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:
67012
Service:
LPD
Call Sign:
KFDY-LD
Channel:
27 (UHF)
File Number:
0000089473
FRN:
0023874712
Eligibility Status:
Eligible
Date Submitted:
05/04/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

FLOOD COMMUNICATIONS OF OMAHA, LLC

Doing Business As: FLOOD COMMUNICATIONS OF OMAHA, LLC

Michael Flood

214 NORTH 17TH STREET

SUITE1

NORFOLK, NE 68702

United States

+1 (420) 371-0100 mike@NEWSCHANNELNEBRASKA.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

Matthew H McCormick , Esq .

Fletcher, Heald & Hildreth, PLC

1300 N 17th Street

Suite 1100

Arlington, VA 22209

United States

+1 (703) 812-0400 mccormick@fhhlaw.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. No
Briefly describe transition plan Please see Transition Plan and Reimbursement Request Narrative

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 AT71P0
Year 2011
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.25 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 EC701HP-BB2
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.3 kW
Justification for New Transmitter Existing transmitter insufficient power capability to make ERP. FURTHER, IN MARCH 2017 COMARK DESIGNATED AT71 AS NOT RECOMMENDED FOR RE-CHANNEL DUE TO PARTS AVAILABILITY.

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 Yes
Size 1.5 inches
Length 100.0 feet
Other Electrical Service Yes
Description New Breaker Disconnect Box
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? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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? No
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: 5.0 kW
Manufacturer
Model SL8
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 Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 4
Lower Limit 470.00 MHz
Upper Limit 862.00 MHz
Design power capacity in use 50.0 %
ERP: 3.65 kW
Manufacturer
Model BAN-4000 CUSTOM
Year 2018
Justification for New Antenna Tower failed and existing antenna destroyed.

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
Power Dividers Does the panel antenna require power dividers? No
Cable Harness Does the panel antenna require cable harness? No

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? 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 Move Equipment
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1022906
Coordinates (NAD83) Latitude (NAD83) 40° 51' 10.0" N-
Longitude (NAD83) 096° 40' 37.0" W-
Overall Structure Height 499.99 feet
Support Structure Height 499.99 feet
Ground Elevation Above Mean Sea Level (AMSL) 1146.97 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner DAVID W BRATCHER LLC
Date Constructed 03/30/1990


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 40
Explanation CURRENT TOWER FAILED. A NEW LEASE SITE WILL BE PURSUED, TRANSMITTER AND LINE PURCHASED AND INSTALLED. NEW SITE EXPECTED TO REQUIRE ELECTRIC SERVICE, HVAC AND OTHER SERVICES REQUIRING PROJECT MANAGEMENT.
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 6
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 Yes
Quantity 6
Negotiation of Lease and other Matter for Shared Locations No
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 No
RF exposure measurements Yes
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Legal Services

Legal fees for advising station regarding displacement and transition to new channel

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 Yes
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 $118,829.17 $91,479.17 N/A $6,949.94 N/A
Total for all systems $253,545.42 $150,680.42 N/A $35,534.29 N/A
Primary Transmitter EC701HP-BB2 $118,829.17 $91,479.17 $6,949.94
Transmitter Building Site Survey/Installation $10,000.00 $5,900.00 N/A $5,870.77 1
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $65,000.00 N/A $0.00 N/A
1.5" Rigid Conduit and Wiring $1,079.17 $1,079.17 N/A $1,079.17 N/A
Other Electrical Service: New Breaker Disconnect Box $3,500.00 $3,500.00 N/A N/A N/A
5 Ton system $20,250.00 $16,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Transmitter Building Site Survey/Installation

Component Description:
Transmitter Building Site Survey/Installation
Amount:
$219.60

Component Description:
Transmitter Building Site Survey/Installation
Amount:
$3,864.07

Component Description:
Transmitter Building Site Survey/Installation
Amount:
$249.60

Component Description:
Transmitter Building Site Survey/Installation
Amount:
$1,537.50

Component Description:
Transmitter Building Site Survey/Installation
Amount:
$1,538.00

Component Description:
Transmitter site survey services
Amount:
$271.20

Component Description:
Transmitter site survey services
Amount:
$246.15

Component Description:
Transmitter Building Site Survey/Installation
Amount:
$3,864.07
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW Information not provided.
1.5" Rigid Conduit and Wiring

Component Description:
1.5" Rigid Conduit and Wiring
Amount:
$115.76

Component Description:
1.5" Rigid Conduit and Wiring
Amount:
$963.41

Component Description:
Conduit and wiring services for transmitter
Amount:
$115.76
Other Electrical Service: New Breaker Disconnect Box Information not provided.
5 Ton system Information not provided.

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 $17,355.00 $13,000.00 N/A $0.00 N/A
Total for all systems $253,545.42 $150,680.42 N/A $35,534.29 N/A
Primary Antenna BAN-4000 CUSTOM $17,355.00 $13,000.00 $0.00
Side Mount antenna brackets $4,625.00 $2,500.00 N/A N/A N/A
Sweep test of transmission line and antenna $5,730.00 $3,500.00 N/A N/A N/A
UHF Broadband panel antenna (per panel), horizontally-polarized $7,000.00 $7,000.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Side Mount antenna brackets Information not provided.
Sweep test of transmission line and antenna Information not provided.
UHF Broadband panel antenna (per panel), horizontally-polarized

Component Description:
Moved to Tower Rigging Short Tower (less than 500').
Amount:
N/A

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 $56,190.00 $8,150.00 N/A $8,150.00 N/A
Total for all systems $253,545.42 $150,680.42 N/A $35,534.29 N/A
Primary Tower TOWER $56,190.00 $8,150.00 $8,150.00
Tower Rigging Short Tower (less than 500') $56,190.00 $8,150.00 N/A $8,150.00 N/A

Components

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

Component Description:
Structural analysis of tower to be used for KFDY-LD transition
Amount:
$750.00

Component Description:
Tower rigging services
Amount:
$7,400.00

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 $56,921.25 $33,506.25 N/A $19,803.75 N/A
Total for all systems $253,545.42 $150,680.42 N/A $35,534.29 N/A
Outside Professional Services $56,921.25 $33,506.25 $19,803.75
Other Legal Services $2,000.00 $2,000.00 N/A $1,550.00 N/A
RF Exposure Measurements $12,100.00 $2,500.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $13,410.00 $4,470.00 N/A $3,353.75 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A $487.50 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $1,500.00 CP application more complex than initially expected $1,431.25 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $650.00 N/A
Prepare request for Special Temporary Authorization $7,680.00 $2,560.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A $1,100.00 N/A
Form 399 assistance or other Program Management costs $6,243.75 $6,243.75 Form 399 more complex than initially expected - requiring additional legal services $6,243.75 N/A
Project management of the transition $4,220.00 $3,700.00 N/A $987.50 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $4,000.00 Form more complex and time consuming than initially expected $4,000.00 N/A

Components

Actual Information Description File Name
Other Legal Services

Component Description:
Legal fees for advising station regarding displacement and transition to new channel
Amount:
$1,550.00
RF Exposure Measurements Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Legal fees for preparing and filing requests for Special Temporary Authority
Amount:
$2,778.75

Component Description:
Legal Services for drafting and filing request for Special Temporary Authority
Amount:
$575.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal services for drafting and filing license application
Amount:
$487.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal fees for preparing and filing Form 2100-CP Displacement Application
Amount:
$718.75

Component Description:
Legal services for preparing and filing CP application
Amount:
$712.50
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

Component Description:
Fees for preparation of Engineering Section for Displacement Application
Amount:
$650.00
Prepare request for Special Temporary Authorization Information not provided.
Perform engineering study for displacement application

Component Description:
Fees for performance of engineering study for displacement application
Amount:
$1,100.00
Form 399 assistance or other Program Management costs

Component Description:
Legal fees associated with Form 399 assistance/Other Program Management Costs
Amount:
$500.00

Component Description:
Form 399 Assistance
Amount:
$2,081.25

Component Description:
Legal services for assistance with Form 399
Amount:
$3,662.50
Project management of the transition

Component Description:
Project Management of the Transition
Amount:
$187.50

Component Description:
Legal services associated with transition to new channel
Amount:
$800.00
Prepare/ Review 399 reimbursement form

Component Description:
Legal fees for preparing and filing Form 399
Amount:
$137.50

Component Description:
Legal services for drafting and filing Form 399
Amount:
$2,062.50

Component Description:
Legal fees for drafting and filing Form 399
Amount:
$1,800.00

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 $4,250.00 $4,545.00 N/A $630.60 N/A
Total for all systems $253,545.42 $150,680.42 N/A $35,534.29 N/A
Other Expenses $4,250.00 $4,545.00 $630.60
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 N/A $30.60 N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $600.00 3 STA Filing Fees at $200 each. $600.00 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 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
Equipment delivery and handling charges
Amount:
$30.60
FCC Filing Fees - Special Temporary Authorization request

Component Description:
STA Filing Fee (9.14.2018)
Amount:
$200.00

Component Description:
STA Filing Fee (7.8.2019)
Amount:
$200.00

Component Description:
STA Request Filing Fee
Amount:
$200.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $253,545.42 $150,680.42 $35,534.29

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. 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

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 Flood

Member


05/04/2021

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 Flood

Member


05/04/2021

Certification

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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.

  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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

  5. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. 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 Flood

Member


05/04/2021

Attachments

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