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:
66257
Service:
DCA
Call Sign:
K49ND-D
Channel:
34 (UHF)
File Number:
0000025459
FRN:
0013866462
Date Submitted:
01/03/2020

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NPG OF IDAHO, INC.

Doing Business As: NPG OF IDAHO, INC.

NPG of Idaho, Inc.

825 EDMOND ST

ST. JOSEPH, MO 64501

United States

+1 (816) 271-8405 TIM.HANNAN@NPGCO.COM Corporation

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

The Preparer is same as the reimbursement contact.

 

 

 

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. Yes
Briefly describe transition plan PURCHASE AND INSTALL NEW ANTENNA, MASK FILTER, FEED LINE AND MASK FILTER. PURCHASE NEW TRANSMITTER TO MEET MAXIMIZATION REQUIREMENTS.

Transmitters

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

Primary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change 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 TXR-SX-2-U-C
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.28 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? No
Manufacturer
Model UAXTE-2P-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 0.4 kW
Justification for New Transmitter K49ND-D will install a like-for-like transmitter due to the fact that its previous transmitter cannot be retuned and is no longer supported. Please see letter from Anywave explaining the situation.

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 Single-Phase, 208-240 Volts
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

Information not provided.

Antennas

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

Primary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
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 Parapanel
ERP: 0.8 kW
Manufacturer
Model 4DR-4-2HW
Year 2015

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Class A
Mounting Side 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 Parapanel
ERP: 5.0 kW
Manufacturer
Model SFN-2030-2346-10 (E/P)
Year 2017
Justification for New Antenna Existing antenna will only produce 656-862 mhz.

Primary Antenna

Back to Top

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

Enter a list of RF channel numbers.

RF Channel Number
35
34

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top

Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) No
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? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 42° 52' 25.35" N-
Longitude (NAD83) 112° 30' 49.4" W-
Overall Structure Height 180.00 feet
Support Structure Height 180.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 5826.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Day Wireless Systems
Date Constructed 08/26/2018


Other Types of Users

Users
Fybercom LLC

Primary Tower

Back to Top

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

Back to Top

Tower Rigging Costs

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

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Information not provided.

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 42° 48' 25.0" N-
Longitude (NAD83) 112° 29' 18.1" W-
Overall Structure Height 60.00 feet
Support Structure Height 60.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 7212.00 feet
Structure Type LTOWER - Lattice Tower
Tower Owner Teton Communications
Date Constructed 06/30/1980


Primary Tower

Back to Top

Tower Rigging Costs

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

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 595
Explanation K49ND-D requires the aid of Project Management services in order to fulfill the requirements of the re-pack transition.
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 Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Additional Repack Legal Services Not Otherwise Specified in Form 399

NON-CATALOG LEGAL SERVICES SUCH AS REVIEW OF QUARTERLY TRANSITION STATUS REPORTS AND OTHER MISCELLANEOUS NON-CATALOG LEGAL FEES

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning 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? No

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 $33,027.30 $33,027.30 N/A $0.00 N/A
Total for all systems $468,472.50 $255,841.85 N/A $70,524.97 N/A
Primary Transmitter UAXTE-2P-C $33,027.30 $33,027.30 $0.00
Other Electrical Service: Single-Phase, 208-240 Volts $0.00 $0.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 0.4 kW $33,027.30 $33,027.30 Please see GatesAir quote Q-82197, part of the combined document "K49ND-D Transmitter Change Justification Document" N/A N/A

Components

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 $117,230.00 $35,558.50 N/A $0.00 N/A
Total for all systems $468,472.50 $255,841.85 N/A $70,524.97 N/A
Primary Antenna SFN-2030-2346-10 (E/P) $117,230.00 $35,558.50 $0.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $25,600.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $5,000.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $4,958.50 Please see Kathrein Quote 1022-2: K49ND, part of the combined document "K49ND-D Combiner Justification Document." $4,958.50 is 50% of total, shared LPTV Station KXPI will seek reimbursement for the remaining amount during the LPTV Repack. N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Transmission Line

Information not provided.

Cost Information

Back to Top

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $168,400.00 $54,680.00 N/A $0.00 N/A
Total for all systems $468,472.50 $255,841.85 N/A $70,524.97 N/A
Primary Tower LTOWER $84,200.00 $10,000.00 $0.00
Short Tower (less than 500') $84,200.00 $10,000.00 Please see attached Wireless Infrastructure Services NPG K49ND Repack antenna system installation budgetary proposal Rev.1 and supporting email correspondence for expenses related to removal of equipment at previous tower. N/A N/A
Primary Tower TOWER $84,200.00 $44,680.00 $0.00
Short Tower (less than 500') $84,200.00 $44,680.00 Please see attached Wireless Infrastructure Services NPG K49ND Repack Rev.1 and supporting email correspondence. Please note that the tower is shared with three LPTV stations and translators that are not part of this repack. N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $133,015.20 $125,326.05 N/A $70,524.97 N/A
Total for all systems $468,472.50 $255,841.85 N/A $70,524.97 N/A
Outside Professional Services $133,015.20 $125,326.05 $70,524.97
Additional Repack Legal Services Not Otherwise Specified in Form 399 $10,345.20 $10,345.20 see Estimated Cost Justification K49ND-D-550-Attorney - Additional Repack Legal Services v0 $10,345.20 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $488.40 K49ND-D Justification New Budget Category Attorney - Special Temporary Authorization $488.40 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $1,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $3,317.45 see Estimated Cost Justification K49ND-D-590-Prepare and_or Review Reimbursement Form v0 $3,317.45 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
Project management of the transition $94,010.00 $99,675.00 Please see attached quote from Widelty. $51,645.05 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $1,500.00 N/A $1,437.50 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $2,000.00 du Treil, Lundin & Rackley, Inc. invoice 242335 $1,000.00 Per invoices received
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $500.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $3,500.00 N/A $2,291.37 N/A

Components

Actual Information Description File Name
Additional Repack Legal Services Not Otherwise Specified in Form 399

Component Description:
Repack legal services
Amount:
$852.30

Component Description:
legal services
Amount:
$170.40

Component Description:
K49ND-D-550-Attorney - Additional Repack Legal Services-
Amount:
$153.00

Component Description:
K49ND-D-550-Attorney - Additional Repack Legal Services
Amount:
$2,273.40

Component Description:
K49ND-D-550-Attorney - Additional Repack Legal Services
Amount:
$1,190.40

Component Description:
K49ND-D-550-Attorney - Additional Repack Legal Services
Amount:
$2,295.00

Component Description:
legal services
Amount:
$391.80

Component Description:
Repack Legal Services for K49ND-D
Amount:
$442.80

Component Description:
Repack Legal Services for K49ND-D
Amount:
$1,160.00

Component Description:
Non-Catalog Legal Services such as review of quarterly transition status reports and other miscellaneous non-catalog legal fees.
Amount:
$37.12

Component Description:
Repack legal services
Amount:
$139.20

Component Description:
Repack legal services
Amount:
$151.90

Component Description:
Repack Legal Services
Amount:
$27.84

Component Description:
Repack Legal Services for K49ND-D
Amount:
$403.60

Component Description:
Repack Legal Services
Amount:
$27.84

Component Description:
Legal Services
Amount:
$46.40

Component Description:
Repack Legal Services for K49ND-D
Amount:
$257.40

Component Description:
Repack legal services
Amount:
$324.80
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
K49ND-D-550-Attorney - Special Temporary Authorization
Amount:
$488.40
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare and or review reimbursement form

Component Description:
Legal Services
Amount:
$1,513.80

Component Description:
Legal Services
Amount:
$102.00

Component Description:
Legal Services
Amount:
$119.40

Component Description:
Review C.P related issues 2017
Amount:
$1,429.25

Component Description:
Legal Services
Amount:
$153.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$1,250.80

Component Description:
Project Management
Amount:
$3,447.80

Component Description:
Project Management
Amount:
$2,333.85

Component Description:
Project Management
Amount:
$4,155.70

Component Description:
Project Management
Amount:
$2,716.10

Component Description:
Project Management
Amount:
$2,440.90

Component Description:
Project Management
Amount:
$4,655.65

Component Description:
Project Management
Amount:
$2,259.05

Component Description:
Project Management
Amount:
$4,440.90

Component Description:
Project Management
Amount:
$3,298.40

Component Description:
Project Management
Amount:
$5,863.05

Component Description:
Project Managment
Amount:
$1,579.80

Component Description:
Project Management
Amount:
$2,047.25

Component Description:
Project Management
Amount:
$1,037.80

Component Description:
Cost Reconciliation
Amount:
$3,169.95

Component Description:
Project Management
Amount:
$4,046.75

Component Description:
Project Management
Amount:
$2,901.30
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$375.00

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$62.50

Component Description:
"Calculation of replication transmitter power output requirement based on FCC issued replication facility effective radiated power."
Amount:
$250.00

Component Description:
ID Fish Creek-K49ND-Study possible use of KXPI-LD facility for interim antenna
Amount:
$250.00

Component Description:
Professional Services
Amount:
$250.00

Component Description:
ID Fish Creek-K49ND-Amend to spec change in antenna-Professional Services
Amount:
$250.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$1,000.00

Component Description:
Prepare Engineering App
Amount:
$1,000.00

Component Description:
Professional Services
Amount:
$1,000.00
Prepare engineering section of 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:
Charges for C.P. Filing and follow up. See "Invoices Cover Memo."
Amount:
$2,291.37

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 $16,800.00 $7,250.00 N/A $0.00 N/A
Total for all systems $468,472.50 $255,841.85 N/A $70,524.97 N/A
Other Expenses $16,800.00 $7,250.00 $0.00
DTV Medical Facility Notification $11,550.00 $2,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,500.00 $1,500.00 N/A N/A N/A
Equipment Delivery and Handling Charges $1,500.00 $1,500.00 N/A N/A N/A
Equipment Storage $1,500.00 $1,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $750.00 $750.00 N/A N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $468,472.50 $255,841.85 $70,524.97

Reimbursement Status

Back to Top
Question Response
The facility has ceased operating on its pre-auction channel. Yes
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.

James W. DeChant

VP of Technology


01/03/2020

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.

James W. DeChant

VP of Technology


01/03/2020

Attachments

Back to Top