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:
18744
Service:
LPD
Call Sign:
KMMW-LD
Channel:
14 (UHF)
File Number:
0000088695
FRN:
0019509470
Eligibility Status:
Eligible
Date Submitted:
01/19/2023

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NBC TELEMUNDO LICENSE LLC

Angela Ball

300 NEW JERSEY AVENUE, NW

SUITE 700

WASHINGTON, DC 20001

United States

+1 (202) 524-6413 Angela.Ball@nbcuni.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Angela Ball

Assistant Secretary

NBCUniversal, LLC

300 New Jersey Avenue, NW

Washington, DC 20001

United States

+1 (202) 524-6413 Angela.Ball@nbcuni.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Install new antenna in place of existing analog antenna and new transmitter for new channel. The old transmitter and antenna will remain in place for interim use until the cut-over.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model SCA202UB
Year 2000
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.0 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model TMU9-3
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.8 kW
Justification for New Transmitter The old transmitter, SCA202UB, was no longer supported.

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? Yes
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 Yes
Description Installation of 240 V outlet behind transmitter.
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Installation and Commissioning at KMMW Stockton, CA

Installation and Commissioning at KMMW Stockton, CA

Other Transmitter Costs

Other Transmitter Costs

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? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model PSILP8ANR-28-CP
Year 2009

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: 5.5 kW
Manufacturer
Model SFN-2030-G-8
Year 2019
Justification for New Antenna The old antenna which was single channel would not operate on the new channel.

Primary Antenna

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Other Antenna Costs

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

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Other Antenna Cost Not Listed

Name Description

Installation Costs

Installation of Antenna

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

Tower Equipment And Rigging Costs

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

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? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1050375
Coordinates (NAD83) Latitude (NAD83) 38° 07' 09.7" N-
Longitude (NAD83) 120° 43' 30.9" W-
Overall Structure Height 415.02 feet
Support Structure Height 410.10 feet
Ground Elevation Above Mean Sea Level (AMSL) 2737.83 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers LLC
Date Constructed 09/02/1998

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
90988 KCAI FM

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: No reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 400
Explanation Project oversight of transmitter install, electrical connectivity, tower work, and antenna installation. Additional time will be spent tracking financial and legal process and coordinating with other broadcasters.
Outside RF consulting Engineering Services Perform engineering study for displacement application No
Prepare engineering section of Form FCC Construction Permit Application No
Prepare engineering section of Form FCC License to Cover Application No
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 No
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 No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 5
Justification Site survey required

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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

Name Description

DTV Medical Facility Notifications

DTV Medical Facility Notifications

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 $331,460.00 $195,810.72 N/A $137,126.42 N/A
Total for all systems $600,912.50 $750,833.22 N/A $500,730.05 N/A
Primary Transmitter TMU9-3 $331,460.00 $195,810.72 $137,126.42
Other Transmitter Costs $4,200.00 $4,200.00 N/A $4,200.00 N/A
Installation and Commissioning at KMMW Stockton, CA $22,000.00 $22,000.00 N/A $22,000.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $10,000.00 N/A $965.70 N/A
Channel 14 -- Additional field engineering time, 5 days $15,000.00 $15,000.00 N/A N/A N/A
Channel 14 Mask Filter $189,500.00 $29,390.00 N/A N/A N/A
RF Consulting Engineer $5,260.00 $5,260.00 N/A $0.00 N/A
Other Electrical Service: Installation of 240 V outlet behind transmitter. $1,500.00 $1,500.00 N/A $1,500.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $108,460.72 Actual costs exceeds predetermined costs $108,460.72 N/A

Components

Actual Information Description File Name
Other Transmitter Costs

Component Description:
Test RX Interference from transmitter
Amount:
$4,200.00
Installation and Commissioning at KMMW Stockton, CA

Component Description:
Remaining expenses- 50% invoiced on completion. Transmitter Installation and Commissioning
Amount:
$11,000.00

Component Description:
Transmitter Installation & Commissioning- 50% of the total cost
Amount:
$11,000.00
Transmitter Building Site Survey/Installation

Component Description:
KMMW Test RX interference from the Telemundo TV transmitter
Amount:
$4,200.00

Component Description:
Field Flanges for Installation
Amount:
$965.70
Channel 14 -- Additional field engineering time, 5 days Information not provided.
Channel 14 Mask Filter Information not provided.
RF Consulting Engineer Information not provided.
Other Electrical Service: Installation of 240 V outlet behind transmitter.

Component Description:
Furnish and install a new 240V single phase
Amount:
$1,500.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
TMU9-3, 1.8kW Ch 14 Transmitter with Spinner Sharp Filter. This is not a request for upgraded equipment.
Amount:
$108,460.72

Component Description:
TMU9-3 Transmitter System
Amount:
$108,460.72

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 $97,475.00 $100,245.00 N/A $93,895.00 N/A
Total for all systems $600,912.50 $750,833.22 N/A $500,730.05 N/A
Primary Antenna SFN-2030-G-8 $97,475.00 $100,245.00 $93,895.00
Installation Costs $63,745.00 $63,745.00 Antenna installations cost $63,745.00 N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 5.5kW input, Horizontal $28,000.00 $28,000.00 N/A $27,200.00 N/A
Sweep test of transmission line and antenna $5,730.00 $8,500.00 Estimated costs is less than predetermined costs estimate $2,950.00 N/A

Components

Actual Information Description File Name
Installation Costs

Component Description:
Broadcast Antenna Installation
Amount:
$20,810.00

Component Description:
Broadcast Antenna Installation
Amount:
$20,810.00

Component Description:
Antenna Reconstitution and Elevations Patterns
Amount:
$22,125.00
UHF-Low Power, Side Mount, Slotted Coaxial, 5.5kW input, Horizontal

Component Description:
Final 50% payment of the mount antenna on the Tower
Amount:
$13,600.00

Component Description:
Mount antenna on the Tower. please find attached quote for details.
Amount:
$13,600.00

Component Description:
SFN-2030-G-8 Antenna for Channel 14
Amount:
$13,600.00

Component Description:
SFN-2030-G-8 Antenna for Channel 14
Amount:
$13,600.00
Sweep test of transmission line and antenna

Component Description:
Sweep transmission line and Antenna
Amount:
$2,950.00

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $77,190.00 $77,190.00 N/A $20,512.00 N/A
Total for all systems $600,912.50 $750,833.22 N/A $500,730.05 N/A
Primary Tower GTOWER $77,190.00 $77,190.00 $20,512.00
Tower Rigging Short Tower (less than 500') $56,190.00 $56,190.00 tbd $16,512.00 N/A
Tower mapping and report for structural engineer $21,000.00 $21,000.00 tbd $4,000.00 N/A

Components

Actual Information Description File Name
Tower Rigging Short Tower (less than 500')

Component Description:
Capital contributions
Amount:
$5,000.00

Component Description:
Labor and travel to test RX interference from the Telemundo TV transmitter
Amount:
N/A

Component Description:
For KMMW 4660 Riata Way Angels Camp, CA 95222 antenna change-out
Amount:
$11,512.00
Tower mapping and report for structural engineer

Component Description:
BROADCAST STRUCTURAL expense
Amount:
$4,000.00

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 $62,332.50 $345,132.50 N/A $232,039.05 N/A
Total for all systems $600,912.50 $750,833.22 N/A $500,730.05 N/A
Outside Professional Services $62,332.50 $345,132.50 $232,039.05
Additional Field Engineering Service, 5 Days $7,500.00 $7,500.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A $714.00 N/A
Form 399 assistance or other Program Management costs $6,320.00 $6,320.00 N/A $5,336.70 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A $719.70 N/A
Project management of the transition $42,200.00 $325,000.00 Extra Project management work has been required for this project. KMMW has accrued a lot of hours because of the CH14 testing/coordination, which makes it more complicated than a normal displaced Low Power station. $224,304.75 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A $963.90 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 5 Days Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
License to cover application fees for the station call sign "KMMW"
Amount:
$35.70

Component Description:
Attorney fees for preparing notice of suspension of operations for displaced station KMMW-LD
Amount:
$535.00

Component Description:
License to cover the displacement CP for KMMW
Amount:
$71.40

Component Description:
license to cover the displacement CP for KMMW
Amount:
$71.40

Component Description:
Legal fees associated with the KMMW repack
Amount:
$535.50
Form 399 assistance or other Program Management costs

Component Description:
Legal fees for preparing form 1876
Amount:
$90.00

Component Description:
Attorney fees and other documentation for the station KMMW-LD
Amount:
$2,655.00

Component Description:
Review 399 reimbursement request for KMMW-LD
Amount:
$45.90

Component Description:
Attorney Fees- discuss status of testing with incumbent channel 14 two-way users to transition for the station
Amount:
$785.40

Component Description:
Legal fees for the discussing transitioning for the station KMMW.
Amount:
$142.80

Component Description:
Attorney Fees- discuss status of testing with incumbent channel 14 two-way users to transition for the station
Amount:
$428.40

Component Description:
Discuss transitioning displaced LPTV station- Attorney Fees
Amount:
$183.60

Component Description:
Attorney fees for the station KMMW
Amount:
$720.00

Component Description:
consultancy fees for Attorney for the station KMMW
Amount:
$285.60
Prepare/ Review 399 reimbursement form

Component Description:
Attention to FCC email regarding to allocation of reimbursement fund- Attorney fees
Amount:
$35.70

Component Description:
Review 399 reimbursement request for KMMW
Amount:
$459.00

Component Description:
Review 399 form reimbursement estimate
Amount:
$225.00
Project management of the transition

Component Description:
Point B October 2019 invoice for KMMW
Amount:
$4,424.00

Component Description:
KMMW - Point B invoice July 2020
Amount:
$34,011.00

Component Description:
Finance Repack resource services for the station(KMMW-LD)
Amount:
$18,611.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services- 18744.
Amount:
$316.00

Component Description:
Finance Repack resource services for the station(KMMW-LD)
Amount:
$16,880.00

Component Description:
Project Management Services for KMMW
Amount:
$237.00

Component Description:
Point B August 2019 invoice for PM work at KMMW
Amount:
$1,540.00

Component Description:
Project management services
Amount:
$4,740.00

Component Description:
KMMW-LD-Engagement Leader-Project Management Services
Amount:
$1,659.00

Component Description:
Point B September 2019 invoice for KMMW
Amount:
$1,659.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services- 18744
Amount:
$5,530.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services- 18744
Amount:
$948.00

Component Description:
KMMW - Point B invoice April 2020
Amount:
$18,611.00

Component Description:
KMMW - Point B invoice May 2020
Amount:
$16,880.00

Component Description:
Project management and Repack Finance resource- Professional services
Amount:
$13,590.00

Component Description:
Project Management and Repack Finance professional services
Amount:
$10,286.00

Component Description:
Finance Repack resource services for the station(KMMW-LD)
Amount:
$34,011.00

Component Description:
Point B invoice January 2020
Amount:
$9,461.00

Component Description:
Project Management services for KMMW
Amount:
$1,501.00

Component Description:
KMMW-LD-Engagement Leader-Project Management Services
Amount:
$5,911.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services-18744 - April 2022
Amount:
$8,848.00

Component Description:
KMMW - Point B invoice February 2020
Amount:
$13,590.00

Component Description:
Project management fee
Amount:
$4,740.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services- 18744
Amount:
$5,530.00

Component Description:
KMMW - Point B invoice June 2020
Amount:
$23,934.00

Component Description:
Repack Financial services for KMMW
Amount:
$5,688.00

Component Description:
KMMW - Point B invoice March 2020
Amount:
$10,286.00

Component Description:
Professional service rendered for KMMW.
Amount:
$25,597.75

Component Description:
Program Leader-Project Management Services
Amount:
$1,078.00

Component Description:
Finance Repack resource services for the station(KMMW-LD)
Amount:
$23,934.00

Component Description:
Project Management Services- 18744. Quoting and ordering equipment; Recurring project planning and status update meetings
Amount:
$1,540.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services- 18744
Amount:
$1,106.00

Component Description:
Project Management Services- 18744
Amount:
$3,157.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services- 18744 12/01/2021 - 12/31/2021
Amount:
$6,162.00

Component Description:
Project Management Services for KMMW
Amount:
$1,078.00

Component Description:
Project Management services
Amount:
$1,232.00

Component Description:
Point B November 2019 invoice for KMMW
Amount:
$5,911.00

Component Description:
Repack Finance Resource- project Management services
Amount:
$4,424.00

Component Description:
KMMW-LD-Engagement Leader-Project Management Services
Amount:
$5,897.00

Component Description:
KMMW-LD-Engagement Leader-Project Management Services
Amount:
$9,461.00

Component Description:
Project Management services
Amount:
$1,540.00

Component Description:
Project Management Services, Initial permitting research for KMMW LPTV and KMUM LPTV
Amount:
$150.00

Component Description:
KMMW-LD-Repack Finance Resource-Project Management Services- 18744
Amount:
$316.00

Component Description:
Point B invoice December 2019 KMMW
Amount:
$5,897.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Discuss transitioning process for the displaced channel-KMMW - Attorney Fees
Amount:
$392.70

Component Description:
Attorney fees- Cost shared 50/50 with KMMW and KBCW
Amount:
$571.20

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 $32,455.00 $32,455.00 N/A $17,157.58 N/A
Total for all systems $600,912.50 $750,833.22 N/A $500,730.05 N/A
Other Expenses $32,455.00 $32,455.00 $17,157.58
DTV Medical Facility Notifications $5,000.00 $5,000.00 N/A $4,950.00 N/A
Equipment Storage $6,000.00 $6,000.00 N/A $4,168.39 N/A
Equipment Delivery and Handling Charges $8,900.00 $8,900.00 N/A $8,039.19 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $4,960.00 N/A $0.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
AM Pattern Disturbance -- Impact study $5,260.00 $5,260.00 N/A $0.00 N/A

Components

Actual Information Description File Name
DTV Medical Facility Notifications

Component Description:
KMMW FCC ID 18744 Land Mobile Notification Mailing Complete per FCC Repack
Amount:
$4,950.00

Component Description:
KMMW FCC ID 18744 Land Mobile Notification Mailing
Amount:
$4,950.00
Equipment Storage

Component Description:
Two months Storage costs.
Amount:
$4,168.39
Equipment Delivery and Handling Charges

Component Description:
Shipping cost for the station
Amount:
$7,172.64

Component Description:
Shipping expenses Station EIN used to submit this item
Amount:
$866.55

Component Description:
Total line haul, only line item 1 requested for the payment. Station EIN is used for submission
Amount:
N/A
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Form 2100 Major change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
AM Pattern Disturbance -- Impact study Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $600,912.50 $750,833.22 $500,730.05

Reimbursement Status

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

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.

Angela Ball

Assistant Secretary


01/19/2023

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

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

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

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

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

Angela Ball

Assistant Secretary


01/19/2023

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