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:
130443
Service:
LPA
Call Sign:
DWNDC-LD
Channel:
17 (UHF)
File Number:
0000089812
FRN:
0017580168
Eligibility Status:
Eligible
Date Submitted:
06/28/2023

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

IGLESIA MANMIN TODA LA CREACION USA INC.

Doing Business As: IGLESIA MANMIN TODA LA CREACION USA INC.

Esteban Handal

1640 WEST FLAGLER ST.

MIAMI, FL 33130

United States

+1 (837) 231-7255 estebanhandal@gmail.com Not-for-Profit

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

Jeffrey C Gehman

Engineering Associate

Kessler and Gehman Associates, Inc.

Jeffrey C. Gehman

507-D NW 60th Street

Gainesville, FL 32607

United States

+1 (352) 332-3157 jeff@kesslerandgehman.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 Moving from channel 2 VHF to channel 17 UHF we need to do the following: purchase a new transmitter purchase a new antenna purchase a new coax cable and move to a new transmitter site

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? No
Existing Transmitter Manufacturer and Type Manufacturer
Model E1000
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 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 BE-TV1000-FAVI
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter We are changing channels from 2 VHF to 17 UHF channel. The old transmitter cannot be re-tuned.

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 Yes
Description 100 amp circuit
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
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

Site survey and training

Site survey and training

Filter

Filter

Filter Mounting Kit

Filter Mounting Kit

Surge Suppressor

Surge Suppressor

Single Rack Cabinet

Single Rack Cabinet

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? No
Is antenna in operating condition? No
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 Middle
Polarization Horizontal
Type Other
Other Antenna Type Dipole Flat Panel
ERP: 3.0 kW
Manufacturer
Model JHD-LV4
Year 2010

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? No
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 Middle
Polarization Horizontal
Type Other
Other Antenna Type non-directional
ERP: 0.25 kW
Manufacturer
Model JUHD-1/4
Year 2019
Justification for New Antenna We need to move from 11 VHF Channel to 17 UHF Channel. The antenna cannot be re-tuned.

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? No

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 Owned
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 Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 50 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 Flexible Air
Diameter 7/8 inches
Number of parallel runs 1
Length 250 feet per run
Justification for New Transmission Line New installation on tower
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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? Terrain Constrained
Is this tower currently shared with any other stations? 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? No
Coordinates (NAD83) Latitude (NAD83) 38° 20' 42.42" N-
Longitude (NAD83) 075° 16' 58.7" W-
Overall Structure Height 20.00 feet
Support Structure Height 20.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 19.00 feet
Structure Type other -
Tower Owner Mobil Tower
Date Constructed 09/09/2007


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
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 Terrain constrained
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 8
Explanation Iglesia Manmin does not have the expertise to perform work. It therefore will need to hire outside professional services.
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 No
RF exposure measurements Yes
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
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)? No
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

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Other Expenses Not Listed

Name Description

RF Engineer

RF Engineer

AV Rack

AV Rack

EAS

EAS

Encoder MUX

Encoder MUX

Generator

Generator

HVAC Installation

HVAC Installation

TX Site Conditioning

TX Site Conditioning

Travel

Travel

UPS

UPS

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 $170,650.00 $140,400.00 N/A $0.00 N/A
Total for all systems $425,764.00 $398,813.50 N/A $18,964.50 N/A
Primary Transmitter BE-TV1000-FAVI $170,650.00 $140,400.00 $0.00
Site survey and training $20,000.00 $20,000.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Filter Mounting Kit $2,700.00 $2,700.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Surge Suppressor $2,800.00 $2,800.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Single Rack Cabinet $1,700.00 $1,700.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
5 Ton system $20,250.00 $4,500.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Other Electrical Service: 100 amp circuit $25,000.00 $25,000.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $69,500.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Filter $14,200.00 $14,200.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A

Components

Actual Information Description File Name
Site survey and training

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$20,000.00
Filter Mounting Kit

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$2,700.00
Surge Suppressor

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$2,800.00
Single Rack Cabinet

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$1,700.00
5 Ton system

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$4,500.00
Other Electrical Service: 100 amp circuit

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$25,000.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$69,500.00
Filter

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$14,200.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $9,900.00 $9,900.00 N/A $0.00 N/A
Total for all systems $425,764.00 $398,813.50 N/A $18,964.50 N/A
Primary Antenna JUHD-1/4 $9,900.00 $9,900.00 $0.00
UHF-Low Power, Side Mount, Other, 0.25kW input, Horizontal $9,900.00 $9,900.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Other, 0.25kW input, Horizontal

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$9,900.00

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 $4,500.00 $3,750.00 N/A $0.00 N/A
Total for all systems $425,764.00 $398,813.50 N/A $18,964.50 N/A
Primary Transmission Line $4,500.00 $3,750.00 $0.00
Flexible Air Transmission Line - dielectric, 7/8" $4,500.00 $3,750.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 7/8"

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$3,750.00

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 $59,000.00 $59,000.00 N/A $0.00 N/A
Total for all systems $425,764.00 $398,813.50 N/A $18,964.50 N/A
Primary Tower other $59,000.00 $59,000.00 $0.00
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $59,000.00 $59,000.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A

Components

Actual Information Description File Name
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas)

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$50,000.00

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$9,000.00

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 $34,899.00 $38,948.50 N/A $18,964.50 N/A
Total for all systems $425,764.00 $398,813.50 N/A $18,964.50 N/A
Outside Professional Services $34,899.00 $38,948.50 $18,964.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $6,862.50 This is the amount charged $7,425.00 This is the amount charged
RF Exposure Measurements $12,100.00 $12,100.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $2,375.00 This is the amount charged $0.00 This is the amount charged
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $2,375.00 This is the amount charged $0.00 This is the amount charged
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $3,200.00 This is the amount charged $3,200.00 This is the amount charged
Form 399 assistance or other Program Management costs $7,425.00 $7,425.00 This is the amount charged $7,425.00 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
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $914.50 N/A $914.50 N/A
Project management of the transition $844.00 $844.00 N/A N/A N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal fees re construction permit application
Amount:
$7,425.00
RF Exposure Measurements Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal Fees re License to Cover Issues
Amount:
$2,375.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering re Displacement Application
Amount:
$3,200.00
Form 399 assistance or other Program Management costs

Component Description:
Legal fees re FCC Form 399
Amount:
$7,425.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Perform engineering study for displacement application Information not provided.
Prepare/ Review 399 reimbursement form

Component Description:
KGA 1043-07 v220902jgv1
Amount:
$914.50
Project management of the transition Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $146,815.00 $146,815.00 N/A $0.00 N/A
Total for all systems $425,764.00 $398,813.50 N/A $18,964.50 N/A
Other Expenses $146,815.00 $146,815.00 $0.00
UPS $24,800.00 $24,800.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Travel $18,000.00 $18,000.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
TX Site Conditioning $20,000.00 $20,000.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
HVAC Installation $5,500.00 $5,500.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Generator $11,500.00 $11,500.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Encoder MUX $12,500.00 $12,500.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
EAS $10,291.00 $10,291.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
AV Rack $16,479.00 $16,479.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
RF Engineer $25,000.00 $25,000.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
Equipment Delivery and Handling Charges $1,300.00 $1,300.00 See attached / uploaded PDF file titled "OM Sys 11719 v220815jgv1.pdf" $0.00 N/A
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

Components

Actual Information Description File Name
UPS

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$24,800.00
Travel

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$5,000.00

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$8,000.00

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$5,000.00
TX Site Conditioning

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$20,000.00
HVAC Installation

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$5,500.00
Generator

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$11,500.00
Encoder MUX

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$12,500.00
EAS

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$10,291.00
AV Rack

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$16,479.00
RF Engineer

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$25,000.00
Equipment Delivery and Handling Charges

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$500.00

Component Description:
OM Sys 11719 v220815jgv1
Amount:
$800.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $425,764.00 $398,813.50 $18,964.50

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. 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.

Esteban Handal

President


06/28/2023

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.

Esteban Handal

President


06/28/2023

Attachments

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