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:
16230
Service:
LPD
Call Sign:
KSOY-LD
Channel:
34 (UHF)
File Number:
0000089365
FRN:
0022119663
Eligibility Status:
Eligible
Date Submitted:
05/10/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

EDUARDO S. GALLEGOS

Applicant

Doing Business As: EDUARDO S. GALLEGOS

5232 RUSTIC MANOR

BROWNSVILLE, TX 78526

United States

+1 (956) 346-5328 EDUARDOGALLEGOS@ME.COM Other

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Tony Zummallen

President

QCommunications, LLC

Tony zumMallen

705 SE MELODY LN

STE B

LEES SUMMIT, MO 64063

United States

+1 (816) 729-1177 Tony@qcomm.tv

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Primary RF 44 to Primary RF 34. We are changing transmission line, replacing filter, and replacing antenna.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer GatesAir
Model USXT
Year 2014
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.5 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New Mask Filter Does the transmitter require a new mask filter? Yes
Mask Filter Type Full Service
Power 1.1-2kW
New Exciter Is a new exciter needed? No

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 16
Design power capacity in use 50.0 %
Lower Limit 650.00 MHz
Upper Limit 656.00 MHz
ERP: 15.0 kW
Manufacturer
Model ALP16L2-8SER-44
Year 2014

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model TLP-16M (SP)
Year 2022
Justification for New Antenna Old antenna cannot be retuned.

Primary Antenna

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Other Antenna Costs

Section Question Response
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? Yes
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

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Leased
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 4 1/16 inches
Segment Length 20 inches
Number of parallel runs 72
Length 20 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 4 1/16 inches
Segment Length 19 1/2 inches
Number of parallel runs 72
Length 19 feet per run
Justification for New Transmission Line Electrical performance of the current line is not compatible with RF 34
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Removal of Existing Line

Costs to remove existing transmission line

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership 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 Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1222106
Coordinates (NAD83) Latitude (NAD83) 26° 06' 02.3" N-
Longitude (NAD83) 097° 50' 21.5" W-
Overall Structure Height 1491.12 feet
Support Structure Height 1402.87 feet
Ground Elevation Above Mean Sea Level (AMSL) 56.10 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Pinnacle Towers LLC
Date Constructed 08/20/2001

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
43328 KRGV-TV DTV
40777 KBFM FM
12523 KVEO-TV DTV
64631 KTEX FM

Other Types of Users

Users
US Gov't Use

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Tower mapping and report for structural engineer
Tower Reinforcements Please select whether tower reinforcements are needed: Major 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

Name Description

Structural Analysis and Site Inspection

Structural Analysis and Site Inspection

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 80
Explanation No expertise.
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Prepare Form 601 No
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 3
Justification Change of RF, proof of performance, making certain direction antenna is correct

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Outside Engineering Services

General engineering services

General Legal

General Legal Services

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application 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
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $15,050.00 $15,050.00 N/A $0.00 N/A
Total for all systems $531,944.50 $568,229.95 N/A $280,983.63 N/A
Primary Transmitter USXT $15,050.00 $15,050.00 $0.00
1.1-2kW w mask filter Full Service $4,050.00 $4,050.00 N/A N/A N/A
Retune - UHF and VHF - minor re-channel issues $11,000.00 $11,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $44,185.00 $49,214.00 N/A $41,142.60 N/A
Total for all systems $531,944.50 $568,229.95 N/A $280,983.63 N/A
Primary Antenna TLP-16M (SP) $44,185.00 $49,214.00 $41,142.60
Pattern scatter analysis for side mount (if not included in antenna base cost) $3,500.00 $3,500.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Horizontal $20,760.00 $20,760.00 Antenna TLP-16M Ch34 per Dielectric Quote 1935142 $18,684.00 N/A
Sweep test of transmission line and antenna $5,730.00 $6,400.00 Per Dielectric Quote 1935142 $5,760.00 N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $6,054.00 Per Dielectric quote 1935142 $5,448.60 N/A
Side Mount antenna brackets $4,625.00 $12,500.00 Custom Pole Mounts per Dielectric Quote 1935142 $11,250.00 N/A

Components

Actual Information Description File Name
Pattern scatter analysis for side mount (if not included in antenna base cost) Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Horizontal

Component Description:
Antenna - Dielectric
Amount:
$18,684.00
Sweep test of transmission line and antenna

Component Description:
Repack Sweep - Dielectric
Amount:
$5,760.00
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
Elbow - Dielectric
Amount:
$5,448.60
Side Mount antenna brackets

Component Description:
Custom Pole Mounts
Amount:
$11,250.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $213,264.00 $223,784.25 N/A $160,905.83 N/A
Total for all systems $531,944.50 $568,229.95 N/A $280,983.63 N/A
Primary Transmission Line $213,264.00 $223,784.25 $160,905.83
Removal of Existing Line $35,000.00 $35,000.00 N/A N/A N/A
Rigid Transmission Line - copper, 4 1/16" $168,264.00 $178,784.25 Per Dielectric quote 1935142 $160,905.83 N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $10,000.00 $10,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Removal of Existing Line Information not provided.
Rigid Transmission Line - copper, 4 1/16"

Component Description:
Transmission line and component parts - Dielectric
Amount:
$160,905.83
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators 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 $126,780.00 $126,780.00 N/A $23,820.00 N/A
Total for all systems $531,944.50 $568,229.95 N/A $280,983.63 N/A
Primary Tower TOWER $126,780.00 $126,780.00 $23,820.00
Major tower reinforcement/modifications $69,280.00 $69,280.00 Per Rio Steel proposal dated 10/27/21 $17,320.00 N/A
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $30,000.00 $30,000.00 N/A N/A N/A
Tower mapping and report for structural engineer $21,000.00 $21,000.00 N/A N/A N/A
Structural Analysis and Site Inspection $6,500.00 $6,500.00 Per actual Crown Castle invoice $6,500.00 N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications

Component Description:
Tower Rigging/antenna removal and install.
Amount:
$17,320.00
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) Information not provided.
Tower mapping and report for structural engineer Information not provided.
Structural Analysis and Site Inspection

Component Description:
Structural analysis and site inspection - Crown - INV 303393
Amount:
$6,500.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $110,220.50 $130,956.70 N/A $55,115.20 N/A
Total for all systems $531,944.50 $568,229.95 N/A $280,983.63 N/A
Outside Professional Services $110,220.50 $130,956.70 $55,115.20
General Legal $7,112.50 $7,112.50 Per actual invoice amounts $7,112.50 N/A
Outside Engineering Services $4,580.00 $4,580.00 Per actual invoices $4,580.00 N/A
Additional Field Engineering Service, 3 Days $15,000.00 $15,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $52,600.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $3,262.50 N/A $3,262.50 This is the amount charged
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $9,787.50 this is the amount charged $9,787.50 This is the amount charged.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,101.50 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Form 399 assistance or other Program Management costs $7,958.00 $7,958.00 Per actual invoice amounts $7,958.00 This is the amount charged
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Project management of the transition $8,440.00 $22,414.70 Per actual costs $22,414.70 Estimated same as actual

Components

Actual Information Description File Name
General Legal

Component Description:
Legal services - Brooks Pierce - INV 4013389
Amount:
$7,112.50
Outside Engineering Services

Component Description:
Engineering - Lohnes - INV 202201-1619-01
Amount:
$4,580.00
Additional Field Engineering Service, 3 Days Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Legal Fees
Amount:
$3,262.50
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:
Legal Fees
Amount:
$9,787.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for displacement application Information not provided.
Form 399 assistance or other Program Management costs

Component Description:
April 2022 PM - QComm - INV 20220511
Amount:
$308.00

Component Description:
Legal fees
Amount:
$7,650.00
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition

Component Description:
April 2022 Tech PM - QComm - INV 20220511
Amount:
$3,080.00

Component Description:
October 2021 PM Hours - QComm - INV 230076
Amount:
$2,109.80

Component Description:
Jan 2022 PM - QComm - INV 220028
Amount:
$3,619.00

Component Description:
Dec 2021 PM - QComm - INV 2022007
Amount:
$5,005.00

Component Description:
March 2022 PM - QComm - INV 20220306
Amount:
$3,565.10

Component Description:
Nov 2021 PM Hours - QComm - INV 230092
Amount:
$1,078.00

Component Description:
Feb 2022 PM - QComm - INV 220044
Amount:
$3,957.80

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 $22,445.00 $22,445.00 N/A $0.00 N/A
Total for all systems $531,944.50 $568,229.95 N/A $280,983.63 N/A
Other Expenses $22,445.00 $22,445.00 $0.00
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A
Equipment Storage $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $8,000.00 $8,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $8,000.00 $8,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $531,944.50 $568,229.95 $280,983.63

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

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

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Eduardo Gallegos

Applicant


05/10/2022

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.

Eduardo Gallegos

Applicant


05/10/2022

Attachments

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