical invoices #2017-997, #2018-1193 and #2019-1368 $43,905.00 N/A
2.50" Rigid Conduit and Wiring $1,659.00 $1,659.00 See attached invoice from Maclean-Riggins $1,659.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $14,400.00 N/A N/A N/A

Components

Actual Information Description File Name
10 Ton system Information not provided.
Filter

Component Description:
Filter cost, 50% balance. #35360
Amount:
$43,042.15

Component Description:
Filter cost, 50% down. #52217
Amount:
$36,563.70

Component Description:
Sales tax difference due. #35360-1
Amount:
$557.98
Audio Processing - Analog/HD basic Information not provided.
Other Transmitter-Related Expenses RDS Encoder Information not provided.
Other Transmitter-Related Expenses Remote Control Information not provided.
Transmitter Installation

Component Description:
Facility construction, 60% balance. #200239
Amount:
$34,552.20

Component Description:
Facility construction, 40% down. #200166
Amount:
$23,034.80

Component Description:
Items/parts needed for the installation. #237433
Amount:
$219.11

Component Description:
Scissor lift rental. #01072019-JT
Amount:
$950.91

Component Description:
Supplies. #01072019-JT
Amount:
$950.91

Component Description:
Tx install parts. #07312017-MA
Amount:
$300.08
HD Exporter

Component Description:
HD Exporter. #US0319549
Amount:
$7,619.18
HD Importer

Component Description:
HD Importer. #US0319549
Amount:
$6,856.88
Air Cooled Solid State FM Transmitter 15 - 20 kW Hybrid

Component Description:
Transmitter cost. #US0319549
Amount:
$91,663.03
Other Electrical Service: Electrical Entrance Panel and wiring to the transmitter.

Component Description:
Other electrical services. #2018-1193
Amount:
$9,800.00

Component Description:
Other electrical services. #2017-997
Amount:
$30,205.00

Component Description:
Other electrical services. #2019-1368
Amount:
$3,900.00
2.50" Rigid Conduit and Wiring

Component Description:
Install conduit and wire. #34116
Amount:
$1,659.00
Service entrance 3 phase/800 amp/208 volt Information not provided.

Cost Information

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Antennas

Information not provided.

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 $30,681.59 $30,681.59 N/A $17,831.59 N/A
Total for all systems $452,570.99 $433,403.68 N/A $348,130.19 N/A
Primary Transmission Line $30,681.59 $30,681.59 $17,831.59
Flexible Air Transmission Line - dielectric, 3" $8,850.00 $8,850.00 N/A $0.00 N/A
Inside Lline Installation $17,500.00 $17,500.00 Install 150 feet 3 1/8 inch line from 3rd floor combiner room to 1st floor transmitter room. See attached invoice from American Antennas. $17,500.00 N/A
Interior RF Systems: Elbows, fitting, hangers, etc. $331.59 $331.59 N/A $331.59 N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $4,000.00 $4,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 3" Information not provided.
Inside Lline Installation

Component Description:
Installation. #12172018
Amount:
$17,500.00
Interior RF Systems: Elbows, fitting, hangers, etc.

Component Description:
Entry port for RF. #10012018-JT
Amount:
$331.59
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

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 $35,002.50 $30,439.00 N/A $26,600.51 N/A
Total for all systems $452,570.99 $433,403.68 N/A $348,130.19 N/A
Outside Professional Services $35,002.50 $30,439.00 $26,600.51
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $480.00 N/A $480.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $84.00 N/A $84.00 N/A
Internal Employee Time Costs $3,500.00 $3,500.00 N/A N/A N/A
Project management of the transition $26,375.00 $26,375.00 N/A $26,036.51 N/A

Components

Actual Information Description File Name
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Consulting engineering cost. #0001-015-0001
Amount:
$480.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Review grant of aux permit. #214268
Amount:
$84.00
Internal Employee Time Costs Information not provided.
Project management of the transition

Component Description:
Project management cost. #LMG20-306
Amount:
$231.00

Component Description:
Project management. #LMG20-506
Amount:
$514.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #214288
Amount:
$723.63

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-279
Amount:
$47.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-1103
Amount:
$9.62

Component Description:
Project management cost. #LBM19-240
Amount:
$1,368.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0006
Amount:
$3,051.81

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-303
Amount:
$82.57

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-703
Amount:
$41.56

Component Description:
Project management. #LMG20-606
Amount:
$231.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0023
Amount:
$203.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-214
Amount:
$36.31

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0008
Amount:
$336.87

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-803
Amount:
$21.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0010
Amount:
$464.81

Component Description:
Project management. #LMG20-1006
Amount:
$19.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0019
Amount:
$156.43

Component Description:
Consulting engineering cost. #0001-015-0003
Amount:
$5,400.00

Component Description:
Project management. #LBM19-222
Amount:
$1,457.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-903
Amount:
$13.23

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0017
Amount:
$404.12

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0015
Amount:
$395.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG215
Amount:
$27.34

Component Description:
Project management cost. #LBM19-273
Amount:
$133.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #215662
Amount:
$49.68

Component Description:
Project management. #LMG20-906
Amount:
$115.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-403
Amount:
$344.20

Component Description:
Project management. #LMG20-806
Amount:
$19.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-1003
Amount:
$25.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0021
Amount:
$91.43

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-1203
Amount:
$25.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-503
Amount:
$126.76

Component Description:
Project management. #LMG20-706
Amount:
$682.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-603
Amount:
$46.92

Component Description:
Project management. #LMG20-1222
Amount:
$194.25

Component Description:
Project management. #LMG20-1106
Amount:
$19.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0020
Amount:
$33.68

Component Description:
Project management. #LMG20-408
Amount:
$57.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0016
Amount:
$1,172.68

Component Description:
Consulting engineering costs. #0001-015-0005
Amount:
$5,445.00

Component Description:
Project management cost. #LBM19-222
Amount:
$1,457.75

Component Description:
Project management cost. #214268
Amount:
$420.00

Component Description:
Project management cost. #LBM20-218
Amount:
$173.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0013
Amount:
$1,069.59

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #217781
Amount:
$16.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0009
Amount:
$359.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #LMG20-115
Amount:
$79.51

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 16 stations. #0001-00-0014
Amount:
$97.75

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 $19,159.07 $19,159.07 N/A $12,774.07 N/A
Total for all systems $452,570.99 $433,403.68 N/A $348,130.19 N/A
Other Expenses $19,159.07 $19,159.07 $12,774.07
FCC Filing Fees - Form 2100 minor change CP application $200.00 $200.00 N/A N/A N/A
Antenna Tune and IM check $6,600.00 $6,600.00 See attached invoice from ERI. $6,600.00 N/A
Point to Point Microwave (STL/ICR): 1 pair IP-only Codecs for fiber, internet or IP microwave systems $5,850.00 $5,850.00 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
Equipment Delivery and Handling Charges $6,174.07 $6,174.07 N/A $6,174.07 N/A

Components

Actual Information Description File Name
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Antenna Tune and IM check

Component Description:
FM system Tune/IM report. #53327
Amount:
$6,600.00
Point to Point Microwave (STL/ICR): 1 pair IP-only Codecs for fiber, internet or IP microwave systems Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Transmitter freight cost. #US0320649
Amount:
$3,920.40

Component Description:
Shipping FM navigator. #01072019-JT
Amount:
$85.34

Component Description:
FM navigator shipping. #01072019-JT
Amount:
$85.34

Component Description:
Move transmitter. #79649
Amount:
$672.00

Component Description:
Move transmitters. #79339
Amount:
$1,496.33

Cost Information

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Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $452,570.99 $433,403.68 $348,130.19

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.

Richard S. Denning

Executive Vice President and General Counsel


01/23/2021

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.

Richard S. Denning

Executive Vice President and General Counsel


01/23/2021

Attachments

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