Applicant | Address | Phone | Applicant Type | |
---|---|---|---|---|
UNIVERSITY OF CENTRAL FLORIDA Doing Business As: UNIVERSITY OF CENTRAL FLORIDA |
Van Nguyen 12201 RESEARCH PARKWAY SUITE 501 ORLANDO, FL 32826 United States |
+1 (407) 882-1046 | VAN.NGUYEN@UCF.EDU | Government Entity |
Applicant | Address | Phone | |
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[Confidential] |
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Applicant | Address | Phone | |
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The Preparer is same as the reimbursement contact. |
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Question | Response |
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Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. | No |
Briefly describe transition plan | Replace IOT transmitter with solid state, replace antenna, re-use existing line. Map and analyze tower; design & modify if needed. Flash-cut to new channel upon coordination with other stations in phase 7. |
Section | Question | Response |
---|---|---|
Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
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 | Paragon DCXP-2 | |
Year | 2003 | |
Type | Inductive Output Tube | |
IOT Power Type | Two | |
Power Capacity | 50 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Manufacturer | ||
Model | ULXTE-72 | |
Transmitter Type | Solid State | |
Solid State Cooling | Liquid Cooled | |
Solid State Power capacity | 47.2 kW | |
Justification for New Transmitter | The cost of this new transmitter will be less than the cost of retuning the existing transmitter. |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | No |
Switchgear (industrial 800 amp) | Yes | |
Transformer (480V) | Yes | |
Power | 150 kVA | |
Rigid Conduit and Wiring | Yes | |
Size | 3 inches | |
Length | 100.0 feet | |
Other Electrical Service | No | |
Description | N/A | |
HVAC Service | Does the replacement transmitter require HVAC Service? | No |
Type | N/A | |
Size | N/A | |
Other Size | N/A | |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | No |
Size | N/A | |
Channel 14 Costs | Is an RF Consulting Engineer needed? | N/A |
Is a channel 14 Mask Filer needed? | N/A | |
Is additional field engineering time needed? | N/A | |
Number of Days | N/A |
Name | Description |
---|---|
Transmitter Decommissioning |
Transmitter Decommissioning |
2nd Exciter |
2nd Exciter with auto switch over to replace existing |
Additional Interior RF System |
Interior RF system to complete the transmitter installation |
Section | Question | Response |
---|---|---|
Antenna Related Expenses | Do you have antenna related expenses? | Yes |
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 | Full Power |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Horizontal | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels | N/A | |
Design power capacity in use | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Other Antenna Type | N/A | |
ERP: | 950.0 kW | |
Manufacturer | ||
Model | TFU-30DSC-R 3C 152 DC | |
Year | 2003 |
Section | Question | Response |
---|---|---|
New Antenna Description | Use | Primary (Main) |
Description of Use | N/A | |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Ownership | Owned | |
Owner | N/A | |
Is antenna shared? | No | |
Is antenna directional? | Yes | |
Will antenna be located on or in close proximity to an antenna farm? | Yes | |
New Antenna Manufacturer and Types | Class | Full Power |
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Elliptical | |
Type | Slotted Coaxial | |
Number of Stations Supported | N/A | |
Number of Panels/Bays | N/A | |
Lower Limit | N/A | |
Upper Limit | N/A | |
Design power capacity in use | N/A | |
Other Antenna Type | N/A | |
ERP: | 1000.0 kW | |
Manufacturer | ||
Model | ATW30HS3-ESCX-34H | |
Year | 2019 | |
Justification for New Antenna | The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel. |
Section | Question | Response |
---|---|---|
Combiner for Shared Antenna | Do you need a Combiner for a Shared Antenna? | |
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? | 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 |
Name | Description |
---|---|
Interior Line Sections |
Interior 6-1/8" line sections to extend the transmission line to the new transmitter location inside the existing building |
Section | Question | Response |
---|---|---|
Transmission Line Related Expenses | Do you have transmission line related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Transmission Line Description | Type of change | Utilize Existing |
Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
Is the existing transmission line shared with another station or stations? | No | |
Is Transmission Line in operating condition? | Yes | |
Existing Transmission Line Manufacturer and Type | Manufacturer | Dielectric |
Type | Rigid | |
Diameter | 6 1/8 inches | |
Other Diameter | N/A | |
Segment Length | Broadband | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 1290 feet per run |
Name | Description |
---|---|
Sweep Tests |
Sweep line to insure acceptable with assigned channel |
Section | Question | Response |
---|---|---|
New Transmission Line Costs | Use | Interim |
Description of Use | N/A | |
Change Type | Purchase New | |
Type | Rigid | |
Diameter | 6 1/8 inches | |
Segment Length | 19 ¾ ' | |
Other Segment Length | ||
Number of parallel runs | 1 | |
Length | 1130 feet per run | |
Justification for New Transmission Line | Required for interim operation |
Section | Question | Response |
---|---|---|
Tower Equipment or Rigging Costs Changes | Do you have tower equipment or rigging costs changes? | Yes |
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) | Yes | |
Others Types of Users | Yes | |
Is tower documented for structural analysis? | Unknown | |
Is tower compliant with Rev G? | Yes | |
Existing Tower Structure Registration | Do you have a tower registration number? | Yes |
ASR Number | 1026744 | |
Coordinates (NAD83) | Latitude (NAD83) | 28° 36' 08.0" N- |
Longitude (NAD83) | 081° 05' 36.0" W- | |
Overall Structure Height | 1608.25 feet | |
Support Structure Height | 1479.97 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 64.96 feet | |
Structure Type | TOWER - Free Standing or Guyed Structure | |
Tower Owner | WPOZ / Charitable Ministry Support Inc. | |
Date Constructed | 01/01/1992 |
Facility ID | Call Sign | Service |
---|---|---|
12857 | WMFE-FM | FM |
9876 | WPOZ | FM |
Users |
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Various mwave |
Section | Question | Response |
---|---|---|
Engineering Study | Please what type of engineering study is required, if any: | Study needed for documented tower |
Tower Reinforcements | Please select whether tower reinforcements are needed: | Minor Reinforcements needed |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
Name | Description |
---|---|
Preliminary Inspection |
Tower / Antenna Preliminary Installation Inspection |
Section | Question | Response |
---|---|---|
Outside Project Management Services | Do you require outside project management services? | Yes |
Number of Hours | 250 | |
Explanation | It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. | |
Outside RF consulting Engineering Services | Perform engineering study for new channel assignment and antenna development | Yes |
Prepare engineering section of Form FCC Construction Permit Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare engineering section of Form FCC License to Cover Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare request for Special Temporary Authority | Yes | |
Quantity | 1 | |
Do you have Distributed Transmission System engineering services? | N/A | |
Critical Facility | N/A | |
Terrain-Shielded Facility | N/A | |
Attorney and Other Outside Consulting Services | Prepare and file Form FCC Construction Permit Application | 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 | Yes | |
Prepare or Review FCC Form 399 for Reimbursement | Yes | |
Address transition timing and coordination issues w/ other stations and wireless providers | Yes | |
RF Field Engineering Services | Comprehensive coverage verification via field study | Yes |
RF exposure measurements | No | |
Additional Field Engineering Service | Yes | |
Number of Days | 14 | |
Justification | It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. |
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 | Yes | |
BLM or NFS Coordination | No | |
FCC Construction Permit Minor Change | No | |
FCC License to Cover Application | No | |
FCC Special Temporary Authority Application | No | |
Other Miscellaneous Expenses | Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? | Yes |
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? | Yes | |
Does this relocation require Equipment Storage? | Yes | |
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? | Yes | |
Does this relocation require MVPD Notification of a Channel Change? | Yes |
Name | Description |
---|---|
Transmitter Training |
Transmitter Training |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $1,649,867.56 | $1,478,174.64 | N/A | $1,447,162.64 | N/A |
Total for all systems | $2,906,096.19 | $2,411,637.52 | N/A | $1,775,561.04 | N/A |
Primary Transmitter ULXTE-72 | $1,649,867.56 | $1,478,174.64 | $1,447,162.64 | ||
Transmitter Decommissioning | $21,750.00 | $21,750.00 | N/A | N/A | N/A |
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW | $1,473,000.00 | $1,316,827.52 | See attached uploaded Revised Transition Plan November 2018 | $1,316,827.52 | N/A |
Switchgear - industrial 800 amp | $38,200.00 | $37,150.00 | N/A | $32,888.00 | N/A |
Additional Interior RF System | $71,217.56 | $71,217.56 | See attached uploaded Revised Transition Plan November 2018 | $71,217.56 | N/A |
2nd Exciter | $14,950.00 | $14,950.00 | See attached uploaded Revised Transition Plan November 2018 | $14,950.00 | N/A |
3" Rigid Conduit and Wiring (Cost per foot) | $5,200.00 | $5,000.00 | N/A | N/A | N/A |
Transformer 3 phase/480v - 150 KVA | $25,550.00 | $11,279.56 | See attached uploaded Revised Transition Plan November 2018 | $11,279.56 | Invoice No. JW3004486A (Quote Q-79081) for $1,295.94 was a change order due to an additional transmitter part. |
Actual Information Description | File Name |
---|---|
Transmitter Decommissioning | Information not provided. |
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW | |
Switchgear - industrial 800 amp | |
Additional Interior RF System | |
2nd Exciter | |
3" Rigid Conduit and Wiring (Cost per foot) | Information not provided. |
Transformer 3 phase/480v - 150 KVA |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $294,064.80 | $275,850.05 | N/A | $150,106.82 | N/A |
Total for all systems | $2,906,096.19 | $2,411,637.52 | N/A | $1,775,561.04 | N/A |
Primary Antenna ATW30HS3-ESCX-34H | $294,064.80 | $275,850.05 | $150,106.82 | ||
Interior Line Sections | $20,134.80 | $20,134.80 | See attached uploaded Revised Transition Plan November 2018 | $12,080.88 | N/A |
Side mount brackets for high power antennas (if not included in antenna base cost) | $23,150.00 | $10,860.00 | See attached uploaded Revised Transition Plan November 2018 | $6,516.00 | N/A |
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized | $231,750.00 | $231,750.00 | See attached uploaded Revised Transition Plan November 2018 | $123,646.78 | N/A |
Sweep test of existing antenna | $6,730.00 | $6,250.00 | See attached uploaded Revised Transition Plan November 2018 | $3,750.00 | N/A |
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) | $12,300.00 | $6,855.25 | See attached uploaded Revised Transition Plan November 2018 | $4,113.16 | N/A |
Actual Information Description | File Name |
---|---|
Interior Line Sections | |
Side mount brackets for high power antennas (if not included in antenna base cost) | |
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized | |
Sweep test of existing antenna | |
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $234,660.00 | $6,400.00 | N/A | $4,172.00 | N/A |
Total for all systems | $2,906,096.19 | $2,411,637.52 | N/A | $1,775,561.04 | N/A |
Interim Transmission Line | $228,260.00 | $0.00 | $0.00 | ||
Rigid Transmission Line - copper, 6 1/8" | $228,260.00 | $0.00 | Not Needed. See attached uploaded Revised Transition Plan November 2018 | N/A | N/A |
Primary Transmission Line | $6,400.00 | $6,400.00 | $4,172.00 | ||
Sweep Tests | $6,400.00 | $6,400.00 | N/A | $4,172.00 | N/A |
Actual Information Description | File Name |
---|---|
Rigid Transmission Line - copper, 6 1/8" | Information not provided. |
Sweep Tests |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $393,100.00 | $304,729.00 | N/A | $100,377.39 | N/A |
Total for all systems | $2,906,096.19 | $2,411,637.52 | N/A | $1,775,561.04 | N/A |
Primary Tower TOWER | $393,100.00 | $304,729.00 | $100,377.39 | ||
Preliminary Inspection | $12,000.00 | $12,000.00 | See attached uploaded Revised Transition Plan November 2018 | $12,000.00 | N/A |
Minor tower reinforcement/modifications | $158,000.00 | $150,000.00 | N/A | N/A | N/A |
Tall Tower (greater than 500') | $210,500.00 | $135,879.00 | See attached uploaded Revised Transition Plan November 2018 | $81,527.39 | N/A |
Structural engineering tower load study for well documented tower | $12,600.00 | $6,850.00 | See attached uploaded Revised Transition Plan November 2018 | $6,850.00 | N/A |
Actual Information Description | File Name |
---|---|
Preliminary Inspection | |
Minor tower reinforcement/modifications | Information not provided. |
Tall Tower (greater than 500') | |
Structural engineering tower load study for well documented tower |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $186,620.00 | $199,250.00 | N/A | $25,566.50 | N/A |
Total for all systems | $2,906,096.19 | $2,411,637.52 | N/A | $1,775,561.04 | N/A |
Outside Professional Services | $186,620.00 | $199,250.00 | $25,566.50 | ||
Additional Field Engineering Service, 14 Days | $28,000.00 | $28,000.00 | N/A | $6,062.50 | N/A |
Comprehensive coverage verification via field study, if needed | $84,200.00 | $80,000.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File request for Special Temporary Authorization | $3,680.00 | $3,500.00 | N/A | N/A | N/A |
Attorney Fees - Negotiation of lease and other matters for shared locations | $4,210.00 | $25,000.00 | The station's legal representative recommends $25,000 to cover this effort. | N/A | N/A |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $2,250.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | N/A | $0.00 | N/A |
Prepare request for Special Temporary Authorization | $2,050.00 | $1,500.00 | N/A | N/A | 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 |
Project management of the transition | $39,500.00 | $37,500.00 | N/A | $7,629.00 | N/A |
Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | $2,500.00 | 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 |
Perform engineering study for new channel assignment and antenna development | $7,360.00 | $7,000.00 | N/A | $6,375.00 | N/A |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | $3,000.00 | N/A |
Actual Information Description | File Name |
---|---|
Additional Field Engineering Service, 14 Days | |
Comprehensive coverage verification via field study, if needed | Information not provided. |
Attorney Fees - Prepare and File request for Special Temporary Authorization | Information not provided. |
Attorney Fees - Negotiation of lease and other matters for shared locations | Information not provided. |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | Information not provided. |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | Information not provided. |
Prepare request for Special Temporary Authorization | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
Project management of the transition | |
Prepare and or review reimbursement form | |
Address transition timing and coordination issues w/ other stations and wireless | Information not provided. |
Perform engineering study for new channel assignment and antenna development | |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $147,783.83 | $147,233.83 | N/A | $48,175.69 | N/A |
Total for all systems | $2,906,096.19 | $2,411,637.52 | N/A | $1,775,561.04 | N/A |
Other Expenses | $147,783.83 | $147,233.83 | $48,175.69 | ||
Disposal Costs (for equipment and other waste, net of any salvage value) | $25,000.00 | $25,000.00 | N/A | $1,350.00 | N/A |
Non-zoning permits | $25,000.00 | $25,000.00 | N/A | $13,785.03 | N/A |
Equipment Delivery and Handling Charges | $40,042.83 | $40,042.83 | $26,975.66 were actual freight charges for transmitter delivery provided on final transmitter invoice US0330449. Antenna freight charges are $13,067.17 | $26,975.66 | N/A |
Equipment Storage | $25,000.00 | $25,000.00 | N/A | N/A | N/A |
Develop and air announcement of upcoming channel change | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
MVPD Notification of Channel Change | $2,000.00 | $2,000.00 | N/A | $1,620.00 | N/A |
Transmitter Training | $9,191.00 | $9,191.00 | N/A | N/A | N/A |
DTV Medical Facility Notification | $11,550.00 | $11,000.00 | N/A | $4,445.00 | N/A |
Actual Information Description | File Name |
---|---|
Disposal Costs (for equipment and other waste, net of any salvage value) | |
Non-zoning permits | |
Equipment Delivery and Handling Charges | |
Equipment Storage | Information not provided. |
Develop and air announcement of upcoming channel change | Information not provided. |
MVPD Notification of Channel Change | |
Transmitter Training | Information not provided. |
DTV Medical Facility Notification |
Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
---|---|---|---|
Total for all systems | $2,906,096.19 | $2,411,637.52 | $1,775,561.04 |
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 |
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. |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Van Nguyen Contracts and Grants Accountant I 03/02/2020 |
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). |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Van Nguyen Contracts and Grants Accountant I 03/02/2020 |