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:
63153
Service:
DTV
Call Sign:
WCAU
Channel:
34 (UHF)
File Number:
0000028212
FRN:
0019509470
Date Submitted:
08/20/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NBC TELEMUNDO LICENSE LLC

Margaret L. Tobey

300 NEW JERSEY AVENUE, NW

SUITE 700

WASHINGTON, DC 20001

United States

+1 (202) 524-6401 MARGARET.TOBEY@NBCUNI.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

Margaret L Tobey

NBCUniversal, LLC

300 New Jersey Ave. NW

Suite 700

Washington, DC 20001

United States

+1 (202) 524-6401 Margaret.Tobey@nbcuni.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 Use existing main transmitter on existing aux antenna. Remove main antenna,. Install new antenna, replace IOT aux with new solid state on new channel for use as main on new antenna. Replace IOT main with solid state as aux and replace aux antenna.

Transmitters

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

Auxiliary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use To maintain coverage when main transmitter or antenna are unavailable
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 DCX Millenium
Year 1998
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9-36
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 55 kW
Justification for New Transmitter New Solid State transmitter is requested as existing IOT is EOL. A Solid State transmitter is less expensive then a replacement IOT.

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Contractor estimate on electrical disconnect and reconnect.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 50000.0 square feet
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Architectural Modification

Architectural Labor, Electrical and mechanical addition

Transmitter Building Addition-modification and Leasehold improvement

Architectural, Electrical, Mechanical, HVAC demolition and restoration/New York

RF System

RF System for new transmitter: Filter and Output Switching

Transmission Facility Design

Design of floor plan and electrical plans for transmitter room

General Condition- permits, inspections, sight safety management, close out docs. and other services

General Condition - please see scope of work attached

Installation and Commissioning of WCAU AUX Transmitter System

AUX Transmitter installation and commissioning

HVAC installation

Removal old HVAC and install new one

Primary Transmitter

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Existing Transmitter Information

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 DCXP-2
Year 2009
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 55 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 THU9-60
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 88.5 kW
Justification for New Transmitter New Solid State transmitter is requested as existing IOT is EOL. A Solid State transmitter is less expensive then a replacement IOT.

Primary Transmitter

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Other Transmitter Costs

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 No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Installation, test and Commissioning

Transmitter Installation, test and commissioning and supervision

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use To maintain coverage when primary antenna is unavailable
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
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: 739.0 kW
Manufacturer
Model TFU-24JTH/VP-R O6
Year 2011

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Used to maintain coverage when main antenna is unavailable
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
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: 618.0 kW
Manufacturer
Model TFU-22JTH/VP-R O6
Year 2019
Justification for New Antenna New antenna required because existing auxiliary is single channel and will not work on new channel (Ch 28)

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
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

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

Building and Planning permit submittal-not included structural analysis

Scope if services related to Antenna

Transmission line Accessories for AUX Antenna

Transmission accessories for WCAU AUX

DACs Monitoring system

DACs system excludes installation and commissioning

Antenna Installation

Install ginpole and remove and replace top mounted antenna.

Primary Antenna

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Existing Antenna Information

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? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Elliptical
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: 700.0 kW
Manufacturer
Model TFU-24ETT/VP-R O6
Year 2009

Primary Antenna

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New Antenna Costs

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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Top
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: 618.0 kW
Manufacturer
Model TFU-22ETT/VP-R O6
Year 2019
Justification for New Antenna Existing antenna will not work on new channel (ch 28)

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
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? No

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Transmission Line accessories

transitions and connectors for installation

Antenna Installation

Remove and replace the existing top mounted NBC located on the South East arbor arm. Remove and replace the existing transmission line. Assist with test and tune of new system.

Helicopter pick- Main Antenna

Helicopter lift for WCAU main antenna

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

Auxiliary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use used to maintain coverage when main antenna is unavailable
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1025386
Coordinates (NAD83) Latitude (NAD83) 40° 02' 31.2" N-
Longitude (NAD83) 075° 14' 10.4" W-
Overall Structure Height 582.01 feet
Support Structure Height 507.87 feet
Ground Elevation Above Mean Sea Level (AMSL) 284.12 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner NBC Telemundo License LLC
Date Constructed 07/29/2005


Auxiliary Tower

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Tower Modification Costs

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: Serious Reinforcements needed

Auxiliary 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

Auxiliary Tower

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Other Tower Expenses Not Listed

Information not provided.

Primary Tower

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Existing Tower

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? Candelabra
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? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1231524
Coordinates (NAD83) Latitude (NAD83) 40° 02' 30.1" N-
Longitude (NAD83) 075° 14' 10.1" W-
Overall Structure Height 1254.91 feet
Support Structure Height 1124.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 292.98 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Global Tower, LLC. through American Towers, LLC
Date Constructed 11/02/2011

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
63153 WCAU 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: Study needed for undocumented/poorly documented tower
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 Candelabra
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 1040
Explanation Project oversight of transmitter install, electrical connectivity, tower work, and antenna installation. Additional time will be spent tracking financial and legal process and coordinating with other broadcasters.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development No
Prepare engineering section of Form FCC Construction Permit Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare engineering section of Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare request for Special Temporary Authority No
Quantity N/A
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
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 Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 40
Justification Ground level RF design

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
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 No
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

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 $6,838,550.00 $5,321,668.00 N/A $4,789,922.36 N/A
Total for all systems $10,307,439.00 $8,015,390.00 N/A $5,650,920.83 N/A
Primary Transmitter THU9-60 $2,805,000.00 $1,594,318.00 $1,592,318.00
Transmitter Installation, test and Commissioning $175,000.00 $175,000.00 N/A $173,000.00 N/A
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW $2,630,000.00 $1,419,318.00 N/A $1,419,318.00 1
Auxiliary Transmitter THU9-36 $4,033,550.00 $3,727,350.00 $3,197,604.36
Installation and Commissioning of WCAU AUX Transmitter System $109,000.00 $109,000.00 N/A $109,000.00 N/A
Other -- Building Addition Size: 50000.0 $15,000.00 $15,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $20,000.00 N/A $19,151.60 N/A
Architectural Modification $50,000.00 $50,000.00 Labor, Electrical and Mechanical addition $39,071.97 N/A
HVAC installation $225,000.00 $225,000.00 Remove existing and install new HVAC system $221,636.96 a
General Condition- permits, inspections, sight safety management, close out docs. and other services $75,000.00 $75,000.00 N/A $50,850.00 N/A
Transmitter Building Addition-modification and Leasehold improvement $400,000.00 $400,000.00 N/A $392,120.44 N/A
5 Ton system $20,250.00 $20,250.00 N/A N/A N/A
Transmission Facility Design $525,000.00 $525,000.00 N/A $507,794.45 N/A
RF System $88,100.00 $88,100.00 see attached transmitter proposal $63,728.50 N/A
Other Electrical Service: Contractor estimate on electrical disconnect and reconnect. $700,000.00 $700,000.00 N/A $672,135.70 N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,500,000.00 N/A $1,122,114.74 N/A

Components

Actual Information Description File Name
Transmitter Installation, test and Commissioning

Component Description:
Please see line 1 and 2
Amount:
$17,300.00

Component Description:
please see line item 1 and 2.
Amount:
$103,800.00

Component Description:
please see line item 1 & 2 from the invoice
Amount:
$51,900.00
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW

Component Description:
final 55% of the total cost. please find attached invoice with quote
Amount:
$183,011.00

Component Description:
deposit 45% of the total quote for transmitter RFS system cost
Amount:
$153,909.00

Component Description:
This is the invoice, purchase order, and quote for the main transmitter for this site. Included is a cover letter explaining which portion we want to be reimbursed for.
Amount:
$1,082,398.00
Installation and Commissioning of WCAU AUX Transmitter System

Component Description:
AUX transmitter to patch panel installation. please line item 1
Amount:
$11,000.00

Component Description:
remaining balance. please find attached Estimate
Amount:
$9,800.00

Component Description:
30% of the work done of WCAU AUX installation and commissioning
Amount:
$29,400.00

Component Description:
60% Major completion of AUX installation for WCAU
Amount:
$58,800.00
Other -- Building Addition Size: 50000.0 Information not provided.
Switchgear - industrial 800 amp

Component Description:
work completed for 15Kv switchgear
Amount:
$19,151.60
Architectural Modification

Component Description:
10% deducted from the line item 5 for retention proportionally
Amount:
$1,953.00

Component Description:
10% deducted from the line item 4-Architectural work for retention
Amount:
$3,907.26

Component Description:
Labor, electric and mechanical component addition and deduct 10% retention (3690.19)
Amount:
$33,211.71
HVAC installation

Component Description:
NBC WCAU repack part of 10 install coolers
Amount:
$10,283.35

Component Description:
WCAU Repack- part of NBC 10 install coolers
Amount:
$59,107.50

Component Description:
WCAU Repack- part of 10 NBC install Coolers
Amount:
$33,442.65

Component Description:
Install transmitter coolers and CRAC units
Amount:
$5,050.00

Component Description:
install heat exchangers, layout, install misc. pipes for the transmitter equipment
Amount:
$96,180.50

Component Description:
10% deducted for retention proportionally from invoice line item 8.
Amount:
$4,881.38

Component Description:
please see cover letter
Amount:
$5,857.65

Component Description:
HVAC installation for Office only and deduct 10% (759.32) for retention.
Amount:
$6,833.93
General Condition- permits, inspections, sight safety management, close out docs. and other services

Component Description:
10% deducted from the invoice line item 1 and 2 for retention
Amount:
$4,176.00

Component Description:
10% deducted for retention from invoice item 1&2
Amount:
$7,830.00

Component Description:
10% deducted for retention from invoice item 1
Amount:
$3,744.00

Component Description:
please line item 1 and 10% deduction for retention
Amount:
$9,360.00

Component Description:
WCAU AUX transmitter facility modified General conditions. Please see continuation sheet attached column E item 1 and minus 10% (2860.00) from the line item for retention
Amount:
$25,740.00
Transmitter Building Addition-modification and Leasehold improvement

Component Description:
T&M demolition work for additional Equipment
Amount:
$35,000.00

Component Description:
Labor to dismantle old transmission equipment
Amount:
$83,798.44

Component Description:
Retention release for all transmitter and building modification cost
Amount:
$117,329.51

Component Description:
10% deducted from the line item 3,4 11 on invoice for retention
Amount:
$16,872.75

Component Description:
Please see invoice item 2,3 and 8 and cover letter deducted 10% retention for each item
Amount:
$11,807.09

Component Description:
please see item 2-5 and 10 line item from the invoice for all demolition scope of work and minus 10% (14145.85) for retention from the line item
Amount:
$127,312.65
5 Ton system Information not provided.
Transmission Facility Design

Component Description:
Work completed for Design modifications/Plans and specifications
Amount:
$29,821.50

Component Description:
fees for Base Design for WCAU AUX Transmitter Facility
Amount:
$53,073.96

Component Description:
WCAUAUX transmitter facility design and other pending work
Amount:
$92,319.16

Component Description:
10% deducted for retention from the invoice line item 8.
Amount:
$16,537.50

Component Description:
please see line item 9 an 10 for reimbursement request and 10% deducted from each.
Amount:
$11,722.50

Component Description:
WCAU plans and specifications for the transmitter
Amount:
$82,783.20

Component Description:
Site Investigations, Report, plan and permit set, and construction phase services
Amount:
$66,285.84

Component Description:
Receipts not manageable and only construction and design portion are requested for reimbursement
Amount:
$60,739.41

Component Description:
Receipts are not attached. please see cover letter for the request
Amount:
$8,607.36

Component Description:
Review Equipment Data, Design Team Site Survey and Report Brief
Amount:
$9,307.36

Component Description:
Demo Plans
Amount:
$17,796.34

Component Description:
Room air-conditioning design to support new transmitter design; Demo plans
Amount:
$68,107.68

Component Description:
Design Coordination and Construction/Permit Set, Expenses
Amount:
$61,439.41
RF System

Component Description:
Electrical work for new Rohde & Schwarz transmitter and RF system install
Amount:
$42,045.00

Component Description:
RF system connection components from Dielectric
Amount:
$21,683.50
Other Electrical Service: Contractor estimate on electrical disconnect and reconnect.

Component Description:
New cable for transformer
Amount:
$18,886.58

Component Description:
Lump sum work for repack Electrical work
Amount:
$22,626.50

Component Description:
10% deducted for retention from the invoice item line 4
Amount:
$31,531.14

Component Description:
10% deducted for retention proportionally from invoice line item 6
Amount:
$157,655.70

Component Description:
10% deducted from the invoice line item 2.
Amount:
$126,124.56

Component Description:
10% deducted for the line item 5 on the invoice for retention
Amount:
$94,593.42

Component Description:
Electrical work. please see line item 7 on invoice and deduct 10% ($24,524.20) from the line item for retention
Amount:
$220,717.80
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
WRC AUX load kit is not reimbursable for WCAU station AUX transmitter expenses
Amount:
$158,735.00

Component Description:
T&M work for support of Transmission equipment install
Amount:
$49,959.74

Component Description:
This is the invoice for the aux transmitter for this site. This includes the quote and invoice. We are asking to be reimbursed for the total amount of the invoice.
Amount:
$913,420.00

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 $1,114,427.00 $1,038,007.00 N/A $579,091.33 N/A
Total for all systems $10,307,439.00 $8,015,390.00 N/A $5,650,920.83 N/A
Primary Antenna TFU-22ETT/VP-R O6 $730,400.00 $646,610.00 $288,961.73
Helicopter pick- Main Antenna $10,000.00 $10,000.00 Custom Lugs for Helicopter pick for MAIN WCAU antenna $5,710.00 N/A
Antenna Installation $363,600.00 $363,600.00 N/A $22,000.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $188,010.00 N/A $179,230.33 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $30,000.00 See attached quote $29,195.65 N/A
Transmission Line accessories $55,000.00 $55,000.00 Included in antenna proposal $52,825.75 N/A
Auxiliary Antenna TFU-22JTH/VP-R O6 $384,027.00 $391,397.00 $290,129.60
Transmission line Accessories for AUX Antenna $25,000.00 $25,000.00 N/A $24,825.90 N/A
DACs Monitoring system $33,342.00 $33,342.00 DACs monitoring system for WCAU $33,342.00 N/A
Building and Planning permit submittal-not included structural analysis $6,950.00 $6,950.00 Permitting Analysis Review and submittal Package $2,350.00 N/A
Antenna Installation $125,000.00 $125,000.00 N/A $125,000.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $20,000.00 please see attached quote $18,146.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 618 kW input, elliptically or circularly polarized $174,705.00 $174,705.00 N/A $86,465.70 N/A

Components

Actual Information Description File Name
Helicopter pick- Main Antenna

Component Description:
Custom lug for helicopter pick for Main Antenna
Amount:
$5,710.00
Antenna Installation

Component Description:
please see line item 3 and 4 from the invoice
Amount:
$2,200.00

Component Description:
Transmission line installation for Antenna test and tune. please see line 3 and 4.
Amount:
$13,200.00

Component Description:
Supervision of transmission line and Antenna line test and tune. please see line item 3 and 4.
Amount:
$6,600.00

Component Description:
Primary Tower install services
Amount:
$167,000.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
please see item 1. 2nd payment for this invoice
Amount:
$84,604.50

Component Description:
Remaining Balance payment for the Item 1. please see attached quote
Amount:
$10,021.33

Component Description:
See line 1 for Main Antenna
Amount:
$84,604.50

Component Description:
See line 1 of invoice
Amount:
$84,604.50
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Please see attached quote
Amount:
$6,035.00

Component Description:
please see attached adjusted Invoice for Elbow complex and other Transmission line component
Amount:
$17,588.30

Component Description:
See line 3 of invoice
Amount:
$5,572.35
Transmission Line accessories

Component Description:
Transmission line accessories- anchor, Gas Barrier, Elbow 8-75
Amount:
$14,034.75

Component Description:
Horizontal wall anchor, ceiling hanger and elbow 7-75.
Amount:
$19,648.00

Component Description:
See lines 2, 4-6 of invoice
Amount:
$19,143.00
Transmission line Accessories for AUX Antenna

Component Description:
Wall anchor for AUX antenna-WCAU
Amount:
$1,339.50

Component Description:
Transmission line accessories for WCAU AUX antenna
Amount:
$1,062.60

Component Description:
Transmission line accessories. please attached invoice
Amount:
$1,062.60

Component Description:
Elbow, EHT Coated, reducer for WCAU antenna accessories
Amount:
$10,261.20

Component Description:
Please see item 3 in the quote- rigid T/L for WCAU AUX
Amount:
$11,100.00
DACs Monitoring system

Component Description:
DACS monitoring system for WCAU transmitter
Amount:
$33,342.00
Building and Planning permit submittal-not included structural analysis

Component Description:
A&E Design Services permit drawings and Building and planning permit clearance
Amount:
$2,350.00
Antenna Installation

Component Description:
Aux Antenna System commissioning and transmitter Proof. please line item 2
Amount:
$10,000.00

Component Description:
Install cost for WCAU aux antenna
Amount:
$57,500.00

Component Description:
aux install for WCAU
Amount:
$57,500.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Please see item 2 in attached quote
Amount:
$12,383.00

Component Description:
Elbow 7-75 digit EHT. please attached quote
Amount:
$5,763.00

Component Description:
This is only for the cost of line item 2. The elbow complex
Amount:
$5,572.35
Sweep test of existing antenna Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 618 kW input, elliptically or circularly polarized

Component Description:
Please line item 1 for the request for reimbursement.
Amount:
$86,465.70

Component Description:
Updated invoice date. This only accounts for the cost of line item 1 on this invoice.
Amount:
$86,465.70

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 $1,880,400.00 $1,179,383.00 N/A $14,600.00 N/A
Total for all systems $10,307,439.00 $8,015,390.00 N/A $5,650,920.83 N/A
Auxiliary Tower TOWER $1,275,100.00 $714,600.00 $14,600.00
Structural engineering tower load study for well documented tower $12,600.00 $14,600.00 Structural analysis and tower mapping for load study $14,600.00 a
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A N/A N/A
Serious tower reinforcement/modifications $1,052,000.00 $500,000.00 N/A N/A N/A
Primary Tower GTOWER $605,300.00 $464,783.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $14,783.00 Tower mapping and structural engineering $0.00 N/A
Minor tower reinforcement/modifications $158,000.00 $50,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Structural engineering tower load study for well documented tower

Component Description:
Structural analysis for load study
Amount:
$6,333.33

Component Description:
WCAU_Broadcast Tower mapping expenses
Amount:
$8,266.67

Component Description:
This is just for the cost of the structural engineering tower load study with no tax. It does not include the cost for mapping. UPDATED INVOICE.
Amount:
$6,333.33
Tall Tower (greater than 500') Information not provided.
Serious tower reinforcement/modifications Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
This is just for the cost of the broadcast tower mapping plus tax. It does not include the structural. UPDATED INVOICE
Amount:
$8,928.00
Minor tower reinforcement/modifications 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 $326,665.00 $336,250.00 N/A $210,191.48 N/A
Total for all systems $10,307,439.00 $8,015,390.00 N/A $5,650,920.83 N/A
Outside Professional Services $326,665.00 $336,250.00 $210,191.48
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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 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 $453.60 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $648.09 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $164,320.00 $220,000.00 Project Management costs higher than predetermined $204,014.98 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $40,000.00 N/A N/A N/A
Additional Field Engineering Service, 40 Days $40,000.00 $40,000.00 N/A $5,074.81 N/A
RF Exposure Measurements $21,050.00 $20,000.00 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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of minor change application, see line 1 of invoice less 10% vendor discount.
Amount:
$37.80

Component Description:
Preparation of minor change application
Amount:
$415.80
Prepare and or review reimbursement form

Component Description:
Amendment of 399 estimates
Amount:
$189.00

Component Description:
See lines 2-4 of invoice, less 10% vendor discount.
Amount:
$371.79

Component Description:
Review of Form 399.
Amount:
$43.65

Component Description:
Review of Form 399
Amount:
$43.65
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
WCAU Aerial lift rescheduling for pre-construction on July 2019
Amount:
$2,732.91

Component Description:
WCAU Aerial lift coordination- June 2019
Amount:
$750.00

Component Description:
WCAU Aerial lift Coordination
Amount:
$750.00

Component Description:
Professional services- Site visit. Please see attached Expense receipts
Amount:
$3,974.62

Component Description:
Coordination and transition planning with all parties onsite.
Amount:
$5,000.00

Component Description:
Point B Project Management September 2019
Amount:
$18,177.50

Component Description:
WNEU Point B project management May 2019
Amount:
$19,414.00

Component Description:
Point B Project Management November 2019
Amount:
$5,706.00

Component Description:
Point B Project Management January 2020
Amount:
$4,370.00

Component Description:
June 2018 Project Management
Amount:
$4,750.00

Component Description:
WCAU Project Management Fees from Point B
Amount:
$10,018.00

Component Description:
Point B Project Management August 2019
Amount:
$19,688.46

Component Description:
August 2018 Project Management
Amount:
$150.00

Component Description:
Project Management Services
Amount:
$348.95

Component Description:
WCAU Project Management Fees from Point B
Amount:
$19,688.46

Component Description:
August 2018 Project Management
Amount:
$5,215.00

Component Description:
Point B project management services for the month of February 2019. See line item.
Amount:
$3,150.00

Component Description:
Modified Point B invoice that includes hours breakdown by resource
Amount:
$600.00

Component Description:
WCAU Project Management Fees from Point B
Amount:
$948.00

Component Description:
Modified SIN001067 invoice to include a breakdown of resource time
Amount:
$4,200.00

Component Description:
WCAU - Point B invoice February 2020
Amount:
$4,830.00

Component Description:
Point B Project Management December 2019
Amount:
$5,720.00

Component Description:
Project Management for Point B for the month of July 2019. These are the new set of invoices with line items describing work done with associated hours.
Amount:
$22,776.70

Component Description:
Project Management
Amount:
$5,060.00

Component Description:
Project management and expenses, see attachments for expense receipts
Amount:
$3,356.09

Component Description:
WCAU - Point B invoice April 2020
Amount:
$2,386.00

Component Description:
Project Management Services
Amount:
$4,200.00

Component Description:
Project Management Services
Amount:
$2,145.00

Component Description:
WNEU Point B project management August 2019
Amount:
$17,546.60

Component Description:
Project Management
Amount:
$600.00

Component Description:
Project management April 18
Amount:
$3,024.70

Component Description:
Project Management Services
Amount:
$975.00

Component Description:
WCAU - Point B invoice May 2020
Amount:
$6,108.00

Component Description:
Point B Project Management July 2019
Amount:
$22,776.70

Component Description:
Project Management Services
Amount:
$1,365.00

Component Description:
Project Management
Amount:
$2,374.50

Component Description:
Project Management Invoice
Amount:
$1,670.65

Component Description:
Modified SIN008963 invoice to include a breakdown of hours by resource
Amount:
$22,776.40

Component Description:
October 2018 Project Management
Amount:
$1,650.00

Component Description:
WCAU - Point B invoice March 2020
Amount:
$3,220.00

Component Description:
WNEU Point B Project Management September 2019
Amount:
$6,900.00

Component Description:
WCAU Project Management Fees from Point B
Amount:
$8,868.00

Component Description:
July 2018 Project Management
Amount:
$6,905.00

Component Description:
Project Management Services
Amount:
$1,072.50

Component Description:
Point B Project Management October 2019
Amount:
$5,662.00

Component Description:
November 2018 Project Management
Amount:
$4,650.00

Component Description:
Point B Project Management January 2019
Amount:
$1,950.00
Comprehensive coverage verification via field study, if needed Information not provided.
Additional Field Engineering Service, 40 Days

Component Description:
Engineering Site Survey, see attached site survey report for supporting documentation.
Amount:
$5,074.81
RF Exposure Measurements 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 $147,397.00 $140,082.00 N/A $57,115.66 N/A
Total for all systems $10,307,439.00 $8,015,390.00 N/A $5,650,920.83 N/A
Other Expenses $147,397.00 $140,082.00 $57,115.66
Equipment Delivery and Handling Charges $30,000.00 $30,000.00 N/A $28,645.66 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A N/A N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Local Zoning $10,817.00 $10,817.00 $4,700 to prepare tower documents $4,700 to prepare ground documents $750 permit application $667 public hearing N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $4,250.00 N/A $4,250.00 N/A
MVPD Notification of Channel Change $12,000.00 $12,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $30,000.00 $30,000.00 N/A N/A N/A
Equipment Storage $25,000.00 $25,000.00 N/A $24,220.00 N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
storage and handling of equipment
Amount:
$20,214.58

Component Description:
Shipping and handling cost. please see attached invoice
Amount:
$269.32

Component Description:
Please see line item 1 for shipping expenses
Amount:
$2,808.19

Component Description:
please line item 1 for the shipping cost.
Amount:
$2,822.32

Component Description:
please see line item 1 for the freight charge.
Amount:
$2,531.25
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

Component Description:
WCAU FCC ID 63153 Medical Notification Mailing complete per FCC repack
Amount:
$4,250.00
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Chapman 48' flatbed storage cost. please see line item 2 on the invoice
Amount:
$1,200.00

Component Description:
Please line item 2 for the storage expenses
Amount:
$15,900.00

Component Description:
Delivery and PAF VAN 15 months storage cost. Please item 2 on invoice
Amount:
$7,120.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $10,307,439.00 $8,015,390.00 $5,650,920.83

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.

Margaret L. Tobey

Assistant Secretary


08/20/2021

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.

Margaret L. Tobey

Assistant Secretary


08/20/2021

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.

Margaret L. Tobey

Assistant Secretary


08/20/2021

Attachments

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