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:
5802
Service:
DTV
Call Sign:
WOTF-DT
Channel:
22 (UHF)
File Number:
0000028573
FRN:
0005877790
Date Submitted:
08/29/2017

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

UNIMAS ORLANDO, INC.

Doing Business As: UNIMAS ORLANDO, INC.

Christopher G. Wood

5999 CENTER DRIVE

LOS ANGELES, CA 90045

United States

+1 (310) 348-3600 CWOOD@UNIVISION.NET Corporation

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

Theodore R Stoner

VP Distribution Technology Strategy

Univision Communications Inc.

FCC Repack Reimbursement - CO Nora Iglesias

5999 Center Drive

Los Angeles, CA 90045

United States

+1 (513) 608-0308 tstoner@univision.net

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. Yes
Briefly describe transition plan Commence interim operation on current channel using site lessor's new wideband antenna and channel combiner. Replace existing antenna, transmitter, and mask filter. See attached Implementation Plan for details.

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)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model CD3200CP2
Year 2002
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 42 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? Yes
Manufacturer
Model THU9-10 EVO
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 15.5 kW
Justification for New Transmitter Existing transmitter incapable of operation below channel 40, see attached IOT Replacement Analysis document

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Installation of 480:400V step-down transformer, secondary distribution, primary AC conduit/wiring to transmitter cabinet, and conduit/wiring to ancillary equipment.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
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: 1000.0 kW
Manufacturer
Model ATW30HS4-HSCX-43H
Year 2006

Primary Antenna

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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? No
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 Types 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/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 600.0 kW
Manufacturer
Model ATW21HS3-HSPX-22H
Year 2018
Justification for New Antenna Current single frequency antenna incapable of operating on post repack channel.

Primary Antenna

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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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 8 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Rent Temporary
Ownership Leased
Owner American Tower Corporation
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 2
Number of Panels/Bays 24
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 80.0 %
Other Antenna Type N/A
ERP: 165.0 kW
Manufacturer
Model TFU-24WB S230
Year 2018
Justification for New Antenna Maintain continuity of operation while station's antenna is replaced atop the tower candelabra.

Interim Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type Additional Module
Number of channels supported 1
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 6 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Enter a list of RF channel numbers.

RF Channel Number
43

Interim 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 Utilize Existing
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 Electronics Research Inc
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1840 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Lease New
Type Rigid
Diameter 6 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 1525 feet per run
Justification for New Transmission Line WOTF requires an interim BBA shared side mount antenna to maintain operations while existing single frequency top mount antenna is replaced.

Interim 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)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1212124
Coordinates (NAD83) Latitude (NAD83) 28° 35' 12.6" N-
Longitude (NAD83) 081° 04' 57.5" W-
Overall Structure Height 1682.07 feet
Support Structure Height 1574.13 feet
Ground Elevation Above Mean Sea Level (AMSL) 66.93 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Tower, LLC
Date Constructed 03/18/2002

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
9881 WTGL DTV
60018 WACX DTV
53465 WKCF DTV
41375 WDYB-CD DTV
24582 WHLV-TV DTV
10549 WRCF-CD DTV

Other Types of Users

Users
WOFT-LD

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for tower with candelabra
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Ground and Building Drawing Package

The generation of a permitting drawing package for one (1) broadcasters, customers.

Tower Permit Drawing Package

The generation of a permitting drawing package for one (1) broadcasters/customers.

Tower construction PM

10 hours on Modification project management and 10 hours for RF installation project management for a total of ten 10 days

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 520
Explanation Univision stations are only staffed for daily station operations and minor equipment changes, major projects are contracted out externally. The large volume of work associated with repack schedule requires using external project management resources.
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 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 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 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 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 No
Additional Field Engineering Service Yes
Number of Days 1
Justification Testing of multi-channel combiner and BBA for optimization, per line #194 of attached WOTF ATC Interim antenna costs.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

American Tower PM

Project management fee for pre-construction services (including initial antenna placement and RF compatibility review, zoning and permitting requirements review; leasing application services) to support the transition of five (5) broadcasters.

Other Expenses

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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 No
Non-zoning permits Yes
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? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? No
Does this relocation require MVPD Notification of a Channel Change? No

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $706,000.00 $488,500.00 N/A $0.00 N/A
Total for all systems $2,457,875.00 $1,701,420.00 N/A $0.00 N/A
Primary Transmitter THU9-10 EVO $706,000.00 $488,500.00 $0.00
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $466,500.00 N/A N/A N/A
Other Electrical Service: Installation of 480:400V step-down transformer, secondary distribution, primary AC conduit/wiring to transmitter cabinet, and conduit/wiring to ancillary equipment. $22,000.00 $22,000.00 See attached WOTF electrical distribution cost estimate. N/A N/A

Components

Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $601,945.00 $485,075.00 N/A $0.00 N/A
Total for all systems $2,457,875.00 $1,701,420.00 N/A $0.00 N/A
Interim Antenna TFU-24WB S230 $302,930.00 $188,550.00 $0.00
Interim antenna rental and installation - Cost will depend on antenna size and height and/or complexity of tower. $115,500.00 $57,600.00 Shared interim antenna and additional tower attachment rental cost per American Tower interim antenna cost estimate, line# 225 N/A N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $5,400.00 Per line #103 of WOTF ATC interim antenna cost. N/A N/A
Adding a module to existing combiner (without antenna) $84,200.00 $38,250.00 Shared interim antenna combiner, per lines #83, #110 of WOTF ATC interim antenna cost. N/A N/A
Sweep test of existing antenna $6,730.00 $4,500.00 Per line #97 of WOTF ATC interim antenna cost. N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 165 kW input, directional,, horizontally polarized $82,800.00 $82,800.00 Apportioned Cost for American tower shared antenna, per line 72 of WOTF ATC Interim antenna cost schedule. (shared by two broadcasters) N/A N/A
Primary Antenna ATW21HS3-HSPX-22H $299,015.00 $296,525.00 $0.00
UHF - High Power, Side Mount, basic slot antenna, 600 kW input, directional,, horizontally polarized $248,625.00 $248,625.00 Per attached WOTF ERI Proposal N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $14,500.00 N/A N/A N/A

Components

Information not provided.

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 $353,800.00 $123,525.00 N/A $0.00 N/A
Total for all systems $2,457,875.00 $1,701,420.00 N/A $0.00 N/A
Interim Transmission Line $353,800.00 $123,525.00 $0.00
Rigid Transmission Line - copper, 6 1/8" broadband $353,800.00 $123,525.00 Shared cost 6 1/8" line for WOTF Interim Antenna ATC cost estimate line #125. (shared with WKCF) N/A N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

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 $610,900.00 $437,555.00 N/A $0.00 N/A
Total for all systems $2,457,875.00 $1,701,420.00 N/A $0.00 N/A
Primary Tower GTOWER $610,900.00 $437,555.00 $0.00
Tower construction PM $2,500.00 $2,500.00 See American Tower cost estimate line 170. N/A N/A
Tower Permit Drawing Package $4,700.00 $4,700.00 See American Tower primary antenna cost estimate line 167. N/A N/A
Ground and Building Drawing Package $4,700.00 $4,700.00 See American Tower cost estimate line 168. N/A N/A
Minor tower reinforcement/modifications $158,000.00 $12,500.00 See attached ATC Primary antenna cost estimate line #152 N/A N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $13,155.00 See American Tower Primary Antenna cost estimate lines 148 and 150. N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A N/A N/A

Components

Information not provided.

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 $135,590.00 $121,530.00 N/A $0.00 N/A
Total for all systems $2,457,875.00 $1,701,420.00 N/A $0.00 N/A
Outside Professional Services $135,590.00 $121,530.00 $0.00
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $3,500.00 American Tower tenant coordination fees, see ATC primary antenna cost estimate lines 175, and 192. N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $5,000.00 Engineering study for ATC shared interim antenna per line 177 of attached WOTF ATC interim antenna costs. N/A N/A
American Tower PM $9,480.00 $9,480.00 See American Tower primary antenna cost estimate line 174. N/A N/A
Additional Field Engineering Service, 1 Days $3,300.00 $3,300.00 Per line #194 of attached WOTF ATC Interim antenna costs. N/A N/A
Project management of the transition $82,160.00 $78,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $2,500.00 N/A N/A N/A

Components

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 $49,640.00 $45,235.00 N/A $0.00 N/A
Total for all systems $2,457,875.00 $1,701,420.00 N/A $0.00 N/A
Other Expenses $49,640.00 $45,235.00 $0.00
Equipment Delivery and Handling Charges $4,500.00 $4,500.00 Per attached WOTF Interim antenna costs, line# 207 N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $31,200.00 $31,200.00 Quote for removing/recycling identical transmitter at WAMI-DT Hollywood, FL attached for reference. N/A N/A
Non-zoning permits $750.00 $750.00 See American Tower cost estimate line 202. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $7,200.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,457,875.00 $1,701,420.00 $0.00

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

CHRISTOPHER G. WOOD

SVP/ASSOC. GEN. COUN.-GOV. & REG. AFF.


08/29/2017

Attachments

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