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:
68549
Service:
DCA
Call Sign:
WOHL-CD
Channel:
15 (UHF)
File Number:
0000028557
FRN:
0018282269
Date Submitted:
07/19/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WEST CENTRAL OHIO BROADCASTING, INC.

Fred Vobbe

1424 RICE AVENUE

LIMA, OH 45805

United States

+1 (419) 228-8835 fvobbe@wlio.com 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

Frederick R Vobbe

VP and Chief Operator

West Central Ohio Broadcasting, Inc.

Frederick R Vobbe

1424 Rice Avenue

Lima, OH 45805

United States

+1 (419) 228-8835 fvobbe@wlio.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. Yes
Briefly describe transition plan WOHL-CD will require a new transmitter site as the present tower failed structual analysis. The FCC has before them WOHL's Request for Waiver of Initial Construction Permit Filing Deadline, granted 7/12/17.

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 LU500BTD
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity .5 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 ULXTE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 8.5 kW
Justification for New Transmitter WOHL's present transmitter can not make the TPO needed for 100% replication of service contour.

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 3 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 20 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 1600.0 square feet
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

Remote ControlSystem

Remote Control System

State and local sales tax

State and Local sales tax

Installation and Proof

Installation of Transmitter system

Electrical

Parallel Surge Supressor and a 75 Kva Transformer three phase 480vDelta Primary

New Transmitter Site

WOHL-CD will need to move from the present transmitter site to a new site. A building to house the transmitter will be required.

Shipping Expense

Shipping expense for 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 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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
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: 9.0 kW
Manufacturer
Model TFU-30JA
Year 1986

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? Yes
Ownership Owned
Owner N/A
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 Class Class A
Mounting Top Mount
Antenna position in stack Top
Polarization Circular
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: 15.0 kW
Manufacturer
Model ATW6H3-CTC3-15H
Year 2017
Justification for New Antenna WOHL-CD will move to a new tower site due to structural issues on the present tower. New antenna is circular polarized, difference of $15,500 from the cost of a horizontally polarized antenna.

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 3 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Shipping cost

Shipping cost

RF Switch

RF switch to change transmitter from antenna to dummy load for testing.

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)
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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 560 feet per run

Primary Transmission Line

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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 Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 650 feet per run
Justification for New Transmission Line WOHL-CD will move to a new transmitter site because of structural problems with present tower.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Ice Bridge

Transmission line will need to be supported between tower and building and protected from ice fall.

Gas Barrier

Transmission line will need to be pressurized from antenna to bldg.

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 Construct New
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1014519
Coordinates (NAD83) Latitude (NAD83) 40° 44' 51.2" N-
Longitude (NAD83) 084° 07' 54.3" W-
Overall Structure Height 548.88 feet
Support Structure Height 499.99 feet
Ground Elevation Above Mean Sea Level (AMSL) 870.07 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner LIMA COMMUNICATIONS CORPORATION
Date Constructed 12/01/2004

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
37503 WLIO DTV

Primary Tower

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Tower Construction Costs

Section Question Response
Construct New Tower Use Primary (Main)
Description of Use N/A
Is this a request for upgraded equipment? Yes
Height 500.00 feet
Justification for New Tower WOHL-CD is moving to a new tower, and site. The present tower did not pass analysis. There is no land at present location to build new tower, which is in urban/residential area.

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Ground System

Upgraded ground system, 100' x 100' to prevent lightning damage.

Shipping cost

Shipping cost

STL Antenna-Installation cost

WOHL-CD will require an STL to feed programming to and to control the transmitter. A TSL is needed to return News ENG program streams along with metering and status data from transmitter, and security monitoring.

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 1000
Explanation WOHL will move to a new location, and build a new tower. To obtain replication of coverage, the station will have to undergo comprehensive engineering and legal analysis, and testing during the construction.
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 1
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 Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 Yes
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

Name Description

Microwave License Study

The STL will require a path study for coordination of license.

Public Utility Analysis

Transmitter site must have proper power and telco services at new site.

RF Consultant D. Everist

RF Consultant that files engineering studies on behalf of WOHL-CD

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 Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
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

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Other Expenses Not Listed

Name Description

Microwave Receive Site ENG

WOHL will need to construct q new ENG Microwave Receive system and place it in service before the old site can be decommissioned due to public and network commitments to news.

Translator

Fill in for coverage lost on move.

STL-TSL system

6/7 Ghz microwave receive transmitter, receiver, antennas and transmission lines to link the studio the new transmitter site

Field Strength Tests

WOHL will conduct field signal tests on present channel, and repacked channel to make sure signal meets service contour.

Generator

WOHL's transmitter presently shares a generator with the studios and offices of WOHL. The move would leave WOHL without backup power in an emergency.

IP Switch for STL-TSL system

Switch control for the transmitter

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 $1,903,104.74 $1,801,370.74 N/A $0.00 N/A
Total for all systems $3,776,950.26 $3,524,056.26 N/A $0.00 N/A
Primary Transmitter ULXTE-20 $1,903,104.74 $1,801,370.74 $0.00
Shipping Expense $5,400.00 $5,400.00 N/A N/A N/A
New Transmitter Site $1,022,821.00 $1,022,821.00 Purchase price of land for new transmitter site. See Settlement Statement. N/A N/A
Electrical $4,226.38 $4,226.38 N/A N/A N/A
Installation and Proof $31,616.00 $31,616.00 N/A N/A N/A
State and local sales tax $31,743.86 $31,743.86 N/A N/A N/A
Other -- Building Addition Size: 1600.0 $104,757.00 $104,757.00 See Exhibit A-Explanation regarding costs associated with the construction of a new transmitter building. N/A N/A
20 Ton system $115,500.00 $102,500.00 N/A N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,750.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,000.00 N/A N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,500.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $410,866.00 N/A N/A N/A
Remote ControlSystem $9,190.50 $9,190.50 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 $211,908.65 $211,228.65 N/A $0.00 N/A
Total for all systems $3,776,950.26 $3,524,056.26 N/A $0.00 N/A
Primary Antenna ATW6H3-CTC3-15H $211,908.65 $211,228.65 $0.00
RF Switch $6,615.00 $6,615.00 N/A N/A N/A
UHF - Lower Power, Top Mount, Class A, basic slot antenna, 15 kW input, elliptically or circularly polarized $188,000.00 $188,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,250.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) $7,600.00 $7,400.00 N/A N/A N/A
Shipping cost $2,963.65 $2,963.65 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 $117,244.86 $148,644.86 N/A $0.00 N/A
Total for all systems $3,776,950.26 $3,524,056.26 N/A $0.00 N/A
Primary Transmission Line $117,244.86 $148,644.86 $0.00
Ice Bridge $48,437.86 $48,437.86 N/A N/A N/A
Gas Barrier $1,207.00 $1,207.00 N/A N/A N/A
Rigid Transmission Line - copper, 3 1/8" $67,600.00 $99,000.00 3-1/8" 50-ohm transmission line N/A N/A

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 $745,750.30 $579,815.30 N/A $0.00 N/A
Total for all systems $3,776,950.26 $3,524,056.26 N/A $0.00 N/A
Primary Tower TOWER $0.00 $0.00 $0.00
Primary Tower $745,750.30 $579,815.30 $0.00
Shipping cost $5,387.30 $5,387.30 N/A N/A N/A
Ground System $23,420.00 $23,420.00 Additional ground, 120 radials, buried 24", 100' due to history of electrical storms in region. N/A N/A
New tower $284,943.00 $284,943.00 N/A N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $255,065.00 N/A N/A N/A
STL Antenna-Installation cost $11,000.00 $11,000.00 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 $367,280.00 $351,900.00 N/A $0.00 N/A
Total for all systems $3,776,950.26 $3,524,056.26 N/A $0.00 N/A
Outside Professional Services $367,280.00 $351,900.00 $0.00
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 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 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 request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 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
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Microwave License Study $7,150.00 $7,150.00 STL Path, and required coordination notifications. Attached quote does not include Comsearch frequency coordination fee. N/A N/A
Public Utility Analysis $12,500.00 $12,500.00 Estimate-American Electric Power, Dominion Gas Company and the City of Lima Water Dept. will not provide quotes until the building plans for the new transmitter building have been submitted for approval. N/A N/A
RF Consultant D. Everist $50,000.00 $50,000.00 N/A N/A N/A
Project management of the transition $158,000.00 $150,000.00 N/A N/A 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

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 $431,661.71 $431,096.71 N/A $0.00 N/A
Total for all systems $3,776,950.26 $3,524,056.26 N/A $0.00 N/A
Other Expenses $431,661.71 $431,096.71 $0.00
Field Strength Tests $25,000.00 $25,000.00 Signal measurements made at twelve or more communities comprising WOHL's DMA. N/A N/A
Translator $110,541.40 $110,541.40 Translator, UHF channel, 15kw, to fill in area lost in coverage due to geographic move of transmitter site, and restriction of overlap of old contour. N/A N/A
Non-zoning permits $7,500.00 $7,500.00 Electrical, plumbing, HVAC, land management, drainage. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,100.00 $2,100.00 Multiple 15yd dumpsters. N/A N/A
Equipment Delivery and Handling Charges $23,582.95 $23,582.95 Shipping for transmitter, antenna, terminal equipment, and specialized equipment. N/A N/A
Equipment Storage $6,000.00 $6,000.00 Power Company N/A N/A
Microwave Receive Site ENG $105,924.44 $105,924.44 N/A N/A N/A
STL-TSL system $85,640.00 $85,640.00 N/A N/A N/A
MVPD Notification of Channel Change $1,000.00 $1,000.00 Notification to 13 cable companies, and 14 MATV businesses. N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A N/A N/A
IP Switch for STL-TSL system $1,342.92 $1,342.92 N/A N/A N/A
Generator $35,950.00 $35,950.00 Caterpillar 100kw/125kva @ 208/120V diesel generator, and transfer switch. N/A N/A
Local Zoning $10,000.00 $10,000.00 Zoning via township and City of Lima (OH) 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 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 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 $3,776,950.26 $3,524,056.26 $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.

KEITH WILKOWSKI

Vice President, Legal/Governmental Affairs


07/19/2018

Attachments

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