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:
73910-24
Service:
DRT
Call Sign:
WPXI
Channel:
24 (UHF)
File Number:
0000089689
FRN:
0014361083
Eligibility Status:
Eligible
Date Submitted:
07/22/2022

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WPXI, LLC

Doing Business As: WPXI, LLC

Director of Engineering

4145 EVERGREEN ROAD

PITTSBURGH, PA 15214

United States

+1 (412) 237-1100 otto@wpxi.com Limited Liability Company

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

Otto Schellin

Director of Engineering

WPXI-TV, LLC

Otto Schellin

4145 Evergreen Road

Pittsburgh, PA 15214

United States

+1 (412) 237-1184 otto@wpxi.com

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 Retune current transmitter to ch. 24. Replace current antenna and mask filter. Replace receive antenna ch. 48 tuned element with ch. 23 element. Channel 23 was displaced on 8/2/2019 and this translator has been off the air since.

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 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 Axcera
Model CU500BRD
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 500 W

Primary Transmitter

Back to Top

Retuning Transmitter Costs

Section Question Response
New Mask Filter Does the transmitter require a new mask filter? Yes
Mask Filter Type Full Service
Power 1kW
New Exciter Is a new exciter needed? No

Primary Transmitter

Back to Top

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

Back to Top

Other Transmitter Cost Not Listed

Name Description

Primary Transmitter - Other Expenses

Primary Transmitter - Other Expenses

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)
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? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
ERP: 2.0 kW
Manufacturer
Model ALP16L4-CSE-23
Year 2010

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
ERP: 2.0 kW
Manufacturer
Model TLP-8M/VP
Year 2019
Justification for New Antenna Old antenna cannot be retuned to new channel.

Primary Antenna

Back to Top

Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Primary 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? No

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)
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 No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1036480
Coordinates (NAD83) Latitude (NAD83) 39° 51' 16.5" N-
Longitude (NAD83) 079° 39' 20.9" W-
Overall Structure Height 237.86 feet
Support Structure Height 229.98 feet
Ground Elevation Above Mean Sea Level (AMSL) 2580.02 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Towers LLC
Date Constructed 07/01/1946

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
68409 WWKH-CD DTV

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? No

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Existing Primary Tower - Tower Mapping

Existing Primary Tower - Tower Mapping

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 194
Explanation WPXI (DRT) does not have sufficient resource capacity and expertise in house to handle all activities necessary for completion of the station's build by the construction deadline. WPXI (DRT) will hire an outside firm to facilitate a timely transition.
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 No
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 No
Form 399 assistance or other program management costs No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 2
Justification These field engineering costs were necessary for the WPXI1 new primary transmitter installation and other expenses necessitated by the repack

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Back to Top
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 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? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

Back to Top

Other Expenses Not Listed

Name Description

Electrical Work

Electrical work to relocate equipment in transmitter room

Notice to Proceed

Notice to Proceed

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 $18,450.00 $15,977.72 N/A $8,732.72 N/A
Total for all systems $150,406.70 $120,517.73 N/A $101,133.98 N/A
Primary Transmitter CU500BRD $18,450.00 $15,977.72 $8,732.72
Retune - UHF and VHF - minor re-channel issues $11,000.00 $7,245.00 Remote control system for monitoring and control of transmitter and exciter needed. Old exciter could not be retuned - we used an existing exciter from other location but that required new remote control to control and monitor $0.00 N/A
1kW w mask filter Full Service $3,350.00 $4,632.72 Please see Estimated Cost Justification WPXI1-110-Primary Transmitter - 1 kW Mask Filter, Full Service v0 $4,632.72 N/A
Primary Transmitter - Other Expenses $4,100.00 $4,100.00 Please see Wellington Power Corporation Quote #19656 & Invoice #7037-15660.pdf $4,100.00 N/A

Components

Actual Information Description File Name
Retune - UHF and VHF - minor re-channel issues Information not provided.
1kW w mask filter Full Service

Component Description:
UHF BandPass Fltr
Amount:
$4,632.72
Primary Transmitter - Other Expenses

Component Description:
Invoicing for WPXI Translator Relocation
Amount:
$4,100.00

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 $22,172.00 $22,842.00 N/A $19,967.00 N/A
Total for all systems $150,406.70 $120,517.73 N/A $101,133.98 N/A
Primary Antenna TLP-8M/VP $22,172.00 $22,842.00 $19,967.00
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Elliptical $16,442.00 $16,442.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Actual quoted cost from Dielectric. Includes antenna and mounting brackets. $16,442.00 N/A
Sweep test of transmission line and antenna $5,730.00 $6,400.00 Actual quote from Dielectric for sweep test (includes one field engineer on-site for one day, travel, expenses, and report) $3,525.00 N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Elliptical

Component Description:
UHF - High power side mount
Amount:
$16,442.00
Sweep test of transmission line and antenna

Component Description:
Daily Rate for Field Service - Sweep test transmission line and antenna
Amount:
$3,525.00

Cost Information

Back to Top

Transmission Line

Information not provided.

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 $62,182.70 $26,992.70 N/A $26,992.70 N/A
Total for all systems $150,406.70 $120,517.73 N/A $101,133.98 N/A
Primary Tower LTOWER $62,182.70 $26,992.70 $26,992.70
Existing Primary Tower - Tower Mapping $3,492.70 $3,492.70 Please see WPXI1 American Tower PO Request March 28, 2019 & Invoice #460219654.pdf $3,492.70 N/A
Existing Primary Tower - Tower Load Study $2,500.00 $2,500.00 Please see WPXI1 American Tower PO Request March 28, 2019 & Invoice #460219652.pdf $2,500.00 N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $21,000.00 Tower climber to remove old antenna, replace with new antenna, replace tuned elements from receive antenna. $21,000.00 N/A

Components

Actual Information Description File Name
Existing Primary Tower - Tower Mapping

Component Description:
Broadcast tower mapping
Amount:
$3,492.70
Existing Primary Tower - Tower Load Study

Component Description:
Broadcast structural
Amount:
$2,500.00
Tower Rigging Short Tower (less than 500')

Component Description:
Remove old & install new antenna
Amount:
$21,000.00

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 $35,362.00 $42,130.31 N/A $38,975.31 N/A
Total for all systems $150,406.70 $120,517.73 N/A $101,133.98 N/A
Outside Professional Services $35,362.00 $42,130.31 $38,975.31
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A $0.00 N/A
Project management of the transition $20,467.00 $24,048.05 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $24,048.05 x
Additional Field Engineering Service, 2 Days $5,100.00 $5,100.00 Please see Ed Murlatt & Associates, Inc. Quote #191212WPXIU & Invoice #WPXI200225U.pdf $5,100.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $1,798.75 Please see WPXI1 Attorney Other Matters Revision Justification Letter. The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $1,798.75 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $223.30 Please see WPXI1 Attorney License to Cover Revision Justification Letter $223.30 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $0.00 N/A
Perform engineering study for displacement application $1,800.00 $7,805.21 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $7,805.21 N/A

Components

Actual Information Description File Name
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$4,442.30

Component Description:
Project Management
Amount:
$3,608.40

Component Description:
Project Management
Amount:
$155.00

Component Description:
Project Management
Amount:
$1,241.55

Component Description:
Project management
Amount:
$124.30

Component Description:
Project Management
Amount:
$155.00

Component Description:
Project Management
Amount:
$155.00

Component Description:
Project Management
Amount:
$1,594.05

Component Description:
Project Management
Amount:
$175.15

Component Description:
Project Management
Amount:
$1,610.45

Component Description:
Project Management
Amount:
$330.15

Component Description:
Project management
Amount:
$40.30

Component Description:
Project Management
Amount:
$156.55

Component Description:
Project Management
Amount:
$389.05

Component Description:
Project Management
Amount:
$1,836.85

Component Description:
Project Management
Amount:
$1,404.60

Component Description:
Project Management
Amount:
$2,538.90

Component Description:
Project Management
Amount:
$3,623.90

Component Description:
Project Management
Amount:
$466.55
Additional Field Engineering Service, 2 Days

Component Description:
Field Service
Amount:
$5,100.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
For services rendered through May 31, 2018
Amount:
$778.10

Component Description:
For services rendered through February 29, 2020
Amount:
$129.45

Component Description:
For services rendered through January 31, 2020
Amount:
$891.20
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
For services rendered through February 29, 2020
Amount:
$223.30
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for displacement application

Component Description:
PROFESSIONAL SERVICES RENDERED
Amount:
$7,655.21

Component Description:
Professional Services Rendered
Amount:
$150.00

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 $12,240.00 $12,575.00 N/A $6,466.25 N/A
Total for all systems $150,406.70 $120,517.73 N/A $101,133.98 N/A
Other Expenses $12,240.00 $12,575.00 $6,466.25
Notice to Proceed $3,500.00 $3,500.00 Please see WPXI1 Notice to Proceed Budget Revision Justification Letter $3,500.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,500.00 $1,500.00 Estimate to remove old antenna and associated parts $0.00 N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $805.00 Please see WPXI1 FCC Filing Fees STA Revision Justification Letter $805.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $170.00 Please see WPXI1 FCC Filing Fees - LTC Budget Revision Justification Letter $170.00 N/A
Electrical Work $4,100.00 $4,100.00 Includes 208V, 30A service connection, removing existing electrical power wiring, and moving equipment $0.00 N/A
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 Estimated costs for antenna and mask filter freight. $1,991.25 N/A

Components

Actual Information Description File Name
Notice to Proceed

Component Description:
PO LINE 3 - NTP Billable - PROJECT MGMT
Amount:
$3,500.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request

Component Description:
For services rendered through June 30, 2018
Amount:
$805.00
FCC Filing Fees - Form 2100 license to cover application

Component Description:
For services rendered through March 31, 2020
Amount:
$170.00
Electrical Work Information not provided.
Equipment Delivery and Handling Charges

Component Description:
RFREIGHT
Amount:
$1,991.25

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $150,406.70 $120,517.73 $101,133.98

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. No

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.

Francis Bobro , Jr .

Engineering Manager


07/22/2022

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.

Francis Bobro , Jr .

Engineering Manager


07/22/2022

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.

Francis Bobro , Jr .

Engineering Manager


07/22/2022

Attachments

Back to Top