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

FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

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

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

File Number:
0000028255
FRN:
0016216038
Facility ID:
81593
Repack Channel:
25 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
11/29/2018

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TRIBUNE BROADCASTING FORT SMITH LICENSE, LLC

Van Comer

318 NORTH 13TH STREET

FORT SMITH, AR 72901

United States

+1 (479) 785-5080 van.comer@kfsm.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

Bill Vanduynhoven , Vanduynhov .

Tribune Broadcasting

Bill Vanduynhoven

2211 Rabbit Hill Cir

Dacula, GA 30019

United States

+1 (404) 312-8693 BillV@Tribunemedia.com

Broadcaster Information and Transition Plan

Back to Top
Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Replace antenna Re-tune Transmitter Purchase interim antenna

Transmitters

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

Primary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Primary (Main)
Description of Use  
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer Harris
Model ULX-4700AT
Year 2010
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 4500 kw
Other Transmitter Type  

Primary Transmitter

Back to Top

Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed  
New Mask Filter Power 10 kw
Other Power  
New Exciter Is a new exciter needed? No
Exciter Type

Primary Transmitter

Back to Top

Other Transmitter Costs

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

Primary Transmitter

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Interim Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use  
Change Type Lease New
Manufacturer
Model UAXTE-2R37
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 1000 kw
Other Transmitter Type  
Justification for New Transmitter Temporary transmitter while current is channel changed

Interim Transmitter

Back to Top

Other Transmitter Costs

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

Interim Transmitter

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? 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: 70.00 kW
Manufacturer
Model SWCS24WC/34
Year 2004

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 60.00 kW
Manufacturer
Model TFU-22DSB/VP-R C160
Year 2019
Justification for New Antenna Current antenna will not operate on assigned channel Changed to Dielectric model at same price Adding Epole

Primary Antenna

Back to Top

Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Class A
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: 50.00 kW
Manufacturer
Model DLP-8B
Year 2018
Justification for New Antenna Temporary antenna during replacement of Main antenna

Interim Antenna

Back to Top

Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

Back to Top
Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 36° 24' 40.9" N-
Longitude (NAD83) 093° 57' 12.9" W-
Overall Structure Height 346.12 feet
Support Structure Height 339.89 feet
Ground Elevation Above Mean Sea Level (AMSL) 1700.11 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Arklahoma Broadcast & Communiaction Towers, LLC
Date Constructed 04/01/2015


Primary Tower

Back to Top

Tower Modification Costs

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

Primary Tower

Back to Top

Tower Rigging Costs

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

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? No
Number of Hours N/A
Explanation N/A
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 No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare and file Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
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 No
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
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)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
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

Back to Top

Other Expenses Not Listed

Information not provided.

Cost Information

Back to Top

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $160,490.00 $90,000.00 N/A $75,086.67 N/A
Total for all systems $625,260.00 $331,310.00 N/A $248,343.98 N/A
Interim Transmitter UAXTE-2R37 $50,000.00 $50,000.00 $35,534.59
UHF - Air Cooled Solid State Transmitter 1000 kW $50,000.00 $50,000.00 N/A $35,534.59 N/A
Primary Transmitter ULX-4700AT $110,490.00 $40,000.00 $39,552.08
10 kW mask filter $8,090.00 $0.00 Included in Gates Air quote $0.00 N/A
UHF and VHF - minor banding issues $102,400.00 $40,000.00 N/A $39,552.08 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 1000 kW

Component Description:
UAXTE-2R37 Interim transmitter first payment
Amount:
$35,534.59
10 kW mask filter Information not provided.
UHF and VHF - minor banding issues

Component Description:
3rd payment - channel change
Amount:
$16,481.90

Component Description:
2nd payment for ULX4700AT and Channel Change
Amount:
$11,535.09

Component Description:
Deposit for ULX4700AT and Channel Change
Amount:
$11,535.09

Cost Information

Back to Top

Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $161,010.00 $143,310.00 N/A $122,914.81 N/A
Total for all systems $625,260.00 $331,310.00 N/A $248,343.98 N/A
Interim Antenna DLP-8B $19,510.00 $19,360.00 $7,209.25
Sweep test of existing antenna $6,550.00 $6,400.00 N/A $0.00 N/A
UHF - Lower Power, Side Mount, Class A, basic slot antenna, 50 kW input, directional,, horizontally polarized $12,960.00 $12,960.00 N/A $7,209.25 N/A
Primary Antenna TFU-22DSB/VP-R C160 $141,500.00 $123,950.00 $115,705.56
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized $100,400.00 $80,000.00 N/A $78,724.56 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,000.00 $15,000.00 Change order $14,336.00 change order
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $22,550.00 N/A $16,245.00 N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A $6,400.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
UHF - Lower Power, Side Mount, Class A, basic slot antenna, 50 kW input, directional,, horizontally polarized

Component Description:
DLP-8B Interim Ant. payment
Amount:
$5,062.50

Component Description:
Jumper Flex air 1-5/8 10ft long payment
Amount:
$1,228.40

Component Description:
shipping of components
Amount:
$918.35
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized

Component Description:
High power side mount antenna TFU-22DSB/VP-R C160 deposit
Amount:
$31,787.44

Component Description:
High power side mount antenna TFU-22DSB/VP-R C160 2nd payment
Amount:
$31,787.44

Component Description:
Antenna TFU-22DSB/VP-R C160 Deposit
Amount:
N/A

Component Description:
3rd payment TFU-22DSB/VP-R C160
Amount:
$7,063.87

Component Description:
parts needed during install
Amount:
$1,475.33

Component Description:
freight charges
Amount:
$6,610.48
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
elbow 6-50 digit 9x9
Amount:
$472.50

Component Description:
elbow complex
Amount:
$5,286.05

Component Description:
Elbow 6-50 Digit 9x9 deposit
Amount:
$2,126.25

Component Description:
Elbow Complex - change order
Amount:
$4,324.95

Component Description:
Elbow 6-50 Digit 9x9 2nd payment
Amount:
$2,126.25
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Mounting brackets for Antenna
Amount:
$8,934.75

Component Description:
Mounting brackets - change order
Amount:
$7,310.25
Sweep test of existing antenna

Component Description:
3rd payment for Eng. on site
Amount:
$640.00

Component Description:
On site engineer for sweep deposit
Amount:
$2,880.00

Component Description:
On site engineer for sweep 2nd payment
Amount:
$2,880.00

Cost Information

Back to Top

Transmission Line

Information not provided.

Cost Information

Back to Top

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $247,700.00 $58,000.00 N/A $47,892.50 N/A
Total for all systems $625,260.00 $331,310.00 N/A $248,343.98 N/A
Primary Tower TOWER $247,700.00 $58,000.00 $47,892.50
Short Tower (less than 500') $81,900.00 $55,000.00 N/A $47,892.50 N/A
Minor tower reinforcement/modifications $153,500.00 $0.00 N/A N/A N/A
Structural engineering tower load study for well documented tower $12,300.00 $3,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Short Tower (less than 500')

Component Description:
tower rigging costs
Amount:
$47,892.50
Minor tower reinforcement/modifications Information not provided.
Structural engineering tower load study for well documented tower Information not provided.

Cost Information

Back to Top

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $33,810.00 $18,000.00 N/A $0.00 N/A
Total for all systems $625,260.00 $331,310.00 N/A $248,343.98 N/A
Outside Professional Services $33,810.00 $18,000.00 $0.00
RF Exposure Measurements $20,500.00 $5,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $1,535.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,535.00 $1,500.00 N/A N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $22,250.00 $22,000.00 N/A $2,450.00 N/A
Total for all systems $625,260.00 $331,310.00 N/A $248,343.98 N/A
Other Expenses $22,250.00 $22,000.00 $2,450.00
DTV Medical Facility Notification $11,250.00 $11,000.00 N/A $2,450.00 N/A
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
MVPD Notification of Channel Change $6,000.00 $6,000.00 N/A N/A N/A

Components

Actual Information Description File Name
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$2,450.00
Local Zoning Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
MVPD Notification of Channel Change Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $625,260.00 $331,310.00 $248,343.98

Construction Status

Back to Top
Question Response
Is construction complete? No

Certification

Back to Top
Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Teri Ann Guillory

Broadcasting Operations


11/29/2018

Certification

Back to Top
Section Question Response
Submission of Actual Cost Documentation 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material.

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

  3. 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).

  4. 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.

  5. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

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

  7. 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.

Teri Ann Guillory

Broadcasting Operations


11/29/2018

Attachments

Back to Top