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:
26025
Service:
DTV
Call Sign:
WIFS
Channel:
21 (UHF)
File Number:
0000028697
FRN:
0022021620
Date Submitted:
05/15/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

BYRNE ACQUISITION GROUP, LLC

2927 Devine St.

SUITE 100

Columbia, SC 29205

United States

+1 (803) 851-7388 jbyrne@whhitv.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

Roy Henn

WIFS Chief Engineer

Byrne Acquisition Group, LLC

Roy Henn

2814 Syene Road

Madison, WI 53713

United States

+1 (608) 270-5940 roy@wi57.tv

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 1) Prepare tower transmitter building site. 2) Install new transmitter and related equipment; connect transmitter to combiner. 3) Flash cutover to new channel. 4) Remove old equipment.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup transmitter
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 NV7081E
Year 2003
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.2 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model TMU9
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter Current backup transmitter cannot be re-channelized

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 Quantum QX
Year 2004
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 29 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 ULXTE-30
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 19.2 kW
Justification for New Transmitter See Attachment 1 to this Form 399.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
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

Name Description

Dummy Load

Dummy load for transmitter testing

Switch

Motorized switch for primary/backup transmitter

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 Retune Existing
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? Yes
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 Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels 10
Design power capacity in use 100.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Other Antenna Type N/A
ERP: 200.0 kW
Manufacturer Dielectric
Model TUA-04-10/40H-1-S-R
Year 2004

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
6870 WMTV

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

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? Yes
Type New
Number of channels supported 2
Frequencies of channels supported Upper and lower frequency
Frequency 500.0 MHz - 518.0 MHz

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 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? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1250 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
6870 WMTV

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? No

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 120
Explanation Station's Chief Engineer constitutes the only engineering staff at the company, and does not have sufficient accreditation to professional verify project design.
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 No
Quantity N/A
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 No
Quantity N/A
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 No
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 No
Number of Days N/A
Justification N/A

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
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 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
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

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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 $1,027,700.00 $905,200.00 N/A $0.00 N/A
Total for all systems $1,208,765.00 $1,074,130.00 N/A $13,107.50 N/A
Primary Transmitter ULXTE-30 $818,350.00 $780,300.00 $0.00
Switch $33,000.00 $33,000.00 N/A N/A N/A
Dummy Load $18,000.00 $18,000.00 N/A N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $650,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Auxiliary Transmitter TMU9 $209,350.00 $124,900.00 $0.00
Transformer 3 phase/480v - 150 KVA $25,550.00 $0.00 Included in cost estimate related to primary transmitter. N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $120,000.00 N/A N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $0.00 Included in cost estimate related to primary transmitter. N/A N/A
Switchgear - industrial 800 amp $38,200.00 $0.00 Included in cost estimate related to primary transmitter. N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A 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 $90,930.00 $81,585.00 N/A $1,500.00 N/A
Total for all systems $1,208,765.00 $1,074,130.00 N/A $13,107.50 N/A
Primary Antenna TUA-04-10/40H-1-S-R $90,930.00 $81,585.00 $1,500.00
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $1,585.00 N/A $1,500.00 N/A
UHF - High Power, Side Mount, broadband panel, 10 bay,, 200 kW input, directional,, horizontally polarized $0.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
New combiner, cost per channel (without antenna) Information not provided.
Sweep test of existing antenna

Component Description:
Sweep test of existing antenna using newly assigned repack channel.
Amount:
$1,500.00
UHF - High Power, Side Mount, broadband panel, 10 bay,, 200 kW input, directional,, horizontally polarized 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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $1,208,765.00 $1,074,130.00 N/A $13,107.50 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

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 $43,940.00 $41,750.00 N/A $11,607.50 N/A
Total for all systems $1,208,765.00 $1,074,130.00 N/A $13,107.50 N/A
Outside Professional Services $43,940.00 $41,750.00 $11,607.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $2,608.50 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
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,250.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $5,499.00 As a small independent station with no qualified professional in-house legal or engineering staff, WIFS (fka WBUW) required more than Widelity estimated to correctly complete the legal and technical engineering aspects of the repack.
Project management of the transition $18,960.00 $18,000.00 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 $2,250.00 N/A

Components

Actual Information Description File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Line item #6) Consultation and communication w/ client in connection w/ construction permit application and reimbursement form
Amount:
$1,144.00

Component Description:
Line item #5) Follow up w/ A. Meltzer re: Form 1876 and issue of incorrect call sign in Commission's system
Amount:
$97.50

Component Description:
Line item #1) Email correspondence w/ J. Byrne re: repack filings
Amount:
$143.00

Component Description:
Line item #2) Email correspondence w/ J. Byrne re: FRN for repack filings
Amount:
$71.50

Component Description:
Line item #6) Email correspondence w/ J. Byrne re: call sign discrepancy in auction system; conference w/ B. Claydon re: resolution of same.
Amount:
$178.75

Component Description:
Line item #2) Finalize and file WIFS modification application
Amount:
$195.00

Component Description:
Line item #3) Conference w/ G. Masters re: auction repack matters; Form 1876 and modification application
Amount:
$39.00

Component Description:
Line item #5) Telephone conference w/ G. Masters, J. Byrne, and R. Henn re: repack reimbursement issues
Amount:
$372.50

Component Description:
Line item #1) Preparatory work on Form 2100, Schedule A; consult w/ client re: Form 1876
Amount:
$643.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
WI Janesville WIFS Auction Repack Work
Amount:
$250.00

Component Description:
WI Janesville WIFS Auction Repack Work
Amount:
$250.00

Component Description:
Auction Repack Work: Engineering study work for new channel assignment and antenna development
Amount:
$1,250.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Line item #3) Email correspondence w/ J. Byrne, R. Henn et al. re: FCC Form 399
Amount:
$214.50

Component Description:
Line item #1) Email correspondence w/ J. Byrne re: repack reimbursement process
Amount:
$357.50

Component Description:
Line item #7) Telephone conference w/ Commission staff/Wireless Bureau re: issue of call sign change for auction related submissions
Amount:
$97.50

Component Description:
Line item #10) Communication w/ client re: FCC Form 399
Amount:
$143.00

Component Description:
Line item #1) Email correspondence w/ J. Byrne re: repack reimbursement preparation
Amount:
$178.75

Component Description:
Line item #4) Conference w/ G. Masters re: auction issues and call sign change for station; telephone conference with Commission staff re: same
Amount:
$97.50

Component Description:
Line item #6) Work on preparation of Form 399
Amount:
$1,001.00

Component Description:
Line item #7) Correspondence to client re: Form 1876 submission for spectrum auction
Amount:
$78.00

Component Description:
Line item #8) Work on preparation of FCC Form 399
Amount:
$2,574.00

Component Description:
Line item #4) Email correspondence w/ J. Byrne re: Form 1876; conference w/ B. Claydon re: same
Amount:
$143.00

Component Description:
Line item #11) Email correspondence w/ client re: Form 399
Amount:
$71.50

Component Description:
Line item #5) Review correspondence from client re: Form 1876; follow up w/ client re: questions re: same
Amount:
$195.00

Component Description:
Line item #9) Follow up matters re: Form 399 for WIFS(TV)
Amount:
$78.00

Component Description:
Line item #4) Communication w/ client and preparation of FCC Form 399
Amount:
$643.50
Project management of the transition Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Auction Repack Work: Engineering study work for new channel assignment including antenna development and preparation of the engineering section of FCC Form 2100
Amount:
$2,250.00

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 $46,195.00 $45,595.00 N/A $0.00 N/A
Total for all systems $1,208,765.00 $1,074,130.00 N/A $13,107.50 N/A
Other Expenses $46,195.00 $45,595.00 $0.00
MVPD Notification of Channel Change $1,000.00 $1,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
Equipment Storage $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $16,700.00 $16,700.00 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
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $6,000.00 $6,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $2,000.00 $2,000.00 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 $1,208,765.00 $1,074,130.00 $13,107.50

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.

Roy E Henn

Chief Engineer


05/15/2018

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.

Roy E Henn

Chief Engineer


05/15/2018

Attachments

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