Applicant | Address | Phone | Applicant Type | |
---|---|---|---|---|
WORD OF GOD FELLOWSHIP, INC. Doing Business As: WORD OF GOD FELLOWSHIP, INC. |
Arnold Torres 3901 HIGHWAY 121 SOUTH BEDFORD, TX 76021 United States |
+1 (817) 571-1229 | arnold.torres@daystar.com | Not-for-Profit |
Applicant | Address | Phone | |
---|---|---|---|
[Confidential] |
|
|
|
Applicant | Address | Phone | |
---|---|---|---|
Samuel Hariton Engineer Widelity, Inc. |
Samuel Hariton 4031 University Drive Ste 100 Fairfax, VA 22030 United States |
+1 (339) 222-8107 | sam.hariton@widelity.com |
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 | Coordinate with tower owner and other Broadcasters; transition during assigned phase. WDMA-CD will transition by changing antenna and transmitter and not changing tower sites. |
Section | Question | Response |
---|---|---|
Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Transmitter Description | Type of change | Purchase New |
Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
Is this transmitter currently shared with another station? | No | |
Is this transmitter currently in operating condition? | Yes | |
Existing Transmitter Manufacturer and Type | Manufacturer | |
Model | AT73-1K5 | |
Year | 2012 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power Capacity | 1.5 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Manufacturer | ||
Model | EKA TXUD2700AC-D | |
Transmitter Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power capacity | 2.7 kW | |
Justification for New Transmitter | Current transmitter cannot be retuned to new antenna at allotted power level. |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | No |
Switchgear (industrial 800 amp) | No | |
Transformer (480V) | No | |
Power | N/A | |
Rigid Conduit and Wiring | No | |
Size | N/A | |
Length | N/A | |
Other Electrical Service | Yes | |
Description | Minimal electric services will be needed to implement new facility. | |
HVAC Service | Does the replacement transmitter require HVAC Service? | Yes |
Type | Cooling Only | |
Size | 10 tons | |
Other Size | N/A | |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | No |
Size | N/A | |
Channel 14 Costs | Is an RF Consulting Engineer needed? | N/A |
Is a channel 14 Mask Filer needed? | N/A | |
Is additional field engineering time needed? | N/A | |
Number of Days | N/A |
Name | Description |
---|---|
Mask Filter |
Mask Filter |
Primary Transmitter Site Survey |
Primary Transmitter Site Survey |
Section | Question | Response |
---|---|---|
Antenna Related Expenses | Do you have antenna related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Antenna Description | Type of change | Purchase New |
Antenna Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
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 | Class | Class A |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Horizontal | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels | N/A | |
Design power capacity in use | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Other Antenna Type | N/A | |
ERP: | 15.0 kW | |
Manufacturer | ||
Model | PSILP16BA | |
Year | 2006 |
Section | Question | Response |
---|---|---|
New Antenna Description | Use | Primary (Main) |
Description of Use | N/A | |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Ownership | Owned | |
Owner | N/A | |
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 | Class | Class A |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Elliptical | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels/Bays | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Design power capacity in use | N/A | |
Other Antenna Type | N/A | |
ERP: | 10.7 kW | |
Manufacturer | ||
Model | SWEDL8WC/16-EP | |
Year | 2017 | |
Justification for New Antenna | Existing antenna is non-tunable to new channel. |
Section | Question | Response |
---|---|---|
Combiner for Shared Antenna | Do you need a Combiner for a Shared Antenna? | No |
Type | ||
Number of channels supported | N/A | |
Frequencies of channels supported | N/A | |
Frequency | N/A | |
Do you need a combiner output splitter/switcher for dual feed lines? | N/A | |
Elbow Complex | Do you require the separate purchase of the Elbow Complex? | No |
Broadband or Single Channel? | N/A | |
Feed Line Size | N/A | |
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 |
Section | Question | Response |
---|---|---|
Transmission Line Related Expenses | Do you have transmission line related expenses? | No |
Section | Question | Response |
---|---|---|
Tower Equipment or Rigging Costs Changes | Do you have tower equipment or rigging costs changes? | Yes |
Section | Question | Response |
---|---|---|
Existing Tower Description | Type of change | Modify Existing |
Tower Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Leased | |
Is this tower consider Complex? | No | |
Is this tower currently shared with any other stations? | Yes | |
One or more FM, AM or TV radio broadcaster(s) | No | |
Others Types of Users | Yes | |
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 | 1018922 | |
Coordinates (NAD83) | Latitude (NAD83) | 32° 50' 28.5" N- |
Longitude (NAD83) | 083° 40' 17.2" W- | |
Overall Structure Height | 639.10 feet | |
Support Structure Height | 623.02 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 437.00 feet | |
Structure Type | GTOWER - Guyed Structure Used for Communication Purposes | |
Tower Owner | American Tower, LLC | |
Date Constructed | 01/01/1993 |
Users |
---|
W247BW |
New Fac 140322 |
Section | Question | Response |
---|---|---|
Engineering Study | Please what type of engineering study is required, if any: | Study needed for documented tower |
Tower Reinforcements | Please select whether tower reinforcements are needed: | Minor Reinforcements needed |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
Name | Description |
---|---|
Ground and Building A and E Permit Drawing Package |
The Generation of Permitting Drawing package. |
Tower Permit Drawing Package |
The Generation of Permitting Drawing package. |
Section | Question | Response |
---|---|---|
Outside Project Management Services | Do you require outside project management services? | Yes |
Number of Hours | 595 | |
Explanation | WDMA-CD does not have sufficient resource capacity and expertise in house to handle all activities necessary for completion of the station's build by the construction deadline. WDMA-CD will hire an outside firm to facilitate a timely transition. | |
Outside RF consulting Engineering Services | Perform engineering study for new channel assignment and antenna development | 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 | |
Do you have Distributed Transmission System engineering services? | N/A | |
Critical Facility | N/A | |
Terrain-Shielded Facility | N/A | |
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 | |
NEPA Section 106 environmental review | Yes | |
Environmental Assessment | Yes | |
ASR Modification | Yes | |
FAA Consultation (including preparation of FAA Form 7460) | Yes | |
Negotiation of Lease and other Matter for Shared Locations | Yes | |
Prepare or Review FCC Form 399 for Reimbursement | Yes | |
Address transition timing and coordination issues w/ other stations and wireless providers | Yes | |
RF Field Engineering Services | Comprehensive coverage verification via field study | No |
RF exposure measurements | Yes | |
Additional Field Engineering Service | Yes | |
Number of Days | 7 | |
Justification | Installation of transmitter and supervision of antenna installation. |
Name | Description |
---|---|
Site Coordination meeting |
Coordination and transition planning with all parties onsite and management of the timelines and schedules occurring during the repack |
Migratory Bird Assessment Permitting if needed |
Migratory Bird Assessment Permitting if needed, per tower owner. |
Section | Question | Response |
---|---|---|
AM Pattern Disturbance | Is an Impact Study needed? | No |
Is Remediation needed? | No | |
Facility Expenses | Name | N/A |
Other Distributed Transmission System Expenses Not listed | N/A | |
Name | N/A | |
Is Notification of a Medical Facility required as a result of DTV broadcasting? | Yes | |
Permit and Filing Costs | Local Zoning | Yes |
Non-zoning permits | Yes | |
BLM or NFS Coordination | 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? | Yes | |
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? | Yes | |
Does this relocation require MVPD Notification of a Channel Change? | Yes |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $210,677.39 | $118,814.39 | N/A | $92,537.00 | N/A |
Total for all systems | $855,738.39 | $545,735.39 | N/A | $209,607.16 | N/A |
Primary Transmitter EKA TXUD2700AC-D | $210,677.39 | $118,814.39 | $92,537.00 | ||
Primary Transmitter Site Survey | $928.64 | $928.64 | Please see WDMA-CD Primary Transmitter - Site Survey Budget Revision Justification Letter | $0.00 | N/A |
Mask Filter | $10,248.75 | $10,248.75 | N/A | $8,199.00 | N/A |
10 Ton system | $38,900.00 | $15,000.00 | N/A | N/A | N/A |
Other Electrical Service: Minimal electric services will be needed to implement new facility. | $5,000.00 | $5,000.00 | N/A | $4,900.00 | N/A |
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW | $155,600.00 | $87,637.00 | Per Eletronika Quote | $79,438.00 | N/A |
Actual Information Description | File Name |
---|---|
Primary Transmitter Site Survey | |
Mask Filter | |
10 Ton system | Information not provided. |
Other Electrical Service: Minimal electric services will be needed to implement new facility. | |
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $33,030.00 | $30,345.00 | N/A | $17,377.16 | N/A |
Total for all systems | $855,738.39 | $545,735.39 | N/A | $209,607.16 | N/A |
Primary Antenna SWEDL8WC/16-EP | $33,030.00 | $30,345.00 | $17,377.16 | ||
Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | N/A | N/A |
UHF - Lower Power Side Mount, Class A One Station antenna -- basic | $26,300.00 | $23,945.00 | N/A | $17,377.16 | N/A |
Actual Information Description | File Name |
---|---|
Sweep test of existing antenna | Information not provided. |
UHF - Lower Power Side Mount, Class A One Station antenna -- basic |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $390,500.00 | $194,875.00 | N/A | $29,675.00 | N/A |
Total for all systems | $855,738.39 | $545,735.39 | N/A | $209,607.16 | N/A |
Primary Tower GTOWER | $390,500.00 | $194,875.00 | $29,675.00 | ||
Tower Permit Drawing Package | $4,700.00 | $4,700.00 | N/A | N/A | N/A |
Ground and Building A and E Permit Drawing Package | $4,700.00 | $4,700.00 | N/A | N/A | N/A |
Minor tower reinforcement/modifications | $158,000.00 | $75,000.00 | N/A | N/A | N/A |
Structural engineering tower load study for well documented tower | $12,600.00 | $10,475.00 | N/A | $10,475.00 | N/A |
Tall Tower (greater than 500') | $210,500.00 | $100,000.00 | N/A | $19,200.00 | N/A |
Actual Information Description | File Name |
---|---|
Tower Permit Drawing Package | Information not provided. |
Ground and Building A and E Permit Drawing Package | Information not provided. |
Minor tower reinforcement/modifications | Information not provided. |
Structural engineering tower load study for well documented tower | |
Tall Tower (greater than 500') |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $189,770.00 | $178,475.00 | N/A | $64,617.10 | N/A |
Total for all systems | $855,738.39 | $545,735.39 | N/A | $209,607.16 | N/A |
Outside Professional Services | $189,770.00 | $178,475.00 | $64,617.10 | ||
Project management of the transition | $94,010.00 | $99,675.00 | Please see Widelity Strategic Quote | $58,119.10 | N/A |
Migratory Bird Assessment Permitting if needed | $1,750.00 | $1,750.00 | N/A | N/A | N/A |
Site Coordination meeting | $2,500.00 | $2,500.00 | N/A | $2,500.00 | N/A |
Additional Field Engineering Service, 7 Days | $14,500.00 | $14,500.00 | N/A | N/A | N/A |
RF Exposure Measurements | $21,050.00 | $10,000.00 | N/A | N/A | N/A |
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase | $2,105.00 | $1,400.00 | N/A | N/A | N/A |
ASR modification (prepare FCC Form 854) | $2,105.00 | $500.00 | N/A | N/A | N/A |
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet | $10,520.00 | $10,000.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File request for Special Temporary Authorization | $3,680.00 | $3,500.00 | N/A | N/A | N/A |
Attorney Fees - Negotiation of lease and other matters for shared locations | $4,210.00 | $4,000.00 | N/A | $712.00 | N/A |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $2,250.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | N/A | N/A | N/A |
Prepare request for Special Temporary Authorization | $2,050.00 | $1,500.00 | N/A | N/A | N/A |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | $1,580.00 | $1,500.00 | N/A | N/A | N/A |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | N/A | N/A |
Perform engineering study for new channel assignment and antenna development | $7,360.00 | $7,000.00 | N/A | N/A | N/A |
Address transition timing and coordination issues w/ other stations and wireless | $2,630.00 | $2,500.00 | N/A | $2,500.00 | N/A |
Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | $786.00 | N/A |
NEPA Section 106 environmental review, if needed | $6,310.00 | $5,400.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
Project management of the transition | |
Migratory Bird Assessment Permitting if needed | Information not provided. |
Site Coordination meeting | |
Additional Field Engineering Service, 7 Days | Information not provided. |
RF Exposure Measurements | Information not provided. |
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase | Information not provided. |
ASR modification (prepare FCC Form 854) | Information not provided. |
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet | Information not provided. |
Attorney Fees - Prepare and File request for Special Temporary Authorization | Information not provided. |
Attorney Fees - Negotiation of lease and other matters for shared locations | |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | Information not provided. |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | Information not provided. |
Prepare request for Special Temporary Authorization | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | Information not provided. |
Perform engineering study for new channel assignment and antenna development | Information not provided. |
Address transition timing and coordination issues w/ other stations and wireless | |
Prepare and or review reimbursement form | |
NEPA Section 106 environmental review, if needed | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $31,761.00 | $23,226.00 | N/A | $5,400.90 | N/A |
Total for all systems | $855,738.39 | $545,735.39 | N/A | $209,607.16 | N/A |
Other Expenses | $31,761.00 | $23,226.00 | $5,400.90 | ||
MVPD Notification of Channel Change | $1,321.00 | $1,321.00 | see Justifying Quote WDMA DTVNotification Quote 001509 | $1,321.00 | N/A |
Develop and air announcement of upcoming channel change | $500.00 | $500.00 | N/A | $0.00 | N/A |
Equipment Storage | $3,500.00 | $3,500.00 | N/A | $0.00 | N/A |
Equipment Delivery and Handling Charges | $5,000.00 | $5,000.00 | N/A | $1,009.90 | N/A |
Disposal Costs (for equipment and other waste, net of any salvage value) | $5,000.00 | $5,000.00 | N/A | N/A | N/A |
Non-zoning permits | $2,500.00 | $2,500.00 | N/A | N/A | N/A |
Local Zoning | $750.00 | $750.00 | N/A | N/A | N/A |
FCC Filing Fees - Special Temporary Authorization request | $195.00 | $190.00 | N/A | $0.00 | N/A |
FCC Filing Fees - Form 2100 license to cover application | $335.00 | $325.00 | N/A | $0.00 | N/A |
DTV Medical Facility Notification | $11,550.00 | $3,070.00 | see Justifying Quote WDMA DTVNotification Quote 001508 | $3,070.00 | N/A |
FCC Filing Fees - Form 2100 minor change CP application | $1,110.00 | $1,070.00 | N/A | $0.00 | N/A |
Actual Information Description | File Name |
---|---|
MVPD Notification of Channel Change | |
Develop and air announcement of upcoming channel change | Information not provided. |
Equipment Storage | Information not provided. |
Equipment Delivery and Handling Charges | |
Disposal Costs (for equipment and other waste, net of any salvage value) | Information not provided. |
Non-zoning permits | Information not provided. |
Local Zoning | 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. |
DTV Medical Facility Notification | |
FCC Filing Fees - Form 2100 minor change CP application | Information not provided. |
Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
---|---|---|---|
Total for all systems | $855,738.39 | $545,735.39 | $209,607.16 |
Question | Response |
---|---|
The facility has ceased operating on its pre-auction channel. | Yes |
Construction of final facilities or all necessary modifications are complete. | Yes |
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 |
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. |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Arnold Torres Business Administrator 03/04/2021 |
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). |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Arnold Torres Business Administrator 03/04/2021 |
Section | Question | Response |
---|---|---|
Submission of Final Allocation or Accounting Information 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. |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Arnold Torres Business Administrator 03/04/2021 |