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:
41674
Service:
DTV
Call Sign:
WNDU-TV
Channel:
27 (UHF)
File Number:
0000028730
FRN:
0018223693
Date Submitted:
12/16/2019

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRAY TELEVISION LICENSEE, LLC

WNDU John O'Brien

54516 STATE ROAD 933

SOUTH BEND, IN 46637

United States

+1 (574) 284-3000 robert.folliard@gray.tv 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

Samuel Hariton

Widelity

Samuel Hariton

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.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 The station is replacing both the main and aux antenna systems, transmission lines, and transmitters with new hardware.

Transmitters

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

Auxiliary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup
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 DCX Gen 1
Year 1998
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 44 kW

Auxiliary Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model HPTV-PARLX-U32
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 55 kW
Justification for New Transmitter Current Comark DCX Gen 1 from 1998 is not compatible with repack channel 27 and no available parts due to being discontinued

Auxiliary 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 N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Auxiliary Transmitter

Back to Top

Other Transmitter Cost Not Listed

Name Description

Internal RF System

A new internal RF System is necessary for this Auxiliary Transmitter.

Primary Transmitter

Back to Top

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 DCX Generation 1
Year 1998
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 49 kW

Primary Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model HPTV-PARLX-U32
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 55 kW
Justification for New Transmitter Per manufacturer -- Current Comark DCX Gen 1 from 1998 is not compatible with repack channel 27 and no available parts due to being discontinued

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 N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.
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

Back to Top

Other Transmitter Cost Not Listed

Name Description

Renovation

Necessary interior wall work for transmitter building

Transmitter Remote

Remote controls for transmitter

Ice shield

Fencing extension for Interim heat exchanger

Site Survey

Basic site survey by GatesAir

Antennas

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

Auxiliary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Backup
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
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 Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 32
Design power capacity in use 100.0 %
Lower Limit 638.00 MHz
Upper Limit 644.00 MHz
Other Antenna Type N/A
ERP: 631.0 kW
Manufacturer
Model TUP-04-8-1
Year 1995

Auxiliary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Backup
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 Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 32
Lower Limit 548.00 MHz
Upper Limit 644.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 573.0 kW
Manufacturer
Model TUM-04-8/32L-R-T-1
Year 2017
Justification for New Antenna Current Dielectric broadband antenna is discontinued and no longer supported starting in 1997-1998

Auxiliary 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? Broadband
Feed Line Size 6 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

Auxiliary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Top Plate Adapter

Adapter for top of tower to match the bolt pattern of the antenna

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? No
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 Not in Stack
Polarization Elliptical
Type Other
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 Travelling Wave Slot
ERP: 800.0 kW
Manufacturer
Model ATW33H3-ETO-42H
Year 2012

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? No
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 Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Other
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 Travelling Wave Slot
ERP: 650.0 kW
Manufacturer
Model TFU-31ETT/VP-R 04
Year 2017
Justification for New Antenna Current ERI antenna single channel on Ch 42, not compatible with repack Ch 27

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 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

Back to Top

Other Antenna Cost Not Listed

Name Description

Top Plate Adapter

Adapter for the top of the tower to match the bolt pattern of the new antenna

Transmission Line

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

Auxiliary Transmission Line

Back to Top

Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup
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 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1040 feet per run

Auxiliary Transmission Line

Back to Top

New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use Backup
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1040 feet per run
Justification for New Transmission Line Current 19.5' sections are not compatible with Ch 27

Auxiliary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Primary Transmission Line

Back to Top

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 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1035 feet per run

Primary Transmission Line

Back to Top

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 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 1035 feet per run
Justification for New Transmission Line Current 19.5' sections are not compatible with Ch 27

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

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 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 Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1027596
Coordinates (NAD83) Latitude (NAD83) 41° 36' 20.0" N-
Longitude (NAD83) 086° 12' 46.0" W-
Overall Structure Height 1007.86 feet
Support Structure Height 946.84 feet
Ground Elevation Above Mean Sea Level (AMSL) 845.13 feet
Structure Type NTOWER - Multiple Structures
Tower Owner Gray Television Group, Inc.
Date Constructed 01/01/1969

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
41675 WNDV-FM FM

Other Types of Users

Users
ATF
FBI

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: Serious 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

Name Description

Level II Corrosion Risk Assessment

Level II Corrosion Risk Assessment

Level I Corrosion Risk Assessment

Level I Corrosion Risk Assessment

Auxiliary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use Backup Tower
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 Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1027597
Coordinates (NAD83) Latitude (NAD83) 41° 36' 19.2" N-
Longitude (NAD83) 086° 12' 45.0" W-
Overall Structure Height 877.94 feet
Support Structure Height 839.88 feet
Ground Elevation Above Mean Sea Level (AMSL) 845.13 feet
Structure Type NTOWER - Multiple Structures
Tower Owner Gray Television Group, Inc.
Date Constructed 06/15/2006

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
41675 WNDV-FM FM
70459 WSND-FM FM

Other Types of Users

Users
Amatuer Radio

Auxiliary 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: Serious Reinforcements needed

Auxiliary 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

Auxiliary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Corrosion analysis and ultrasound measurements

Corrosion analysis and ultrasound measurements of lower 480 feet of auxiliary tower

Level 1 Foundation study

Level 1 Foundation study

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 900
Explanation Strategic Support
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
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 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

Name Description

Attorney Fees and Other Matters

Legal Services

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
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 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

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 $3,863,412.59 $2,864,938.59 N/A $2,396,282.49 N/A
Total for all systems $7,855,259.59 $6,540,531.67 N/A $3,671,461.70 N/A
Primary Transmitter HPTV-PARLX-U32 $1,894,512.59 $1,339,944.59 $1,176,168.16
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,233,432.00 Comark quote P#4034WNDU-PARLX-170530 $1,093,805.24 N/A
Other Electrical Service: The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors. $62,381.00 $62,381.00 N/A $55,359.12 N/A
Renovation $16,050.00 $16,050.00 N/A $11,716.50 N/A
Transmitter Remote $2,990.65 $2,990.65 N/A $0.00 N/A
Ice shield $2,634.34 $2,634.34 N/A N/A N/A
Site Survey $22,456.60 $22,456.60 Please see Estimated Cost Justification WNDU-110-Basic Site Survey v0 $15,287.30 N/A
Auxiliary Transmitter HPTV-PARLX-U32 $1,968,900.00 $1,524,994.00 $1,220,114.33
Internal RF System $140,000.00 $140,000.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,372,044.00 Comark quote P#4034WNDU-DCXP2-170530 Comark quote P#4034WNDU-PARLX-170530 $1,220,114.33 N/A
Other Electrical Service: The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors. $2,000.00 $2,000.00 N/A N/A N/A
10 Ton system $38,900.00 $10,950.00 See quote from Ideal Consolidated Inc. for 10 ton system N/A N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
System, WNDU U32 D27 PH2
Amount:
$436,800.88

Component Description:
SYSTEM, WNDU U32 D27 PH2
Amount:
$657,004.36
Other Electrical Service: The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.

Component Description:
New Transmitters Phase II 75% Complete
Amount:
$23,232.37

Component Description:
Add 1200A neutral per Quote #S21-1018
Amount:
$25,813.75

Component Description:
Run code compliant power
Amount:
$6,313.00
Renovation

Component Description:
Trane/American Standard Cooling Units
Amount:
$11,716.50
Transmitter Remote

Component Description:
Remote control New 1st Primary Transmitter
Amount:
$2,842.77
Ice shield Information not provided.
Site Survey

Component Description:
Basic Site Survey
Amount:
$7,307.30

Component Description:
Site Survey
Amount:
$7,980.00
Internal RF System Information not provided.
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
System, WNDU U32 D42 PH1
Amount:
$742,248.37

Component Description:
New Auxiliary Transmitter
Amount:
$476,989.97

Component Description:
306 Commercial Chain Link
Amount:
$875.99
Other Electrical Service: The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors. Information not provided.
10 Ton system Information not provided.

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 $643,000.00 $516,712.55 N/A $309,819.88 N/A
Total for all systems $7,855,259.59 $6,540,531.67 N/A $3,671,461.70 N/A
Primary Antenna TFU-31ETT/VP-R 04 $313,550.00 $313,688.00 $147,977.98
Top Plate Adapter $19,520.00 $19,520.00 N/A $10,736.00 N/A
UHF - High Power Top Mount One Station antenna elliptically or circularly polarized $275,000.00 $275,000.00 Catalog Cost $124,145.98 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $12,768.00 JEHQ1248-02 $9,576.00 a
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $3,520.00 N/A
Auxiliary Antenna TUM-04-8/32L-R-T-1 $329,450.00 $203,024.55 $161,841.90
Top Plate Adapter $19,520.00 $19,520.00 N/A $19,520.00 N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $12,768.00 N/A $10,214.40 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $157,689.50 Updated JEHQ1308 & Radome Addition JEHQ1508 $125,707.50 N/A
Sweep test of existing antenna $6,730.00 $13,047.05 See Estimated Cost Justification WNDU-210-Sweep test New Primary Antenna V0 $6,400.00 N/A

Components

Actual Information Description File Name
Top Plate Adapter

Component Description:
Top Plate Adapter New Primary Antenna
Amount:
$4,880.00

Component Description:
Top plate adapter, New Primary Antenna
Amount:
$5,856.00
UHF - High Power Top Mount One Station antenna elliptically or circularly polarized

Component Description:
UHF-High Power Top Mount (200-1000KW)
Amount:
$67,715.99

Component Description:
UHF- High Power Top Mount (200-1000KW)
Amount:
$56,429.99
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
WNDU-210-Elbow complex New Primary Antenna
Amount:
$2,553.60

Component Description:
Elbow complex, New Primary Antenna
Amount:
$3,830.40

Component Description:
Elbow Complex New Primary Antenna
Amount:
$3,192.00
Sweep test of existing antenna

Component Description:
Sweep test, New Primary Antenna
Amount:
$1,920.00

Component Description:
Sweep Test New Primary Antenna
Amount:
$1,600.00
Top Plate Adapter

Component Description:
WNDU-250-Top plate adapter New Auxiliary Antenna
Amount:
$3,904.00

Component Description:
Auxiliary/Interim Antenna Top Plate Adapter
Amount:
$4,880.00

Component Description:
Auxiliary/Interim Antenna Top Plate Adapter
Amount:
$4,880.00

Component Description:
Auxiliary/Interim Antenna Top Plate Adapter
Amount:
$5,856.00
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Auxiliary/Interim Antenna - Elbow Complex
Amount:
$3,192.00

Component Description:
Auxiliary/Interim Antenna Elbow Complex
Amount:
$3,830.40

Component Description:
Auxiliary/Interim Antenna - Elbow Complex
Amount:
$3,192.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
UHF - BROADBAND PANEL, TOP MOUNT AUX/INTERIM
Amount:
$29,319.89

Component Description:
New Auxiliary Antenna
Amount:
$30,121.13

Component Description:
UHF Broadband Panel Top mount Aux/Interim TV Antenna
Amount:
$36,145.35

Component Description:
New Auxiliary Antenna
Amount:
$30,121.13
Sweep test of existing antenna

Component Description:
Auxiliary/Interim Antenna Sweep Test
Amount:
$1,600.00

Component Description:
WNDU-250-Sweep test New Auxiliary Antenna
Amount:
$1,280.00

Component Description:
Auxiliary/Interim Antenna Sweep Test
Amount:
$1,600.00

Component Description:
Sweep Test Auxiliary/Interim Antenna
Amount:
$1,920.00

Cost Information

Back to Top

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 $450,350.00 $357,846.03 N/A $288,199.42 N/A
Total for all systems $7,855,259.59 $6,540,531.67 N/A $3,671,461.70 N/A
Primary Transmission Line $209,070.00 $152,101.30 $83,655.69
Rigid Transmission Line - copper, 6 1/8" $209,070.00 $152,101.30 N/A $83,655.69 N/A
Auxiliary Transmission Line $241,280.00 $205,744.73 $204,543.73
Rigid Transmission Line - copper, 6 1/8" broadband $241,280.00 $205,744.73 Increased per shipping on Justifying Invoice - WNDU DTVPros 179-3 $204,543.73 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8"

Component Description:
New Primary Transmission Line
Amount:
$45,630.38

Component Description:
New Primary Transmission Line
Amount:
$38,025.31
Rigid Transmission Line - copper, 6 1/8" broadband

Component Description:
WNDU-350-New Auxiliary Transmission Line
Amount:
$52,780.23

Component Description:
Auxiliary/Interim Transmission Line
Amount:
$47,426.09

Component Description:
Interim Transmission Line
Amount:
$56,911.32

Component Description:
Auxiliary/Interim Transmission Line
Amount:
$47,426.09

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 $2,562,250.00 $2,486,037.50 N/A $525,960.24 N/A
Total for all systems $7,855,259.59 $6,540,531.67 N/A $3,671,461.70 N/A
Auxiliary Tower NTOWER $1,281,650.00 $1,241,950.00 $370,738.99
Tall Tower (greater than 500') $210,500.00 $227,700.00 see Estimated Cost Justification WNDU-450-Tall Tower - Auxiliary Tower v0 $227,700.00 N/A
Serious tower reinforcement/modifications $1,052,000.00 $1,000,000.00 N/A $134,988.99 N/A
Level 1 Foundation study $750.00 $750.00 N/A $0.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $7,700.00 Additional official stamped tower analysis required because of the addition of radomes to aux antenna, radomes required to reduce wind loading and meet tower loading. $2,250.00 N/A
Corrosion analysis and ultrasound measurements $5,800.00 $5,800.00 See attached invoice and purchase order 072617TD $5,800.00 N/A
Primary Tower NTOWER $1,280,600.00 $1,244,087.50 $155,221.25
Tall Tower (greater than 500') $210,500.00 $230,000.00 See WNDU PO 19-FCCMain2 Quote Q17-06-013 $57,500.00 N/A
Serious tower reinforcement/modifications $1,052,000.00 $1,000,000.00 N/A $86,383.75 N/A
Level II Corrosion Risk Assessment $4,750.00 $4,750.00 N/A $2,750.00 N/A
Level I Corrosion Risk Assessment $750.00 $750.00 N/A N/A N/A
Structural engineering tower load study for well documented tower $12,600.00 $8,587.50 N/A $8,587.50 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
Aux TWR Rigging, Antenna & Complete Feedline Removal
Amount:
$133,000.00

Component Description:
Project Extra Costs
Amount:
$47,200.00

Component Description:
AUX TWR Rigging, Antenna & Complete feedline removal
Amount:
$47,500.00
Serious tower reinforcement/modifications

Component Description:
Tower Resocket on 840' Level 6 B&C Anchor Points
Amount:
$19,407.74

Component Description:
Tower reinforcement & design drawings Existing Auxiliary Tower
Amount:
$2,750.00

Component Description:
Tower Reinforcement/Modification of Auxiliary Tower
Amount:
$26,590.50

Component Description:
Tower Resocket on Level 6 B&C anchor points Auxiliary Tower
Amount:
$6,469.25

Component Description:
75% costs Tower Reinforcement/Modification on 840ft Tower (Auxiliary)
Amount:
$79,771.50
Level 1 Foundation study Information not provided.
Structural engineering tower load study for well documented tower

Component Description:
Structural Analysis of Auxiliary Tower
Amount:
$5,450.00

Component Description:
Structural Analysis
Amount:
$2,250.00
Corrosion analysis and ultrasound measurements

Component Description:
Corrosion inspection and Ultrasound measurements - Primary Tower
Amount:
$2,900.00

Component Description:
Corrosion inspection and Ultrasound measurements of tower legs in preparation for design and application of reinforcing required for re-pack tower modifications.
Amount:
$2,900.00
Tall Tower (greater than 500')

Component Description:
Mobilize crew to WNDU main tower (ASRN 1027596) and rig for top mounted antenna replacement
Amount:
$57,500.00
Serious tower reinforcement/modifications

Component Description:
Tower reinforcement & design drawings Existing Primary Tower
Amount:
$2,750.00

Component Description:
75% costs of Tower Reinforcement/Modification on 945ft Tower (Primary)
Amount:
$56,283.94

Component Description:
Perform sub-surface soil evaluation on towers - Laboratory Services
Amount:
$2,892.00

Component Description:
Tower reinforcement./Modifications-Primary Tower
Amount:
$18,761.31

Component Description:
Perform sub-surface soil evaluation on towers - Mobilization
Amount:
$5,696.50
Level II Corrosion Risk Assessment

Component Description:
Corrosion inspection and Ultrasound measurements
Amount:
$2,750.00
Level I Corrosion Risk Assessment Information not provided.
Structural engineering tower load study for well documented tower

Component Description:
Structural Engineering Tower Load study - Primary Tower
Amount:
$5,450.00

Component Description:
Take measurements for tower modifications and record elevations
Amount:
$2,137.50

Component Description:
Structural Engineering Tower Load study
Amount:
$1,000.00

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 $222,925.00 $210,910.00 N/A $106,775.14 N/A
Total for all systems $7,855,259.59 $6,540,531.67 N/A $3,671,461.70 N/A
Outside Professional Services $222,925.00 $210,910.00 $106,775.14
Project management of the transition $142,200.00 $135,000.00 N/A $94,298.40 N/A
Attorney Fees and Other Matters $1,660.00 $1,660.00 N/A $971.00 N/A
RF Exposure Measurements $21,050.00 $20,000.00 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 $325.00 N/A
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 FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A $1,327.50 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $196.50 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $700.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A $250.00 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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A $800.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,625.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $4,621.74 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,660.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$2,472.50

Component Description:
Project Management
Amount:
$2,876.70

Component Description:
Project Management
Amount:
$3,752.30

Component Description:
Project Management
Amount:
$2,022.10

Component Description:
Project Management
Amount:
$2,813.80

Component Description:
Project Management
Amount:
$802.25

Component Description:
Transition Related Project Management Costs
Amount:
$4,050.00

Component Description:
Project Management
Amount:
$4,083.75

Component Description:
Project Management
Amount:
$2,668.05

Component Description:
Project management
Amount:
$2,817.65

Component Description:
Project Management
Amount:
$3,325.45

Component Description:
Project Management
Amount:
$5,859.45

Component Description:
Project Management
Amount:
$1,813.95

Component Description:
Project management
Amount:
$2,471.90

Component Description:
Project Management
Amount:
$2,594.50

Component Description:
Project Management
Amount:
$2,403.10

Component Description:
Project Management
Amount:
$2,461.65

Component Description:
Project Management
Amount:
$3,645.85

Component Description:
Project Management
Amount:
$4,463.80

Component Description:
Project Management
Amount:
$3,593.55

Component Description:
Project Management
Amount:
$3,620.95

Component Description:
Project Management
Amount:
$2,725.85

Component Description:
Project Management
Amount:
$2,471.50

Component Description:
Project Management
Amount:
$4,104.40

Component Description:
Project Management
Amount:
$3,558.10

Component Description:
Project Management
Amount:
$28.20

Component Description:
Project Management
Amount:
$3,495.95

Component Description:
Project Management
Amount:
$2,903.55

Component Description:
Project managment
Amount:
$1,553.55

Component Description:
Project Management
Amount:
$2,411.25

Component Description:
Project Management
Amount:
$2,547.60

Component Description:
Project Management
Amount:
$755.80

Component Description:
Project Management
Amount:
$3,129.40
Attorney Fees and Other Matters

Component Description:
Total Professional Services
Amount:
$222.00

Component Description:
Legal Services
Amount:
$83.00

Component Description:
Legal services
Amount:
$666.00
RF Exposure Measurements Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase

Component Description:
Provide response to FAA project status request
Amount:
$325.00
ASR modification (prepare FCC Form 854) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application

Component Description:
Professional Services
Amount:
$1,327.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Complete and file repack CP application
Amount:
$196.50
Prepare request for Special Temporary Authorization

Component Description:
Develop final technical parameters for interim broadband antenna on pre-auction Ch-42 for use during transition.
Amount:
$700.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
Regarding buildout of repack Ch-27
Amount:
$250.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Develop final technical parameters for auxiliary antenna
Amount:
$800.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
FCC CP application
Amount:
$1,625.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering Study for New Channel Assignment
Amount:
$800.00

Component Description:
Review technical details of alternate antenna proposal from RFS regarding top-mount on repack Ch-27.
Amount:
$125.00

Component Description:
Perform engineering study for new channel assignment
Amount:
$1,950.00

Component Description:
AM station measurements for impact of TV antenna installation
Amount:
$1,746.74
Prepare and or review reimbursement form

Component Description:
WNDU-TV (FID 41674) South Bend, IN Repack
Amount:
$1,660.00
Address transition timing and coordination issues w/ other stations and wireless 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 $113,322.00 $104,087.00 N/A $44,424.53 N/A
Total for all systems $7,855,259.59 $6,540,531.67 N/A $3,671,461.70 N/A
Other Expenses $113,322.00 $104,087.00 $44,424.53
MVPD Notification of Channel Change $2,000.00 $2,000.00 see Estimated Cost Justification WNDU-610-MVPD Notifications v0 $2,000.00 N/A
Develop and air announcement of upcoming channel change $11,500.00 $11,500.00 N/A $222.00 N/A
Equipment Storage $6,140.00 $6,140.00 N/A N/A N/A
Equipment Delivery and Handling Charges $8,929.00 $8,929.00 N/A $8,036.10 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $43,733.00 $43,733.00 See attached Comark quote P#4034WNDU-PARLX-170530 for disposal costs for existing main and auxiliary transmitters See attached TecServ quote for removal & disposal of transmitter coolant $25,714.80 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $200.00 see Estimated Cost Justification WNDU-610-STA FCC Filing Fees v0 $200.00 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 $4,260.00 N/A $4,260.00 N/A
AM Pattern Disturbance -- Remedy $21,050.00 $20,000.00 N/A N/A N/A
AM Pattern Disturbance -- Impact study $7,890.00 $7,000.00 A study will be require for each tower, the auxiliary tower and the primary tower @ $3,500 per study. $3,991.63 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
Legal services
Amount:
$2,000.00
Develop and air announcement of upcoming channel change

Component Description:
Legal services
Amount:
$222.00
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
WNDU Equipment Delivery
Amount:
$4,910.95

Component Description:
Equipment Delivery and Handling Charges
Amount:
$3,125.15
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal Costs (for equipment and other waste, net of any salvage value)
Amount:
$10,000.20

Component Description:
WNDU Disposal Costs
Amount:
$15,714.60
FCC Filing Fees - Special Temporary Authorization request

Component Description:
Joan Stewart - Filing Fees - WNDU-TV FCC STA Filing Fee. 05/29/2019
Amount:
$200.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$4,260.00
AM Pattern Disturbance -- Remedy Information not provided.
AM Pattern Disturbance -- Impact study

Component Description:
Check phase monitor and power, measure the daytime MP's, measure the nighttime MP's, report
Amount:
$2,145.31

Component Description:
As part of the construction Permit for WNDU
Amount:
$1,846.32

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $7,855,259.59 $6,540,531.67 $3,671,461.70

Reimbursement Status

Back to Top
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

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.

Robert Folliard , III .

Assistant Secretary


12/16/2019

Certification

Back to Top
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.

Robert Folliard , III .

Assistant Secretary


12/16/2019

Attachments

Back to Top