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:
12171
Service:
DTV
Call Sign:
WDSC-TV
Channel:
24 (UHF)
File Number:
0000028323
FRN:
0004573416
Date Submitted:
07/09/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

DAYTONA STATE COLLEGE, INC.

Doing Business As: DAYTONA STATE COLLEGE, INC.

Larry Lowe

P.O. BOX 2811

DAYTONA BEACH, FL 32120

United States

+1 (386) 506-3508 larry.lowe@daytonastate.edu Private Not-for-Profit Educational Institution

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

Robert Gehman

ConsultingEngineer

Kessler and Gehman Associates, Inc.

Robert Gehman

507 NW 60 Street

Suite D

Gainesville, FL 32607

United States

+1 (352) 332-3157 bob@kesslerandgehman.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 Replace transmitter and combiner using existing antenna and line.

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 DHD45P2
Year 2003
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 10.3 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 TBD
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 9.9 kW
Justification for New Transmitter The manufacturer of the existing transmitter advises that the transmitter cannot be re-tuned to the assigned channel. See attachment.

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) 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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Standby Exciter and Switch

Standby Exciter with Automatic Change Over Switch

Additional Interior RF System

Interior RF System new Transmitter to existing Transmission line

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? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 3
Number of Panels 32
Design power capacity in use 100.0 %
Lower Limit 470.00 MHz
Upper Limit 806.00 MHz
Other Antenna Type N/A
ERP: 308.0 kW
Manufacturer Dielectric
Model TCI-888-32
Year 2003

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

Facility ID Call Sign
71293 WKMG-TV
6744 WEFS

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 RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
30
24

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 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1730 feet per run

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

Facility ID Call Sign
71293 WKMG-TV
6744 WEFS

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep Line

Sweep tests to verify performance on assigned channel

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1063249
Coordinates (NAD83) Latitude (NAD83) 28° 36' 36.0" N-
Longitude (NAD83) 081° 03' 34.0" W-
Overall Structure Height 1694.86 feet
Support Structure Height 1623.01 feet
Ground Elevation Above Mean Sea Level (AMSL) 52.49 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner BROWN ROAD TOWER, L.L.C.
Date Constructed 03/05/2001

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
6744 WEFS DTV
54940 WRBW DTV
71293 WKMG-TV DTV
25738 WESH DTV

Other Types of Users

Users
WEFS STL
WESH STL
WKMG RPU
WKMG STL
WRBW STL

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

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 20
Explanation Fewer Project Management "PM" tasks are required & Other Engineering Services "OES" are required, therefore the PM total has been reduced to 20 hrs ($3,000 at $150/hr), & a new OES category has been created & funded with the money removed from PM.
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 Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 13
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Engineering Services

Other Engineering 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 No
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)? 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 $553,950.00 $550,500.00 N/A $0.00 N/A
Total for all systems $1,292,730.00 $989,850.00 N/A $35,699.59 N/A
Primary Transmitter TBD $553,950.00 $550,500.00 $0.00
Standby Exciter and Switch $25,000.00 $25,000.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 9.9 kW $320,000.00 $320,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Additional Interior RF System $140,000.00 $140,000.00 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 $104,630.00 $99,400.00 N/A $3,982.50 N/A
Total for all systems $1,292,730.00 $989,850.00 N/A $35,699.59 N/A
Primary Antenna TCI-888-32 $104,630.00 $99,400.00 $3,982.50
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $3,982.50 Sweep test of transmission line and antenna
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 The station needs a new combiner to add post-transition channel 24 into the existing system. N/A N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $13,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Sweep test of transmission line and antenna
Amount:
$3,982.50
New combiner, cost per channel (without antenna) Information not provided.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) 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 $6,400.00 $6,400.00 N/A $0.00 N/A
Total for all systems $1,292,730.00 $989,850.00 N/A $35,699.59 N/A
Primary Transmission Line $6,400.00 $6,400.00 $0.00
Sweep Line $6,400.00 $6,400.00 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 $421,000.00 $100,000.00 N/A $0.00 N/A
Total for all systems $1,292,730.00 $989,850.00 N/A $35,699.59 N/A
Primary Tower TOWER $421,000.00 $100,000.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $100,000.00 Rigging to replace and/or tune the elbow complex of an inverted antenna hanging below the candelabra arm, if necessary. 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 $168,200.00 $195,550.00 N/A $31,717.09 N/A
Total for all systems $1,292,730.00 $989,850.00 N/A $35,699.59 N/A
Outside Professional Services $168,200.00 $195,550.00 $31,717.09
Other Engineering Services $25,650.00 $25,650.00 Fewer Project Management "PM" tasks are required & Other Engineering Services "OES" are required, therefore the PM total has been reduced to 20 hrs ($3,000 at $150/hr), & a new OES category has been created & funded with the money removed from PM. $7,612.50 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $4,875.00 Consultation regarding auction, CP application and reimbursement filings, Attorney section of Form FCC Construction Permit Application Main Facility
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,500.00 Engineering section of Form FCC Construction Permit Application Main Facility
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $3,250.00 Engineering study for new channel assignment and antenna development
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $3,160.00 $28,650.00 N/A $750.00 Outside Project Management Services, Form 387 Progress Report
Additional Field Engineering Service, 13 Days $26,000.00 $26,000.00 N/A $9,885.09 Additional Field Engineering Service
Prepare and or review reimbursement form $2,630.00 $10,000.00 The Estimated Cost is based on the current invoicing as well as a reasonable estimate for completing submission of the station's remaining Actual Cost invoices. $2,844.50 Prepare or Review FCC Form 399 for Reimbursement

Components

Actual Information Description File Name
Other Engineering Services

Component Description:
KGA 167-66 v190709jgv1
Amount:
$600.00

Component Description:
KGA 167-65 v190709jgv1
Amount:
$1,125.00

Component Description:
KGA 167-59 v190709jgv1
Amount:
$625.00

Component Description:
KGA 163-55 v190709jgv1
Amount:
$4,637.50

Component Description:
KGA 167-62 v190709jgv1
Amount:
$75.00

Component Description:
KGA 167-64 v190709jgv1
Amount:
$450.00

Component Description:
KGA 167-61 v190709jgv1
Amount:
$100.00
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations 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:
Consultation regarding auction, reimbursement and CP application, Attorney section of Form FCC Construction Permit Application Main Facility
Amount:
$2,500.00

Component Description:
Consultation regarding auction and reimbursement filings, Attorney section of Form FCC Construction Permit Application Main Facility
Amount:
$750.00

Component Description:
Consultation regarding auction, CP application and reimbursement filings, Attorney section of Form FCC Construction Permit Application Main Facility
Amount:
$1,625.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering section of Form FCC Construction Permit Application Main Facility
Amount:
$2,500.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering study for new channel assignment and antenna development
Amount:
$3,250.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
KGA 163-48 v190709jgv1
Amount:
$300.00

Component Description:
KGA 163-54 v190709jgv1
Amount:
$150.00

Component Description:
KGA 163-53 v190709jgv1
Amount:
$150.00

Component Description:
KGA 163-57 v190709jgv1
Amount:
$150.00

Component Description:
Outside Project Management Services, Form 387 Progress Report
Amount:
$300.00
Additional Field Engineering Service, 13 Days

Component Description:
KGA 167-58 v190709jgv1
Amount:
$4,668.16

Component Description:
Additional Field Engineering Service, Site Survey and Planning
Amount:
$5,216.93
Prepare and or review reimbursement form

Component Description:
KGA 163-56 v190709jgv1
Amount:
$344.50

Component Description:
Prepare FCC Form 399 for Reimbursement
Amount:
$2,500.00

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 $38,550.00 $38,000.00 N/A $0.00 N/A
Total for all systems $1,292,730.00 $989,850.00 N/A $35,699.59 N/A
Other Expenses $38,550.00 $38,000.00 $0.00
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
Equipment Storage $10,000.00 $10,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $10,000.00 $10,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 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 $1,292,730.00 $989,850.00 $35,699.59

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.

Jeffrey C Gehman

Engineering Associate


07/09/2019

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.

Jeffrey C Gehman

Engineering Associate


07/09/2019

Attachments

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