Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission)FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

File Number:
0000028155
FRN:
0001726447
Facility ID:
54443
Repack Channel:
30 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
07/11/2017

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

R & F BROADCASTING, INC.

A02 Ceiba Street

Valle Arriba Heights

CAROLINA, PR 00983

United States

+1 (787) 648-7187 rickineas@gmail.com Corporation

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

Alejandro Luciano , PE .

Repack Coordinator

Alejandro Luciano PE

Alejandro Luciano PE

PO Box 194528

SAN JUAN, PR 00919

United States

+1 (787) 717-6984 aluciano@aluciano.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 File for construction permit, construction of Interim Facility, Tower Modifications, facilities maximization, Antenna, transmission line and transmitter installation, RF systems sweep and test, transition to new channel.

Transmitters

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

Primary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use  
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model AFFINITY
Year 2008
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 2.0 kw
Other Transmitter Type  

Primary Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Description of Use  
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model TMU9
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 5.0 kw
Other Transmitter Type  
Justification for New Transmitter Existing transmitter on channel 51 is not re-tunable to channel 30.

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power
Rigid Conduit and Wiring Yes
Size 2 inches
Length 40.0 feet
Other Electrical Service Yes
Description UPS for Above transmitter
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Primary Transmitter

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Interim Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use  
Change Type Purchase
Manufacturer
Model TMU9
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 1.5 kw
Other Transmitter Type  
Justification for New Transmitter An small interim transmitter is needed to remain on the air while the existing is removed.

Interim Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service No
Description  
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 16.00 kW
Manufacturer
Model ATC-24H6C2-51
Year 2008

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 10.70 kW
Manufacturer
Model ALP24M6-CSW-30
Year 2018
Justification for New Antenna The existing antenna on Channel 51 can't be retuned to new repack channel 30.

Primary Antenna

Back to Top

Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for 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

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Class A
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other Type
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type Broadband Panel Array
ERP: 16.00 kW
Manufacturer
Model 75010013
Year 2018
Justification for New Antenna An interim antenna is needed to remain on the air while the repack facilities are built

Interim Antenna

Back to Top

Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for 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

Interim Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

Back to Top

Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 275 feet per run

Primary Transmission Line

Back to Top

New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Type Flexible Air
Diameter 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 275 feet per run
Justification for New Transmission Line The existing line will be used to remain on the air while the new facilities on channel 30 are built.

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1043939
Coordinates (NAD83) Latitude (NAD83) 18° 16' 37.0" N-
Longitude (NAD83) 065° 51' 11.0" W-
Overall Structure Height 333.99 feet
Support Structure Height 300.19 feet
Ground Elevation Above Mean Sea Level (AMSL) 2411.39 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner ESTRADA, JORGE L DBA = COMMUNICATIONS TOWER SERVICES
Date Constructed 01/01/1987


Primary Tower

Back to Top

Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

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

Information not provided.

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 750
Explanation Station lacks personnel to perform the project management.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility N/A
For Main Facility Yes N/A
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Quarterly Progress Reports.

Quarterly Repack Progress Report.

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
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? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

Back to Top

Other Expenses Not Listed

Name Description

State Service Tax

State Service Tax 4 percent

State and City Sales Tax

State and City Sales Tax 11.5 percent

Station Employees Time

Station Employees Time dedicated to the repack functions.

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 $444,500.00 $444,500.00 N/A $0.00 N/A
Total for all systems $1,564,397.00 $1,564,397.00 N/A $0.00 N/A
Interim Transmitter TMU9 $139,250.00 $139,250.00 $0.00
5 Ton system $19,250.00 $19,250.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $120,000.00 $120,000.00 N/A N/A N/A
Primary Transmitter TMU9 $305,250.00 $305,250.00 $0.00
2" Rigid Conduit and Wiring (Cost per foot) $1,000.00 $1,000.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $260,000.00 $260,000.00 N/A N/A N/A
5 Ton system $19,250.00 $19,250.00 N/A N/A N/A
Other Electrical Service: UPS for Above transmitter $25,000.00 $25,000.00 Based on consultations with manufacturer local sales office. N/A N/A

Components

Information not provided.

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 $162,800.00 $162,800.00 N/A $0.00 N/A
Total for all systems $1,564,397.00 $1,564,397.00 N/A $0.00 N/A
Interim Antenna 75010013 $31,400.00 $31,400.00 $0.00
Sweep test of existing antenna $6,400.00 $6,400.00 N/A N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $25,000.00 $25,000.00 N/A N/A N/A
Primary Antenna ALP24M6-CSW-30 $131,400.00 $131,400.00 $0.00
Sweep test of existing antenna $6,400.00 $6,400.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $22,000.00 $22,000.00 N/A N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,000.00 $5,000.00 N/A N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 11 kW input, directional,, elliptically or circularly polarized $98,000.00 $98,000.00 Based on previous experience with ERI elliptic polarized antennas. Final pricing will be submitted as soon as a final quote is available N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $15,400.00 $15,400.00 N/A $0.00 N/A
Total for all systems $1,564,397.00 $1,564,397.00 N/A $0.00 N/A
Primary Transmission Line $15,400.00 $15,400.00 $0.00
Flexible Air Transmission Line - dielectric, 3" $15,400.00 $15,400.00 N/A N/A N/A

Components

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 $505,000.00 $505,000.00 N/A $0.00 N/A
Total for all systems $1,564,397.00 $1,564,397.00 N/A $0.00 N/A
Primary Tower TOWER $505,000.00 $505,000.00 $0.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $25,000.00 $25,000.00 N/A N/A N/A
Major tower reinforcement/modifications $400,000.00 $400,000.00 N/A N/A N/A
Short Tower (less than 500') $80,000.00 $80,000.00 N/A N/A N/A

Components

Information not provided.

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 $179,900.00 $179,900.00 N/A $0.00 N/A
Total for all systems $1,564,397.00 $1,564,397.00 N/A $0.00 N/A
Outside Professional Services $179,900.00 $179,900.00 $0.00
Project management of the transition $112,500.00 $112,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,500.00 $2,500.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,500.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,000.00 $7,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,000.00 $3,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,000.00 $2,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,500.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,500.00 $1,500.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $3,000.00 $3,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,000.00 $5,000.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,000.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,250.00 $2,250.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,000.00 $4,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,000.00 $7,000.00 N/A N/A N/A
RF Exposure Measurements $20,000.00 $20,000.00 N/A N/A N/A
Quarterly Progress Reports. $2,150.00 $2,150.00 Quarterly Repack progress Report Documents preparation and filling. N/A N/A

Components

Information not provided.

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 $256,797.00 $256,797.00 N/A $0.00 N/A
Total for all systems $1,564,397.00 $1,564,397.00 N/A $0.00 N/A
Other Expenses $256,797.00 $256,797.00 $0.00
FCC Filing Fees - Form 2100 minor change CP application $1,070.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $325.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $190.00 $190.00 N/A N/A N/A
DTV Medical Facility Notification $11,000.00 $11,000.00 N/A N/A N/A
Local Zoning $8,000.00 $8,000.00 Based on previous experience. Estimated fees of the local authority for obtaining permits for the tower work needed. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $4,500.00 $4,500.00 Based on previous experience during the analog to digital transition. N/A N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 Based on previous experience during the analog to digital transition N/A N/A
Develop and air announcement of upcoming channel change $20,000.00 $20,000.00 Based on previous experience during the analog to digital transition N/A N/A
Equipment Storage $5,000.00 $5,000.00 Based on previous experience during the analog to digital transition N/A N/A
MVPD Notification of Channel Change $7,000.00 $7,000.00 Based on previous experience during the analog to digital transition N/A N/A
State Service Tax $25,592.00 $25,592.00 State Service Tax 4% N/A N/A
State and City Sales Tax $99,120.00 $99,120.00 State and City Sales Tax 11.5% N/A N/A
Station Employees Time $50,000.00 $50,000.00 Estimated amount for Stations Employees time exclusively dedicated to the repack functions. N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,564,397.00 $1,564,397.00 $0.00

Construction Status

Back to Top
Question Response
Is construction complete? 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.

Enrique A. Sanchez

President


07/11/2017

Attachments

Back to Top
Information not provided.