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:
25704
Service:
LPD
Call Sign:
WIVM-LD
Channel:
11 (High VHF)
File Number:
0000088721
FRN:
0004662409
Eligibility Status:
Eligible
Date Submitted:
06/23/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Michael Tonges

Michael Tonges

PO Box 44720

North Canton, OH 44720

United States

+1 (330) 284-2574 MCTONGES@AOL.COM Individual

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

Tony Zummallen

President

Q Communications, LLC

Tony Zummallen

705B SE Melody Lane #314

Lee's Summit, MO 64063

United States

+1 (816) 729-1177 tony@Qcomm.tv

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 Replace the transmitter and antenna per the channel reassignment with reasonable and customary engineering and business practices.

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 INNOVATOR-LX
Year 2004
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.80 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 TMU9-3 EVO
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.15 kW
Justification for New Transmitter New transmitter needed to overcome tropo effects on new channel.

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 No
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size Other
Other Size 3 tons
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

Decommission Old Transmitter

Disconnect and de-install the existing primary transmitter, RF components and the filter system and cooling system from service

Transmitter Taxes

Transmitter sales tax

Transmitter Shipping fees

Transmitter shipping fees

Transmitter Site Prep

Site preparation for main transmitter installation: Receive and inventory new transmitter and components; pre-assemble cabinets; ensure all materials available for installation crew.

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: 15.0 kW
Manufacturer
Model PSiLP16-39
Year 2009

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Other
Other Antenna Type Panel
ERP: 2.5 kW
Manufacturer
Model PSILP8OI-34-EP
Year 2020
Justification for New Antenna See attached letter from WES Broadcast Consultants, Inc dated 10-02-2019 regarding issues caused by repack including loss of viewers due to poor reception. This change is for a UHF Antenna, not a VHF as originally approved.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Shipping fees

Shipping fees of new antenna to site

Antenna Taxes

Antenna sales tax

Transmission Line

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

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1050165
Coordinates (NAD83) Latitude (NAD83) 40° 53' 55.0" N-
Longitude (NAD83) 081° 12' 36.0" W-
Overall Structure Height 300.85 feet
Support Structure Height 300.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 1253.27 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner IMAGE VIDEO TELEPRODUCTIONS, INC.
Date Constructed 06/24/1997


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Tower mapping and report for structural engineer
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

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

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 200
Explanation Required to assist in the turnkey management of the channel relocation project in order that the existing personnel can maintain and operate the stations daily operational requirements and plans.
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Prepare Form 601 Yes
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Negotiation of Lease and other Matter for Shared Locations 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 No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Vehicle expenses - mileage

Vehicle expenses - mileage - IRS 2019

Airfare

Airfare expenses

Hotel Expenses

Hotel Expenses

Meals and sundries

Meals and sundries

Rental car expenses

Rental car expenses

Travel labor

Travel Labor rate

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 Yes
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
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Name Description

Foam Coax jumper

7/8" foam coax jumper

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 $142,950.00 $92,883.00 N/A $46,533.00 N/A
Total for all systems $385,372.99 $318,502.99 N/A $105,867.54 N/A
Primary Transmitter TMU9-3 EVO $142,950.00 $92,883.00 $46,533.00
High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW $101,000.00 $42,433.00 Actual costs per Rohde & Schwarz inv 9500119820 (less upgrade value of $2566.28 according to Rohde quote). $42,433.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $18,500.00 Per attached QCommunications quote. N/A N/A
Decommission Old Transmitter $8,000.00 $8,000.00 Per attached QCommunications quote. N/A N/A
Transmitter Taxes $10,100.00 $10,100.00 Estimated sales tax collected by vendors as part of the repack. Actual costs to be determined. N/A N/A
Transmitter Shipping fees $2,500.00 $2,500.00 Estimated shipping costs for transmitter. Actual costs to be determined. N/A N/A
Transmitter Site Prep $7,250.00 $7,250.00 Per attached QCommunications quote. N/A N/A
Other -- HVAC Service Type: C Size:3 (Other) $4,100.00 $4,100.00 3-ton mini-split by Accurate Air Flow LLP $4,100.00 N/A

Components

Actual Information Description File Name
High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW

Component Description:
Amount requested does not include upgrade. Rohde transmitter invoice # 9500119820
Amount:
$42,433.00
Transmitter Building Site Survey/Installation Information not provided.
Decommission Old Transmitter Information not provided.
Transmitter Taxes Information not provided.
Transmitter Shipping fees Information not provided.
Transmitter Site Prep Information not provided.
Other -- HVAC Service Type: C Size:3 (Other)

Component Description:
Mini-split HVAC - Accurate - INV 4206
Amount:
$4,100.00

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 $26,100.41 $26,100.41 N/A $10,113.16 N/A
Total for all systems $385,372.99 $318,502.99 N/A $105,867.54 N/A
Primary Antenna PSILP8OI-34-EP $26,100.41 $26,100.41 $10,113.16
High VHF-Low Power, Side Mount, Other, 2.5kW input, Elliptical $12,694.75 $12,694.75 Switch from VHF Antenna to UHF Antenna. Elliptical upgrade. See Propagation Systems proposals P13120-DR1 and P13120-DR attached to invoices DP2149 and 2149. $9,662.50 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A
Side Mount antenna brackets $4,625.00 $4,625.00 N/A N/A N/A
Antenna Shipping fees $450.66 $450.66 Estimated shipping costs for antenna. Actual costs to be determined. $450.66 N/A
Antenna Taxes $2,600.00 $2,600.00 Estimated sales tax collected by vendors as part of the repack. Actual costs to be determined. N/A N/A

Components

Actual Information Description File Name
High VHF-Low Power, Side Mount, Other, 2.5kW input, Elliptical

Component Description:
Down payment for antenna.
Amount:
$7,000.00

Component Description:
See cover letter. Balance on antenna PLUS freight.
Amount:
$2,662.50
Sweep test of transmission line and antenna Information not provided.
Side Mount antenna brackets Information not provided.
Antenna Shipping fees

Component Description:
Freight charges for Antenna. PSI INV 2149
Amount:
$450.66
Antenna Taxes Information not provided.

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $77,190.00 $58,265.00 N/A $37,265.00 N/A
Total for all systems $385,372.99 $318,502.99 N/A $105,867.54 N/A
Primary Tower TOWER $77,190.00 $58,265.00 $37,265.00
Tower Rigging Short Tower (less than 500') $56,190.00 $37,265.00 Per Baker Tower Quote attached to invoice 9-4-2020. $37,265.00 N/A
Tower mapping and report for structural engineer $21,000.00 $21,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower Rigging Short Tower (less than 500')

Component Description:
Antenna install - Baker Tower - 9-4-2020
Amount:
$37,265.00
Tower mapping and report for structural engineer 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 $128,928.00 $131,050.00 N/A $10,961.80 N/A
Total for all systems $385,372.99 $318,502.99 N/A $105,867.54 N/A
Outside Professional Services $128,928.00 $131,050.00 $10,961.80
Form 399 assistance or other Program Management costs $30,646.00 $30,646.00 Per attached QCommunications quote. $7,961.80 N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A N/A N/A
Project management of the transition $21,100.00 $30,800.00 Required to assist in the turnkey management of the channel relocation project in order that the existing internal personal can maintain and operate the stations daily operational requirements and plans. $0.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $3,000.00 Per attached QCommunications quote. Includes initial 399 eligibility plus 399 application $3,000.00 Actual invoice for 399 preparation and submittal. See attached invoice.
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A N/A N/A
Prepare Form 601 $755.00 $755.00 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 - Negotiation of lease and other matters for shared locations $3,262.50 $3,262.50 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $43,732.00 Per attached QForce quote 716-R N/A N/A
Vehicle expenses - mileage $290.00 $290.00 Per attached QCommunications quote. N/A N/A
Airfare $500.00 $500.00 Per attached QCommunications quote. N/A N/A
Hotel Expenses $800.00 $800.00 Per attached QCommunications quote. N/A N/A
Meals and sundries $432.00 $432.00 Per attached QCommunications quote N/A N/A
Rental car expenses $70.00 $70.00 Per attached QCommunications quote. N/A N/A
Travel labor $3,690.00 $3,690.00 Per attached QCommunications quote. N/A N/A

Components

Actual Information Description File Name
Form 399 assistance or other Program Management costs

Component Description:
April 2021 PM Hours - QC21-861
Amount:
$1,355.20

Component Description:
Jan 2021 PM Hours - QComm - QC21-751
Amount:
$446.60

Component Description:
Feb 2021 PM Hours - QComm - INV QC21-788
Amount:
$177.10

Component Description:
March 2021 PM Hours - QC21-838
Amount:
$261.80

Component Description:
Revised cover letter - WIVM - QComm - May PM hours - QC20-328
Amount:
$469.70

Component Description:
Nov 2020 PM Hours - QComm - QC20-625
Amount:
$315.70

Component Description:
Sept 2020 PM Hours - QComm - QC20-498
Amount:
$585.20

Component Description:
Project Management hours for June 2020 - QComm QC20-352
Amount:
$415.80

Component Description:
October 2020 PM HOurs - QComm - QC20-518
Amount:
$1,054.90

Component Description:
WIVM QComm - July 2020 PM hours - QC20-445
Amount:
$723.80

Component Description:
WIVM - QComm - August PM hours - QC20-465
Amount:
$400.40

Component Description:
Proj Mgmt hours from Nov 16, 2019 through March 31,2020. QComm INV QC20-270
Amount:
$592.90

Component Description:
Revised cover letter - WIVM - QComm - April PM hours - QC20-294
Amount:
$877.80

Component Description:
Dec 2020 PM HOurs - QComm - QC21-711
Amount:
$284.90
Prepare request for Special Temporary Authorization Information not provided.
Project management of the transition

Component Description:
PM hours 11/16/19 thru 3/31/20 - QComm - INV QC20-270
Amount:
N/A
Prepare/ Review 399 reimbursement form

Component Description:
WIVM - QComm - 399 Form Eligibility; 399 Preparation and submittal to meet 11/16/2019 deadline - QC20-246
Amount:
$3,000.00
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.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare Form 601 Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Vehicle expenses - mileage Information not provided.
Airfare Information not provided.
Hotel Expenses Information not provided.
Meals and sundries Information not provided.
Rental car expenses Information not provided.
Travel labor 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 $10,204.58 $10,204.58 N/A $994.58 N/A
Total for all systems $385,372.99 $318,502.99 N/A $105,867.54 N/A
Other Expenses $10,204.58 $10,204.58 $994.58
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $4,960.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,000.00 $1,000.00 4-6 yard disposal bin on site to capture all waste from on site system integration and tower vendors. N/A N/A
Equipment Delivery and Handling Charges $1,000.00 $1,000.00 Transport, forklift rental and handling fees from staging area to transmitter site. N/A N/A
Equipment Storage $500.00 $500.00 Expecting multiple staggered equipment deliveries from different vendors and need to store and stage new equipment prior to installation date. N/A N/A
Foam Coax jumper $994.58 $994.58 Actual costs for a 7/8" foam coax jumper per SWR INV 20308 $994.58 N/A

Components

Actual Information Description File Name
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 Major change CP application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Equipment Storage Information not provided.
Foam Coax jumper

Component Description:
Includes shipping costs for jumper. SWR - INV 20308
Amount:
$994.58

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $385,372.99 $318,502.99 $105,867.54

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.

Michael Tonges

President


06/23/2021

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.

Michael Tonges

President


06/23/2021

Attachments

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