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:
13594
Service:
DTV
Call Sign:
WEDW
Channel:
21 (UHF)
File Number:
0000027937
FRN:
0003574662
Date Submitted:
10/04/2021

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CONNECTICUT PUBLIC BROADCASTING, INC.

Meg Sakellarides

1049 ASYLUM AVENUE

HARTFORD, CT 06105

United States

+1 (860) 278-5310 msakellarides@cptv.org Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

Back to Top
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 Purchase of a new transmitter, new transmission line, and new antenna. Current transmitter cannot be retuned to the new channel. Interim antenna and interim transmission line are planned during transition to main antenna.

Transmitters

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

Primary Transmitter

Back to Top

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 Ultimate TDU2 5K00LV
Year 2002
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 5 kW

Primary Transmitter

Back to Top

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 ULXTE-16
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 10.8 kW
Justification for New Transmitter Comark, the manufacturer, has indicated that the existing transmitter cannot be retuned to meet the new channel requirement. The existing transmitter is channel-specific.

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 100.0 feet
Other Electrical Service Yes
Description Labor and materials to accomplish either modification of existing electrical service or new electrical service and new wiring for new transmitter and 3-phase 208V and wiring for 480 3-phase.
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

Back to Top

Other Transmitter Cost Not Listed

Name Description

RF Line 3 and one eighth inches

Internal transmission line and RF system including elbow complex

Mask Filter

8-Pole Mask Filter

Antennas

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

Primary Antenna

Back to Top

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? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 170.0 kW
Manufacturer
Model TFU-20JDAS/P
Year 1980

Primary Antenna

Back to Top

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? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class 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: 120.0 kW
Manufacturer
Model SAA18-04A-J480-ET5R-21
Year 2019
Justification for New Antenna Existing antenna is single channel and is channel-specific. The new antenna is provided by RFS and includes an upgrade for elliptical polarization.

Primary Antenna

Back to Top

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 4 1/16 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? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Project Expenses

Other services

Rubbing Shoe

4-50/6 CONN QS

Spring Assy Watch Band

Spring Assy Watch Band Assy 1.38 ID QS

Reducer

Reducer 4-50 EIA X 3-50 STD QS

Screw Shoulder

1/4-20 5/16 DIA

Interim Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
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: 165.0 kW
Manufacturer
Model TFU-12DSB-J R
Year 2019
Justification for New Antenna In order to complete the project, an interim antenna is necessary while the main antenna is being replaced.

Interim Antenna

Back to Top

Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Interim Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

Back to Top
Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

Back to Top

Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
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 Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 600 feet per run

Primary Transmission Line

Back to Top

New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 600 feet per run
Justification for New Transmission Line Dielectric has indicated that the existing WR1500 motorized four-port switch and the existing WR1500 waveguides and adapters used both inside and outside to the horizontal run to the tower base will not work on channel 21.

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Name Description

Project Expenses

Other services

Primary Transmission Line - Additional Parts

Primary Transmission Line - Additional Parts

Interim Transmission Line

Back to Top

New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 4 1/16 inches
Segment Length 19 ¾ '
Other Segment Length
Number of parallel runs 1
Length 80 feet per run
Justification for New Transmission Line In order to complete the project, an interim transmission line is necessary while the main antenna is being replaced.

Interim Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1205267
Coordinates (NAD83) Latitude (NAD83) 41° 16' 44.3" N-
Longitude (NAD83) 073° 11' 06.4" W-
Overall Structure Height 491.14 feet
Support Structure Height 459.97 feet
Ground Elevation Above Mean Sea Level (AMSL) 520.01 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Pinnacle Towers LLC
Date Constructed 06/01/1953

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
48721 WEZN-FM FM
58515 WSHU-FM FM

Other Types of Users

Users
Cell Providers

Primary Tower

Back to Top

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? Yes

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Existing Primary Tower - Tower Mapping

Existing Primary Tower - Tower Mapping

Tower Lease

Additional tower rent expense for interim antenna and transmission line necessary during transition.

Existing Primary Tower-Tower Load Study

Existing Primary Tower-Tower Load Study

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 695
Explanation The transmitter manufacturer will project manage the project.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 18
Justification Engineer oversight work required during equipment installation.

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Project Expenses

See attached detailed estimate

Other Expenses

Back to Top
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 No
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)? 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

Back to Top

Other Expenses Not Listed

Name Description

Engineering and Administrative

Internal Project management

Cost Information

Back to Top

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 $590,719.30 $419,985.43 N/A $380,263.17 N/A
Total for all systems $1,890,640.08 $1,721,497.15 N/A $1,204,856.25 N/A
Primary Transmitter ULXTE-16 $590,719.30 $419,985.43 $380,263.17
4" Rigid Conduit and Wiring (Cost per foot) $10,100.00 $9,600.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $5,549.36 Please see quote Q-79872. This is a 75 KVA transformer, documented at 150 KVA due to lowest available in LMS. $0.00 N/A
RF Line 3 and one eighth inches $6,314.65 $6,314.65 Please see attached quote Q-79872 N/A N/A
Mask Filter $22,464.65 $22,464.65 Please see attached quote Q-79872. $22,464.64 N/A
Other Electrical Service: Labor and materials to accomplish either modification of existing electrical service or new electrical service and new wiring for new transmitter and 3-phase 208V and wiring for 480 3-phase. $31,790.00 $31,790.00 Per Eastside Electric Proposal #117042 grand total and Construction Services of Branford Proposal $17,890.00 N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $344,266.77 Please see Estimated Cost Justification WEDW-110-1st Primary Transmitter - UHF Liquid Cooled Solid State 4.9-6.5 kW v0 $339,908.53 N/A

Components

Actual Information Description File Name
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
RF Line 3 and one eighth inches Information not provided.
Mask Filter

Component Description:
1st Primary Transmitter - Mask Filter
Amount:
$3,130.00

Component Description:
WEDW-110-1st Primary Transmitter - Mask Filter
Amount:
$7,488.22

Component Description:
WEDW-110-1st Primary Transmitter - Mask Filter
Amount:
$4,358.21

Component Description:
WEDW-110-1st Primary Transmitter - Mask Filter
Amount:
$7,488.21
Other Electrical Service: Labor and materials to accomplish either modification of existing electrical service or new electrical service and new wiring for new transmitter and 3-phase 208V and wiring for 480 3-phase.

Component Description:
Materials
Amount:
$12,740.00

Component Description:
Work done at the Trumbull location
Amount:
$5,150.00
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
ULXTE-16 Transmitter
Amount:
$33,091.81

Component Description:
Electronic Equipment
Amount:
$365.00

Component Description:
ULXTE-16 Transmitter
Amount:
$65,264.57

Component Description:
ULXTE-16 Transmitter down payment
Amount:
$46,870.00

Component Description:
1/3 payment - ULXTE-16 Transmitter
Amount:
$112,134.57

Component Description:
ULXTE-16 Transmitter
Amount:
$82,182.58

Cost Information

Back to Top

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 $450,778.19 $286,519.19 N/A $231,277.25 N/A
Total for all systems $1,890,640.08 $1,721,497.15 N/A $1,204,856.25 N/A
Interim Antenna TFU-12DSB-J R $119,280.00 $64,296.00 $61,696.00
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $7,884.00 Please see Dielectric quote 800258CMZ-2 $7,884.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $50,012.00 Please see quote 800258CMZ-2. This cost includes estimated freight. $47,412.00 N/A
Primary Antenna SAA18-04A-J480-ET5R-21 $331,498.19 $222,223.19 $169,581.25
Screw Shoulder $78.75 $78.75 N/A N/A N/A
Reducer $1,860.00 $1,860.00 N/A N/A N/A
Spring Assy Watch Band $1,076.25 $1,076.25 N/A N/A N/A
Rubbing Shoe $288.75 $288.75 N/A N/A N/A
Project Expenses $17,134.44 $17,134.44 N/A N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 Please see Radio Frequency Systems Quote #20089331 & Invoice #16624370.pdf $5,000.00 N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $6,585.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,000.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $183,800.00 Please see attached RFS Quote 20093610 $158,581.25 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
WEDW-280-Interim Antenna - Custom Side Mount Bracket
Amount:
$3,060.00

Component Description:
WEDW-280-Interim Antenna - Custom Side Mount Bracket
Amount:
$2,365.20

Component Description:
WEDW-280-Interim Antenna - Custom Side Mount Bracket
Amount:
$93.60

Component Description:
WEDW-280-Interim Antenna - Custom Side Mount Bracket
Amount:
$2,365.20
Sweep test of existing antenna

Component Description:
Sweep & Pulse and undetermined length of flexible Transmission Line located at the WEDW-DT Transmitter site
Amount:
$2,460.00

Component Description:
INCLUDES ONE FIELD ENGINEER ON-SITE FOR ONE DAY
Amount:
$100.00

Component Description:
WEDW-280-Interim Antenna - Sweep Test
Amount:
$1,920.00

Component Description:
WEDW-280-Interim Antenna - Sweep Test
Amount:
$1,920.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
UHF Side Mount One Station Antenna
Amount:
$14,223.60

Component Description:
UHF- SIDE MOUNT
Amount:
$18,403.20

Component Description:
UHF - Side Mount One Station Antenna
Amount:
$14,223.60

Component Description:
FREIGHT, SHIPPING, AND HANDLING
Amount:
$561.60
Screw Shoulder Information not provided.
Reducer Information not provided.
Spring Assy Watch Band Information not provided.
Rubbing Shoe Information not provided.
Project Expenses Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
BDS ENGINEERING SCATTER STUDY
Amount:
$5,000.00
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
WEDW-210-Primary Antenna - Sweep Test
Amount:
$2,400.00

Component Description:
WEDW-210-Primary Antenna - Sweep Test
Amount:
$600.00

Component Description:
WEDW-210-Primary Antenna - Sweep Test
Amount:
$3,000.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
SAA18-04A-J480-ET5R-21 UHF Antenna
Amount:
$63,120.00

Component Description:
SAA18-04A-J480-ET5R-21 UHF Antenna
Amount:
$16,561.25

Component Description:
SAA18-04A-J480-ET5R-21 UHF Antenna
Amount:
$78,900.00

Cost Information

Back to Top

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 $102,826.40 $104,970.09 N/A $89,332.29 N/A
Total for all systems $1,890,640.08 $1,721,497.15 N/A $1,204,856.25 N/A
Interim Transmission Line $11,360.00 $48,012.09 $40,646.79
Rigid Transmission Line - copper, 4 1/16" $11,360.00 $48,012.09 see Estimated Cost Justification WEDW-380-Interim Transmission Line - 4 1:16" Air Dielectric v1 $40,646.79 N/A
Primary Transmission Line $91,466.40 $56,958.00 $48,685.50
Project Expenses $5,730.00 $5,730.00 N/A N/A N/A
Primary Transmission Line - Additional Parts $536.40 $536.40 Please see Radio Frequency Systems Quote #20098637 & Invoice #16626942.pdf $536.40 N/A
Rigid Transmission Line - copper, 4 1/16" $85,200.00 $50,691.60 See Estimated Cost Justification WEDW-310-Primary Transmission Line - Rigid Copper V0 $48,149.10 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 4 1/16"

Component Description:
CONN ANCHOR 3-50 W/SCALLOP INS "QS"
Amount:
$773.95

Component Description:
FREIGHT, SHIPPING, AND HANDLING
Amount:
$1,560.00

Component Description:
WEDW-380-Interim Transmission Line - 4 1/16" Air Dielectric
Amount:
$2,460.00

Component Description:
FREIGHT AND SHIPPING
Amount:
$704.54

Component Description:
WEDW-380-Interim Transmission Line - 4 1/16" Air Dielectric
Amount:
$4,870.50

Component Description:
INCLUDES ONE FIELD ENGINEER ON-SITE FOR ONE DAY, TRAVEL, EXPENSES AND REPORT
Amount:
$3,840.00

Component Description:
WEDW-380-Interim Transmission Line - 4 1/16" Air Dielectric
Amount:
$2,542.50

Component Description:
Other hanger assembly 4 fixed added per change order added 7.24.19
Amount:
$567.80

Component Description:
Flexible Transmission Line
Amount:
$3,146.00

Component Description:
WEDW-380-Interim Transmission Line - 4 1/16" Air Dielectric
Amount:
$9,898.35

Component Description:
WEDW-380-Interim Transmission Line - 4 1/16" Air Dielectric
Amount:
$9,898.35

Component Description:
WEDW-380-Interim Transmission Line - 4 1/16"" Air Dielectric
Amount:
$384.80
Project Expenses Information not provided.
Primary Transmission Line - Additional Parts

Component Description:
4 1/16" cover cap, with 1/8" NPT gas inlet plug.
Amount:
$536.40
Rigid Transmission Line - copper, 4 1/16"

Component Description:
4 1/16" Expansion Line Assy, 19.5'
Amount:
$4,814.91

Component Description:
4 1/6" Expansion Line Assy, 19.5'
Amount:
$16,717.14

Component Description:
4 1/16" Expansion Line Assy, 19.5'
Amount:
$24,074.55

Component Description:
Rigid Transmission Line
Amount:
$2,542.50

Cost Information

Back to Top

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 $258,715.00 $365,805.00 N/A $294,290.00 N/A
Total for all systems $1,890,640.08 $1,721,497.15 N/A $1,204,856.25 N/A
Primary Tower TOWER $258,715.00 $365,805.00 $294,290.00
Existing Primary Tower - Tower Mapping $2,500.00 $2,500.00 Please see Construction Services of Branford, LLC quote dated 6-30-20 $2,500.00 N/A
Tower Lease $71,515.00 $71,515.00 N/A N/A N/A
Existing Primary Tower-Tower Load Study $2,500.00 $2,500.00 Please see WEDW Existing Primary Tower-Tower Load Study Budget Revision Justification Letter $2,500.00 N/A
Tower Helicopter Lift $98,000.00 $98,000.00 Please see Northeast Towers, Inc. quote SSJR-20-1009-03 with email clarifying helicopter costs $98,000.00 N/A
Short Tower (less than 500') $84,200.00 $191,290.00 Please see Estimated Cost Justification WEDW-410-Existing Primary Tower - Tower Rigging and Equipment V0 $191,290.00 N/A

Components

Actual Information Description File Name
Existing Primary Tower - Tower Mapping

Component Description:
Labor - measure and map existing top plate
Amount:
$2,500.00
Tower Lease Information not provided.
Existing Primary Tower-Tower Load Study

Component Description:
Structural analysis
Amount:
$2,500.00
Tower Helicopter Lift

Component Description:
WEDW-410-Existing Primary Tower - Helicopter Lift: $24,500.00
Amount:
$24,500.00

Component Description:
WEDW-410-Existing Primary Tower - Helicopter Lift: $49,000.00
Amount:
$49,000.00

Component Description:
WEDW-410-Existing Primary Tower - Helicopter Lift: $24,500.00
Amount:
$24,500.00
Short Tower (less than 500')

Component Description:
Structural Analysis
Amount:
$5,000.00

Component Description:
50% Progress Invoice
Amount:
$74,945.00

Component Description:
25% Progress Invoice
Amount:
$37,472.50

Component Description:
WEDW - Installation of new side mounted TV antenna
Amount:
$36,400.00

Component Description:
25% Progress Invoice
Amount:
$37,472.50

Cost Information

Back to Top

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 $281,051.19 $338,217.44 N/A $176,529.69 N/A
Total for all systems $1,890,640.08 $1,721,497.15 N/A $1,204,856.25 N/A
Outside Professional Services $281,051.19 $338,217.44 $176,529.69
Project Expenses $14,980.00 $14,980.00 See attached detailed estimate N/A N/A
Additional Field Engineering Service, 18 Days $6,151.19 $6,151.19 WEDW Additional Field Engineering Services Budget Revision Justification Letter $6,151.19 see submitted invoices
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A $4,291.55 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $13,715.15 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $13,715.15 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $439.20 N/A
Prepare request for Special Temporary Authorization $4,100.00 $4,630.00 Please see WEDW-530-RF Eng - Special Temporary Authorization Budget Increase Justification Cover Letter v1 $4,630.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $26,000.00 Actual cost per invoices. $2,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $2,125.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $211.50 N/A
Project management of the transition $109,810.00 $140,339.60 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $140,339.60 N/A
Prepare and or review reimbursement form $2,630.00 $3,151.50 Professional Services Invoices $2,626.50 N/A

Components

Actual Information Description File Name
Project Expenses Information not provided.
Additional Field Engineering Service, 18 Days

Component Description:
Reimbursement is required for Peter Douglas
Amount:
$2,962.35

Component Description:
Engineering Services Expense Reimbursement
Amount:
$3,188.84

Component Description:
Reimbursement is required for Peter Douglas
Amount:
$3,188.84
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Review emails from FCC
Amount:
$144.00

Component Description:
WEDW-550-Attorney - Special Temporary Authorization
Amount:
$1,008.00

Component Description:
WEDW-550-Attorney - Special Temporary Authorization
Amount:
$378.00

Component Description:
WEDW-550-Attorney - Special Temporary Authorization
Amount:
$115.20

Component Description:
Draft exhibit STA to transition
Amount:
$2,048.75

Component Description:
WEDW-550-Attorney - Special Temporary Authorization
Amount:
$108.00

Component Description:
Email Exchange
Amount:
$489.60
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
WEDW-550-Attorney - Negotiate Lease and Other Matters
Amount:
$144.00

Component Description:
Legal services negotiating lease with Crown Castle for shared location.
Amount:
$900.00

Component Description:
WEDW-550-Attorney - Negotiate Lease and Other Matters
Amount:
$46.25

Component Description:
Invoice for legal services rendered through November 30, 2018.
Amount:
$139.50

Component Description:
Invoice for legal services rendered through May 31, 2019.
Amount:
$324.00

Component Description:
Legal services negotiating lease with Crown Castle for shared location.
Amount:
$1,200.00

Component Description:
a
Amount:
$685.00

Component Description:
Television Repacking Services - WEDW
Amount:
$378.00

Component Description:
Television Repacking Services - WEDW
Amount:
$1,080.00

Component Description:
Professional Services Rendered
Amount:
$2,658.60

Component Description:
Negotiate Lease and Other Matters
Amount:
$525.00

Component Description:
Professional Services Rendered
Amount:
$964.80

Component Description:
Legal services
Amount:
$432.00

Component Description:
Professional Services Rendered
Amount:
$60.30

Component Description:
Reversal of initial cost component submitted in error
Amount:
($2,400.00)

Component Description:
Reversal of initial cost component submitted in error
Amount:
($1,800.00)

Component Description:
Professional Services Rendered
Amount:
$120.60

Component Description:
Review FCC rulings denying applications
Amount:
$1,267.20

Component Description:
WEDW-550-Attorney - Negotiate Lease and Other Matters
Amount:
$54.00

Component Description:
Professional Services
Amount:
$115.20

Component Description:
Television Repacking Services - WEDW
Amount:
$279.00

Component Description:
WEDW-550-Attorney - Special Temporary Authorization
Amount:
$115.20

Component Description:
WEDW-550-Attorney - Negotiate Lease and Other Matters
Amount:
$662.40

Component Description:
Legal services negotiating lease with Crown Castle for shared location.
Amount:
$2,400.00

Component Description:
Reversal of initial cost component submitted in error
Amount:
($4,800.00)

Component Description:
Attorney - Negotiate Lease and Other Matters
Amount:
$221.00

Component Description:
Television Repacking Services - WEDW
Amount:
$325.50
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

Component Description:
Television Repacking Services
Amount:
$162.00

Component Description:
Professional Services
Amount:
$115.20

Component Description:
Legal Services
Amount:
$162.00
Prepare request for Special Temporary Authorization

Component Description:
E-filling of FCC engineering
Amount:
$450.00

Component Description:
Television Repacking Services - WEDW
Amount:
$2,430.00

Component Description:
Initial preparation of the engineering portion of the WEDW-DT STA request in Bridgeport/Stamford, CT
Amount:
$1,750.00
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:
Engineering services.
Amount:
$24,000.00

Component Description:
Engineering study Construction Permit Application (Main)
Amount:
$2,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$875.00

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$1,250.00

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$1,250.00

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$2,500.00

Component Description:
Reversal of initial cost component submitted
Amount:
($875.00)

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$2,500.00

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$875.00

Component Description:
Reversal of initial cost component submitted
Amount:
($2,500.00)

Component Description:
Reversal of initial cost component submitted
Amount:
($1,250.00)
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Attorney Fees to Address Transition Timing
Amount:
$39.00

Component Description:
Address transition timing and coordination.
Amount:
$39.00

Component Description:
Attorney Fees to Address Transition Timing
Amount:
$39.00

Component Description:
Reversal of initial cost component submitted
Amount:
$39.00

Component Description:
Address transition timing and coordination.
Amount:
$39.00

Component Description:
Reversal of initial cost component submitted
Amount:
($172.50)

Component Description:
Address transition timing and coordination.
Amount:
$172.50

Component Description:
Reversal of initial cost component submitted
Amount:
($39.00)

Component Description:
Attorney Fees to Address Transition Timing
Amount:
$172.50
Project management of the transition

Component Description:
Project Management
Amount:
$5,012.00

Component Description:
Project Management
Amount:
$2,596.25

Component Description:
Project Management
Amount:
$2,997.20

Component Description:
Project Management
Amount:
$250.00

Component Description:
Project Management
Amount:
$2,337.50

Component Description:
Project Management
Amount:
$2,511.60

Component Description:
Project management
Amount:
$3,511.85

Component Description:
Project Management
Amount:
$3,040.85

Component Description:
Project Management
Amount:
$4,298.55

Component Description:
Project Management
Amount:
$4,426.40

Component Description:
Project Management
Amount:
$3,657.90

Component Description:
Project Management
Amount:
$2,209.35

Component Description:
Project Management
Amount:
$3,016.80

Component Description:
Project management
Amount:
$8,071.05

Component Description:
Project Management
Amount:
$3,298.80

Component Description:
Project Management services for August, 2021.
Amount:
$2,913.75

Component Description:
Project Management
Amount:
$8,463.75

Component Description:
Project Management
Amount:
$8,197.95

Component Description:
Project Management
Amount:
$3,767.70

Component Description:
Project Management
Amount:
$2,287.95

Component Description:
Project Management
Amount:
$1,861.25

Component Description:
Project Management
Amount:
$2,472.15

Component Description:
Project Management
Amount:
$4,711.70

Component Description:
Project Management
Amount:
$3,838.05

Component Description:
Project Management
Amount:
$1,344.95

Component Description:
Project Management
Amount:
$4,149.95

Component Description:
Project Management
Amount:
$7,243.25

Component Description:
Project Management
Amount:
$3,736.65

Component Description:
Project management
Amount:
$3,439.45

Component Description:
Project Management
Amount:
$2,843.75

Component Description:
Project Management
Amount:
$257.70

Component Description:
Project Management
Amount:
$2,677.25

Component Description:
Project management
Amount:
$6,397.45

Component Description:
Project Management
Amount:
$553.75

Component Description:
Project Management
Amount:
$5,473.35

Component Description:
Project Management
Amount:
$2,472.15

Component Description:
Project Management
Amount:
$3,344.80

Component Description:
Project Management
Amount:
$1,577.50

Component Description:
Project Management
Amount:
$3,946.65

Component Description:
Project Management
Amount:
$3,602.80
Prepare and or review reimbursement form

Component Description:
Television Repacking Services - WEDW
Amount:
$711.00

Component Description:
Legal services for preparing, reviewing, and submitting FCC Reimbursement Form 399.
Amount:
$657.00

Component Description:
Legal services for preparing, reviewing, and submitting FCC Reimbursement Form 399.
Amount:
$375.00

Component Description:
Attorney Fees to prepare and review resubmitted Reimbursement Form 399
Amount:
N/A

Component Description:
Legal Services
Amount:
$651.00

Component Description:
Reversal of initial cost component submitted
Amount:
($618.00)

Component Description:
Reversal of initial cost component submitted
Amount:
($657.00)

Component Description:
Reversal of initial cost component submitted.
Amount:
($900.00)

Component Description:
Legal services preparing, reviewing, and submitting FCC Reimbursement Form 399
Amount:
$900.00

Component Description:
Legal services for preparing, reviewing, and submitting FCC Reimbursement Form 399.
Amount:
$618.00

Component Description:
Attorney Fees to prepare and review Reimbursement Form 399
Amount:
$657.00

Component Description:
Legal Services
Amount:
$232.50

Cost Information

Back to Top

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 $206,550.00 $206,000.00 N/A $33,163.85 N/A
Total for all systems $1,890,640.08 $1,721,497.15 N/A $1,204,856.25 N/A
Other Expenses $206,550.00 $206,000.00 $33,163.85
MVPD Notification of Channel Change $11,000.00 $11,000.00 N/A $2,216.00 N/A
Develop and air announcement of upcoming channel change $69,000.00 $69,000.00 See attachment for detailed justification. $270.00 N/A
Equipment Storage $10,000.00 $10,000.00 N/A $0.00 N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 N/A $18,911.94 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $40,000.00 $40,000.00 N/A $589.00 N/A
Non-zoning permits $10,000.00 $10,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $5,500.00 N/A
Local Zoning $10,000.00 $10,000.00 N/A N/A N/A
Engineering and Administrative $20,000.00 $20,000.00 N/A $5,676.91 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
WEDW-610-MVPD Notification
Amount:
$216.00

Component Description:
Prepare letters to MVPDs. Research and contact all relevant MVPD entities
Amount:
$2,000.00
Develop and air announcement of upcoming channel change

Component Description:
Email exchanges with M. Sakellarides
Amount:
$270.00
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Lull
Amount:
$3,749.06

Component Description:
Environmental, Crane, Labor
Amount:
$13,762.88

Component Description:
Labor - WEDW FCC Repack CH.21
Amount:
$1,400.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Bridgeport (CT)- Mixed Debris- 30 yard dumpster rental- 3 ton weight limit
Amount:
$589.00
Non-zoning permits Information not provided.
DTV Medical Facility Notification

Component Description:
Mailing: Print and mail a two page, black and white generically addressed letter
Amount:
$5,500.00
Local Zoning Information not provided.
Engineering and Administrative

Component Description:
Reimbursement is required for Peter Douglas
Amount:
$126.88

Component Description:
Modification Design
Amount:
$4,500.00

Component Description:
Peter Douglas's expenses incurred during a trip to CT to Repack
Amount:
$1,050.03

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,890,640.08 $1,721,497.15 $1,204,856.25

Reimbursement Status

Back to Top
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. Yes

Certification

Back to Top
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.

Meg Sakellarides

Chief Financial Officer


10/04/2021

Certification

Back to Top
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.

Meg Sakellarides

Chief Financial Officer


10/04/2021

Certification

Back to Top
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.

Meg Sakellarides

Chief Financial Officer


10/04/2021

Attachments

Back to Top