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:
70657
Service:
FM
Call Sign:
WABD
File Number:
0000086393
FRN:
0002834810
Eligibility Status:
Eligible
Date Submitted:
01/10/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CUMULUS LICENSING LLC

Doing Business As: CUMULUS LICENSING LLC

3280 PEACHTREE ROAD, NW

SUITE 2200

ATLANTA, GA 30305

United States

+1 (404) 949-0700 FCCLicenseManagement@cumulus.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Cynthia M Jacobson, PE

Consulting Engineer

Carl T. Jones Corp.

7901 Yarnwood Ct.

Springfield, VA 22153

United States

+1 (703) 569-7704 cjacob@ctjc.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 FM AUXILIARY FACILITY for WABD (FM) (FM impacted by TV Repack).This is to construct a new community antenna on an existing tower to maintain the station signals during TV repack work at main tower sites.

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)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? No
Existing Transmitter Manufacturer and Type Manufacturer
Model No existing aux
Year 2000
Type Solid State
Solid State Cooling Air Cooled
Model Type Analog
Solid State Power Capacity 10 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 HARFAX5KFAX150
Transmitter Type Solid State
Solid State Cooling Air Cooled
Model Type Analog
Solid State Power capacity 5.5 kW
Justification for New Transmitter This is for a new auxiliary site to keep WABD(FM) on the air during TV Repack at the main site. Site will require STL, Remote Control, Power panel,switching gear, etc.
Does the transmitter require the purchase of a new HD Importer? No
Does the transmitter require the purchase of a new HD Exporter? No

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs Does the transmitter installation require an Additional Exciter? No
Does the transmitter installation require any additional transmitter installation costs? Yes
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Rigid Conduit and Wiring Yes
Size 2.0 inches
Length 20.0 feet
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 10 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Other Transmitter-Related Expenses Does the replacement transmitter require a Remote Control? Yes
Does the replacement transmitter require an RDS Encoder? No
Does the replacement transmitter require Audio Processing? Yes
Audio Processing Analog Basic

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Uninterruptible Power Supply

Uninterruptible power supply

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? No
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Bottom
Polarization Circular
Type Cross Dipole
ERP: 100.0 kW
Manufacturer
Model No Model
Year 2000

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Cross Dipole
ERP: 30.0 kW
Manufacturer
Model 6842-4
Year 2019
Justification for New Antenna New community antenna to permit uninterrupted service from 3 FM stations impacted by TV Repack

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 3
Frequencies of channels supported Upper and lower frequency
Frequency 92.9 MHz - 104.1 MHz
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 1 5/8 inches 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
FM Band Pass Filters Do you require an FM band pass filter? Yes
Notch Filter Do you require a Notch filter? No
De-Icers Do you require De-Icers? No
Radomes Do you require Radomes? No

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? No
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 3 inches
Number of parallel runs 1
Length 200 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 711 feet per run
Justification for New Transmission Line New coaxial cable run from combiner to antenna. This is a shared 3 station system.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes
Does the Installation of the Transmission Line require additional or replacement Inside RF system elbows, fitting, hangers, etc.? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Nitrogen gas regulator

Nitrogen reg for pressurized line

1 5-8 inch rigid coax

70 feet

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)
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1055374
Coordinates (NAD83) Latitude (NAD83) 30° 35' 56.0" N-
Longitude (NAD83) 087° 52' 56.0" W-
Overall Structure Height 264.43 feet
Support Structure Height 261.48 feet
Ground Elevation Above Mean Sea Level (AMSL) 154.85 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Cumulus Broadcasting LLC
Date Constructed 05/01/1988


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 N/A
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 175
Explanation Project Management of Transition
Outside RF consulting Engineering Services 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 No
Prepare request for Special Temporary Authority Yes
Quantity 1
Prepare Form 601 Yes
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application No
Prepare and file Form FCC License to Cover Application No
Prepare request for Special Temporary Authority No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement No
Form 399 assistance or other program management costs No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Internal Employee Time Costs

Internal Employee Time Costs

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System Yes
New Point to Point Microwave System Yes
Type 950 MHz Licensed Part 74 Systems
1 pair IP-only Codecs for fiber, internet or IP microwave systems 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 $201,170.00 $201,170.00 N/A $29,501.55 N/A
Total for all systems $413,860.21 $294,550.20 N/A $53,961.14 N/A
Primary Transmitter HARFAX5KFAX150 $201,170.00 $201,170.00 $29,501.55
Other Transmitter-Related Expenses Remote Control $2,400.00 $2,400.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $38,200.00 N/A N/A N/A
Air Cooled Solid State FM Transmitter 3.5 - 6 kW Analog $32,250.00 $32,250.00 N/A $29,501.55 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $14,400.00 N/A N/A N/A
2.0" Rigid Conduit and Wiring $520.00 $520.00 N/A N/A N/A
10 Ton system $38,900.00 $38,900.00 N/A N/A N/A
Transmitter Installation $70,500.00 $70,500.00 N/A N/A N/A
Uninterruptible Power Supply $500.00 $500.00 Backup for Remote Control System N/A N/A
Audio Processing - Analog basic $3,500.00 $3,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Other Transmitter-Related Expenses Remote Control Information not provided.
Switchgear - industrial 800 amp Information not provided.
Air Cooled Solid State FM Transmitter 3.5 - 6 kW Analog

Component Description:
Transmitter cost. #US0326642
Amount:
$29,501.55
Service entrance 3 phase/800 amp/208 volt Information not provided.
2.0" Rigid Conduit and Wiring Information not provided.
10 Ton system Information not provided.
Transmitter Installation Information not provided.
Uninterruptible Power Supply Information not provided.
Audio Processing - Analog basic 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 $52,690.61 $35,092.10 N/A $13,103.99 N/A
Total for all systems $413,860.21 $294,550.20 N/A $53,961.14 N/A
Primary Antenna 6842-4 $52,690.61 $35,092.10 $13,103.99
Side Mount antenna brackets $1,520.61 $1,520.61 N/A N/A N/A
Elbow complex, 1 5/8 $2,800.00 $2,800.00 N/A N/A N/A
New FM combiner, cost per channel (depends on power input and min. frequency separation) $21,782.50 $9,916.66 1/3 of $29,750.00 combiner cost. WABD, WBLX-FM and WDLT-FM are co-located and sharing the same combiner, antenna and transmission line. See attached quote from Broadcast Connection. $9,916.66 N/A
High Power 26 kW - 50 kW Circularly-polarized $5,100.00 $3,187.33 1/3 of $9,562.00 antenna cost. WABD, WBLX-FM and WDLT-FM are co-located and sharing the same combiner, antenna and transmission line. See attached quote from Broadcast Connection. $3,187.33 N/A
Sweep test of existing antenna $5,730.00 $1,910.00 1/3 of $5730.00 catalog cost for sweep test of antenna shared with WABD, WBLX-FM and WDLT-FM that are co-located and sharing the same combiner, antenna and transmission line. N/A N/A
FM Band pass filter (depends on power input and number of sections) $15,757.50 $15,757.50 N/A N/A N/A

Components

Actual Information Description File Name
Side Mount antenna brackets Information not provided.
Elbow complex, 1 5/8 Information not provided.
New FM combiner, cost per channel (depends on power input and min. frequency separation)

Component Description:
Combiner cost. #13145
Amount:
$9,916.66
High Power 26 kW - 50 kW Circularly-polarized

Component Description:
Antenna cost. #13145
Amount:
$3,187.33
Sweep test of existing antenna Information not provided.
FM Band pass filter (depends on power input and number of sections) 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 $22,048.64 $7,666.64 N/A $3,666.64 N/A
Total for all systems $413,860.21 $294,550.20 N/A $53,961.14 N/A
Primary Transmission Line $22,048.64 $7,666.64 $3,666.64
1 5-8 inch rigid coax $0.00 $0.00 N/A N/A N/A
Interior RF Systems: Elbows, fitting, hangers, etc. $984.64 $984.64 1/3 of $2,953.94 transmission line related cost. WABD, WBLX-FM and WDLT-FM are co-located and sharing the same combiner, antenna and transmission line. See attached quote from Broadcast Connection, line item 5-15. $984.64 N/A
Flexible Foam Transmission Line - dielectric, 1 5/8" $17,064.00 $2,682.00 1/3 of $8,046.00 transmission line cost. WABD, WBLX-FM and WDLT-FM are co-located and sharing the same combiner, antenna and transmission line. See attached quote from Broadcast Connection, line item 4. $2,682.00 N/A
Nitrogen gas regulator $0.00 $0.00 N/A N/A N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $4,000.00 $4,000.00 N/A N/A N/A

Components

Actual Information Description File Name
1 5-8 inch rigid coax Information not provided.
Interior RF Systems: Elbows, fitting, hangers, etc.

Component Description:
Interior RF systems cost. #13145
Amount:
$984.64
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
Transmission line cost. #13145
Amount:
$2,682.00
Nitrogen gas regulator Information not provided.
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators 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 $73,650.00 $2,734.67 N/A $0.00 N/A
Total for all systems $413,860.21 $294,550.20 N/A $53,961.14 N/A
Primary Tower GTOWER $73,650.00 $2,734.67 $0.00
Tower Rigging Short Tower (less than 500') $73,650.00 $2,734.67 Tower work quotation divided by 3 stations sharing the cost. See attached quote from North Star Tower Service. 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 $26,100.00 $25,917.50 N/A $3,038.00 N/A
Total for all systems $413,860.21 $294,550.20 N/A $53,961.14 N/A
Outside Professional Services $26,100.00 $25,917.50 $3,038.00
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Internal Employee Time Costs $3,500.00 $3,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $1,920.00 N/A $1,920.00 N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A N/A N/A
Project management of the transition $18,462.50 $18,462.50 N/A $1,118.00 N/A

Components

Actual Information Description File Name
Prepare Form 601 Information not provided.
Internal Employee Time Costs Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Consulting engineering services. #0001-045-0001
Amount:
$1,440.00

Component Description:
Consulting engineering services. #0001-045-0002
Amount:
$480.00
Prepare request for Special Temporary Authorization Information not provided.
Project management of the transition

Component Description:
Project management cost. #LBM19 -232
Amount:
$938.00

Component Description:
Consulting engineering cost. #0001-045-0005
Amount:
$180.00

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 $38,200.96 $21,969.29 N/A $4,650.96 N/A
Total for all systems $413,860.21 $294,550.20 N/A $53,961.14 N/A
Other Expenses $38,200.96 $21,969.29 $4,650.96
Point to Point Microwave (STL/ICR): Frequency Coordination for Bi-Direction System $1,100.00 $550.00 STL costs split among 2 stations sharing system (WABD FM and WDLT-FM) N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $200.00 $200.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
AM Pattern Disturbance -- Impact study $5,260.00 $1,753.33 Cost of impact study divided among 3 stations sharing the system (WABD FM, WDLT-FM, WBLX-FM). N/A N/A
New Point to Point Microwave System: 950 MHz Licensed Part 74 Systems(price includes 6-foot antennas. Single link and redundant systems are included in this price range) $18,500.00 $9,250.00 STL cost divided by 2 stations sharing the cost (WABD FM and WDLT-FM). N/A N/A
Point to Point Microwave (STL/ICR): 1 pair IP-only Codecs for fiber, internet or IP microwave systems $5,850.00 $2,925.00 STL system cost divided by 2 stations sharing the cost (WABD FM and WDLT-FM) N/A N/A
Equipment Delivery and Handling Charges $4,650.96 $4,650.96 N/A $4,650.96 N/A

Components

Actual Information Description File Name
Point to Point Microwave (STL/ICR): Frequency Coordination for Bi-Direction System Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
AM Pattern Disturbance -- Impact study Information not provided.
New Point to Point Microwave System: 950 MHz Licensed Part 74 Systems(price includes 6-foot antennas. Single link and redundant systems are included in this price range) Information not provided.
Point to Point Microwave (STL/ICR): 1 pair IP-only Codecs for fiber, internet or IP microwave systems Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Transmitter freight cost. #US0328159
Amount:
$3,394.30

Component Description:
Freight cost. #13145
Amount:
$1,256.66

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $413,860.21 $294,550.20 $53,961.14

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.

Richard S. Denning

Executive Vice President and General Counsel


01/10/2020

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.

Richard S. Denning

Executive Vice President and General Counsel


01/10/2020

Attachments

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