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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:
61217
Service:
DTV
Call Sign:
WNKY
Channel:
24 (UHF)
File Number:
0000025350
FRN:
0026650200
Date Submitted:
09/06/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MARQUEE BROADCASTING KENTUCKY, INC.

Doing Business As: MMK LICENSE LLC

Patricia R Lane

4400 BROOKEVILLE ROAD

BROOKEVILLE, MD 20833

United States

 +1 (301) 661-9610 patricia_lane@marqueebroadcasting.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

Patricia R Lane

President

Marquee Broadcasting Kentucky, Inc.

4400 Brookeville Road

Brookeville, MD 20833

United States

 +1 (301) 661-9610 patricia_lane@marqueebroadcasting.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Replace transmitter, antenna, feedline, and strengthen tower to hold new antenna and comply with Rev G. Detailed transition plan attached.

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 HX HU5000AD
Year 2007
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 THU9evo-3
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 4.9 kW
Justification for New Transmitter Existing transmitter is not frequency agile. New transmitter will allow coordination with linked stations during testing phase and ensure the station meets the deadline for converting to its new channel.

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 Estimated electrical and building modifications required to install new transmitter
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? No
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: 120.0 kW
Manufacturer
Model SWMP16PN/16
Year 2009

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? No
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: 120.0 kW
Manufacturer
Model Pending
Year 2019
Justification for New Antenna Existing antenna will not support operation on the new channel. Pending completion of tower study, the plan is to mount the new antenna above the existing one, allowing for testing of new channel prior to conversion deadline.

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? 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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
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
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 500 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? No
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 575 feet per run
Justification for New Transmission Line Plan to install new antenna and feedline above existing antenna, which eliminates the need for interim facilities.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1042998
Coordinates (NAD83) Latitude (NAD83) 37° 02' 05.5" N-
Longitude (NAD83) 086° 10' 40.9" W-
Overall Structure Height 501.96 feet
Support Structure Height 499.99 feet
Ground Elevation Above Mean Sea Level (AMSL) 836.93 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner MMK License LLC
Date Constructed 10/04/2016


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 documented tower
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 N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Rigging

Tower rigging for installation of new antenna and feedline

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 80
Explanation Project management and coordination of tower strengthening, installation of new equipment, and testing.
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

Name Description

Site Survey

Transition assessment

Site prep

Return trip for site prep, etc.

Additional Legal Services

Miscellaneous repack related services

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 No
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? No
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

Lease Negotiations

Estimate for legal work related to negotiating with tenants on tower

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 $308,500.00 $247,790.26 N/A $118,810.26 N/A
Total for all systems $994,381.80 $757,852.06 N/A $163,345.06 N/A
Primary Transmitter THU9evo-3 $308,500.00 $247,790.26 $118,810.26
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $212,790.26 Original transmitter is being replaced with a lower cost Anywave transmitter. System components and installation materials are obtained from various sources. See explanation uploaded as "WNKY Main Transmitter Updated Quote Explanation.pdf" $118,810.26 N/A
Other Electrical Service: Estimated electrical and building modifications required to install new transmitter $35,000.00 $35,000.00 Transformer 3 phase / 480v 300 kVA N/A N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
Final Payment for RF System Components
Amount:
$17,572.10

Component Description:
Deposit for Main Transmitter.
Amount:
$72,180.00

Component Description:
Deposit for Main Transmitter RF System
Amount:
$26,358.16

Component Description:
Deposit for Main Transmitter Installation Kit
Amount:
$2,700.00
Other Electrical Service: Estimated electrical and building modifications required to install new transmitter 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 $96,130.00 $91,400.00 N/A $0.00 N/A
Total for all systems $994,381.80 $757,852.06 N/A $163,345.06 N/A
Primary Antenna Pending $96,130.00 $91,400.00 $0.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $85,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Used Widelity estimate 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 $33,925.00 $32,200.00 N/A $0.00 N/A
Total for all systems $994,381.80 $757,852.06 N/A $163,345.06 N/A
Primary Transmission Line $33,925.00 $32,200.00 $0.00
Flexible Air Transmission Line - dielectric, 3" $33,925.00 $32,200.00 N/A 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 $461,100.00 $301,860.00 N/A $21,860.00 N/A
Total for all systems $994,381.80 $757,852.06 N/A $163,345.06 N/A
Primary Tower GTOWER $461,100.00 $301,860.00 $21,860.00
Structural engineering tower load study for well documented tower $12,600.00 $21,860.00 See attached quote from ERI. $21,860.00 N/A
Tower Rigging $80,000.00 $80,000.00 Preliminary estimate pending completion of tower mapping and structural analysis. To be updated. N/A N/A
Tall Tower (greater than 500') $210,500.00 $0.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $200,000.00 Installing second antenna and feedline, which eliminates the need for interim facilities, and strengthening tower to meet Rev G. N/A N/A

Components

Actual Information Description File Name
Structural engineering tower load study for well documented tower

Component Description:
50% deposit for tower mapping and structural study.
Amount:
$10,930.00

Component Description:
Final payment for tower study.
Amount:
$10,930.00
Tower Rigging Information not provided.
Tall Tower (greater than 500') Information not provided.
Minor tower reinforcement/modifications 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 $52,646.80 $48,276.80 N/A $22,674.80 N/A
Total for all systems $994,381.80 $757,852.06 N/A $163,345.06 N/A
Outside Professional Services $52,646.80 $48,276.80 $22,674.80
Project management of the transition $12,640.00 $12,000.00 N/A $9,112.50 N/A
Additional Legal Services $4,100.00 $4,100.00 Estimate 10 hours of additional legal services to review forms and associated emails and phone calls. $1,949.00 N/A
Site prep $8,400.00 $8,400.00 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
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $2,376.00 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 and or review reimbursement form $2,630.00 $2,500.00 N/A $1,788.00 See detailed description on Garvey Schubert Barer invoices.
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $0.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,942.50 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,980.00 N/A
Site Survey $2,526.80 $2,526.80 N/A $2,526.80 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management fees for work performed in August 2018.
Amount:
$1,200.00

Component Description:
Project management fees. Added detail to invoice per fund admin request.
Amount:
$2,850.00

Component Description:
Project Management
Amount:
$975.00

Component Description:
Project Management Fees for May 2018.
Amount:
$1,162.50

Component Description:
Project Management fees. Revised per admin request.
Amount:
$750.00

Component Description:
Project Management Fees for June and July, 2018. NOTE - the invoice is 2 pages long.
Amount:
$1,275.00

Component Description:
Project Management in January 2018.
Amount:
$225.00

Component Description:
Project Management fees.
Amount:
$675.00
Additional Legal Services

Component Description:
To correct typo on Form number.
Amount:
$287.00

Component Description:
Repack related legal services.
Amount:
$432.00

Component Description:
Repack Related Legal fees.
Amount:
$756.00

Component Description:
Review post auction transition status report (form 387)
Amount:
$150.00

Component Description:
Repack related legal fees.
Amount:
$54.00

Component Description:
Repack related legal fees.
Amount:
$270.00
Site prep Information not provided.
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:
Form 2100 legal fees.
Amount:
$1,944.00

Component Description:
Form 2100 legal fees.
Amount:
$432.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare and or review reimbursement form

Component Description:
Legal fees.
Amount:
$216.00

Component Description:
Review and revise 399 form to correct licensee information, post sale. Attorney fee.
Amount:
$492.00

Component Description:
Legal fees.
Amount:
$1,080.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Review of FCC notification and filing process related to new channel
Amount:
$370.00

Component Description:
Work related to new antenna study
Amount:
$786.25

Component Description:
Work on antenna and structural compatibility
Amount:
$786.25
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Final antenna analysis and file CP
Amount:
$2,980.00
Site Survey

Component Description:
Cover letter explaining site survey
Amount:
$2,526.80

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 $42,080.00 $36,325.00 N/A $0.00 N/A
Total for all systems $994,381.80 $757,852.06 N/A $163,345.06 N/A
Other Expenses $42,080.00 $36,325.00 $0.00
Lease Negotiations $2,000.00 $2,000.00 Preliminary estimate pending tower inspection. Cost of legal work related to negotiating changes in leases with existing tenants on tower. N/A N/A
MVPD Notification of Channel Change $1,000.00 $1,000.00 Legal review and coordination of notices. N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 Production of announcements N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $6,000.00 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
FCC Filing Fees - Special Temporary Authorization request $195.00 $0.00 N/A N/A N/A
Local Zoning $0.00 $0.00 N/A N/A N/A
Equipment Delivery and Handling Charges $12,000.00 $12,000.00 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 $994,381.80 $757,852.06 $163,345.06

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.

Edward J Murlatt

Project Manager


09/06/2018

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.

Edward J Murlatt

Project Manager


09/06/2018

Attachments

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