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:
183814
Service:
LPT
Call Sign:
KMNF-LD
Channel:
13 (High VHF)
File Number:
0000089927
FRN:
0018223693
Eligibility Status:
Eligible
Date Submitted:
07/29/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRAY TELEVISION LICENSEE, LLC

Lucy Brown

4370 PEACHTREE ROAD, NE

ATLANTA, GA 30319

United States

+1 (703) 237-5211 Robert.Folliard@gray.tv 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

Sam Hariton

Widelity

Sam Hariton

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.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 KMNF is planning to purchase an upgraded transmitter, purchase an upgraded antenna, purchase new transmission line, and move to a new tower .

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 CX
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model TBD
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 90 W
Justification for New Transmitter KMNF cannot retune the transmitter, as the station is getting newer equipment, moving to a different band, moving to a different site, and obtaining a higher TPO.

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? No
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? No
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

Other Electrical Costs: Conduit and Wiring

Other Electrical Costs: Conduit and Wiring

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 Leased
Owner CTV of Southern Minnesota
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type broadband superturnstile
ERP: 1.9 kW
Manufacturer
Model 771-304
Year 2009

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
13839 K19LI-D
125749 K32GX-D
13838 K21DG-D
13840 K14KE-D
13844 K26CS-D
13846 K18NE-D
167237 K34JX-D
28003 K30FN-D

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? No
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 Top
Polarization Horizontal
Type Slotted Coaxial
ERP: 3.0 kW
Manufacturer
Model TLS-V4
Year 2019
Justification for New Antenna KMNF Is requesting new equipment. This antenna is the smallest low band VHF antenna available - KMNF would have installed this antenna if it was operating at its like-for-like ERP and operating on a like-for-like transmitter.

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

Information not provided.

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 Leased
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 1040 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 Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 1100 feet per run
Justification for New Transmission Line KMNF is moving towers and will require a new transmission line.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1025277
Coordinates (NAD83) Latitude (NAD83) 43° 56' 12.3" N-
Longitude (NAD83) 094° 24' 39.0" W-
Overall Structure Height 1072.82 feet
Support Structure Height 1008.52 feet
Ground Elevation Above Mean Sea Level (AMSL) 1051.17 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Gray Media Group, Inc.
Date Constructed 09/01/1960

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
68853 KEYC-TV DTV

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: Minor 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 254
Explanation KMNF does not have sufficient resource capacity and expertise in house to handle all of the reimbursement activities necessary to facilitate on-time completion of the station's build. KMNF will hire an outside firm to support KMNF in these tasks.
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 No
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 No
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 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

Information not provided.

Other Expenses

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

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 $11,300.00 $11,300.00 N/A $0.00 N/A
Total for all systems $468,721.32 $471,455.61 N/A $82,906.86 N/A
Primary Transmitter TBD $11,300.00 $11,300.00 $0.00
High VHF - Air Cooled Solid State Transmitter 10 - 100 Watts $11,300.00 $11,300.00 Please see Justification KMNF Transmitter Cost_Like-For-Like for details N/A N/A
Other Electrical Costs: Conduit and Wiring $0.00 $0.00 Filler until a quote is available for this cost N/A N/A

Components

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 $56,877.68 $56,877.68 N/A $46,522.68 N/A
Total for all systems $468,721.32 $471,455.61 N/A $82,906.86 N/A
Primary Antenna TLS-V4 $56,877.68 $56,877.68 $46,522.68
Side Mount antenna brackets $4,625.00 $4,625.00 N/A N/A N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A
High VHF-Low Power, Side Mount, Slotted Coaxial, 3.0kW input, Horizontal $46,522.68 $46,522.68 Please see Estimated Cost Justification KMNF-LD-210-Primary Antenna - High VHF, Low Power Side Mount, H-POL v0 $46,522.68 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.
High VHF-Low Power, Side Mount, Slotted Coaxial, 3.0kW input, Horizontal

Component Description:
KMNF-LD-210-Primary Antenna - High VHF, Low Power Side Mount, H-POL
Amount:
$2,992.68

Component Description:
Antenna
Amount:
$43,530.00

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 $26,400.00 $14,021.29 N/A $14,021.29 N/A
Total for all systems $468,721.32 $471,455.61 N/A $82,906.86 N/A
Primary Transmission Line $26,400.00 $14,021.29 $14,021.29
Flexible Foam Transmission Line - dielectric, 1 5/8" $26,400.00 $14,021.29 Please see Estimated Cost Justification KMNF-LD-310-Primary Transmission Line - 1 5_8_ Flexible Foam Dielectric v1 $14,021.29 N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
sales tax invoices
Amount:
$27.84

Component Description:
ELBOW ASSY 1 5/8 REINFORCED ELBOW 6 X 3 SOLDER WIPE W/ DRAIN
Amount:
$405.00

Component Description:
Flexible transmission line
Amount:
$12,714.34

Component Description:
sales tax invoices
Amount:
$874.11

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 $328,750.00 $328,750.00 N/A $0.00 N/A
Total for all systems $468,721.32 $471,455.61 N/A $82,906.86 N/A
Primary Tower GTOWER $328,750.00 $328,750.00 $0.00
Tower Rigging Tall Tower (greater than 500') $157,750.00 $157,750.00 N/A N/A N/A
Tower mapping and report for structural engineer $21,000.00 $21,000.00 N/A N/A N/A
Minor tower reinforcement/modifications $150,000.00 $150,000.00 Per catalog of costs N/A N/A

Components

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 $38,819.50 $53,932.50 N/A $22,193.75 N/A
Total for all systems $468,721.32 $471,455.61 N/A $82,906.86 N/A
Outside Professional Services $38,819.50 $53,932.50 $22,193.75
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 - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A N/A
Project management of the transition $26,797.00 $41,910.00 Please see KMNF-LD LPTV strategic support quote $22,193.75 N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A

Components

Actual Information Description File Name
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 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.
Project management of the transition

Component Description:
Project Management
Amount:
$3,768.90

Component Description:
Project management
Amount:
$183.75

Component Description:
Project Management
Amount:
$38.75

Component Description:
Project Management
Amount:
$2,531.95

Component Description:
Project Management
Amount:
$491.10

Component Description:
Project Management
Amount:
$70.00

Component Description:
Project Management
Amount:
$421.20

Component Description:
Project Management
Amount:
$2,409.55

Component Description:
Project Management
Amount:
$61.40

Component Description:
Project Management
Amount:
$853.40

Component Description:
Project Management
Amount:
$1,598.40

Component Description:
Project Management
Amount:
$380.45

Component Description:
Project Management
Amount:
$416.30

Component Description:
Project Management
Amount:
$1,676.10

Component Description:
Project Management
Amount:
$513.70

Component Description:
Project management
Amount:
$2,443.55

Component Description:
Project Management
Amount:
$143.60

Component Description:
Project Management
Amount:
$2,863.35

Component Description:
Project Management
Amount:
$406.65

Component Description:
Project management
Amount:
$921.65
Prepare Form 601 Information not provided.
Perform engineering study for displacement application Information not provided.
Prepare/ Review 399 reimbursement form 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 $6,574.14 $6,574.14 N/A $169.14 N/A
Total for all systems $468,721.32 $471,455.61 N/A $82,906.86 N/A
Other Expenses $6,574.14 $6,574.14 $169.14
Equipment Delivery and Handling Charges $169.14 $169.14 Please see Estimated Cost Justification KMNF-LD-610-Equipment Delivery and Handling v0 $169.14 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 - 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:
MN Sales Tax - Invoice 628006
Amount:
$10.88

Component Description:
FREIGHT AND SHIPPING
Amount:
$158.26
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 - 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 $468,721.32 $471,455.61 $82,906.86

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.

Robert Folliard , III .

Assistant Secretary


07/29/2021

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.

Robert Folliard , III .

Assistant Secretary


07/29/2021

Attachments

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