Applicant | Address | Phone | Applicant Type | |
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COACHELLA COMMUNICATIONS, LLC |
5670 WILSHIRE BLVD. SUITE 1620 LOS ANGELES, CA 90036 United States |
+1 (323) 904-4090 | form399@LOOP.COM | Limited Liability Company |
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 | The plan is for KPOM is to replace the existing channel 45 system with a new channel 27 antenna and new transmitter. |
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 | Innovator LX 3000U | |
Year | 2003 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power Capacity | 3.0 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | Yes | |
Manufacturer | ||
Model | THU9EVO-2 | |
Transmitter Type | Solid State | |
Solid State Cooling | Liquid Cooled | |
Solid State Power capacity | 3.3 kW | |
Justification for New Transmitter | The existing transmitter is is obsolete. The manufacturer is out of business, and there is no manufacturer support to retune the transmitter. |
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 | Yes | |
Size | 2 inches | |
Length | 20.0 feet | |
Other Electrical Service | Yes | |
Description | The new main 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 |
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? | No | |
Existing Antenna Manufacturer and Type | Class | Class A |
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: | 10.5 kW | |
Manufacturer | ||
Model | ALP4L1-HSN-45 | |
Year | 2014 |
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? | No | |
New Antenna Manufacturer and Types | Class | Class A |
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: | 14.4 kW | |
Manufacturer | ||
Model | AL4M-27-E | |
Year | 2018 | |
Justification for New Antenna | The existing antenna is single channel and not capable of broadcasting on the new channel. Buying the upgraded antenna is less expensive than buying an antenna comparable to the existing antenna. |
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? | 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 |
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 | 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 | Flexible Foam | |
Diameter | Other | |
Other Diameter | 2 1/4 inches | |
Segment Length | N/A | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 180 feet per run |
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 | Flexible Air | |
Diameter | 1 5/8 inches | |
Other Diameter | N/A | |
Segment Length | N/A | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 125 feet per run | |
Justification for New Transmission Line | The new antenna will be installed at the new site while the existing antenna remains at the old site. The size transmission line is the closest available size to the existing line, which is no longer available. See exhibit details. |
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) | 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? | Yes |
ASR Number | 1018937 | |
Coordinates (NAD83) | Latitude (NAD83) | 33° 57' 41.8" N- |
Longitude (NAD83) | 117° 16' 50.3" W- | |
Overall Structure Height | 123.03 feet | |
Support Structure Height | 122.05 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 3083.95 feet | |
Structure Type | LTOWER - Lattice Tower | |
Tower Owner | SpectraSite Communications, LLC. through American Towers, LLC. | |
Date Constructed | 06/01/1997 |
Users |
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KRMV-LD |
K272FQ |
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: | No reinforcements needed |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
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? | Yes | |
One or more FM, AM or TV radio broadcaster(s) | Yes | |
Others Types of Users | No | |
Is tower documented for structural analysis? | No | |
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) | 34° 02' 12.95" N- |
Longitude (NAD83) | 116° 58' 10.0" W- | |
Overall Structure Height | 61.90 feet | |
Support Structure Height | 60.70 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 1469.70 feet | |
Structure Type | LTOWER - Lattice Tower | |
Tower Owner | InSight Towers | |
Date Constructed | 01/01/2000 |
Facility ID | Call Sign | Service |
---|---|---|
67354 | KQIE | FM |
25809 | KRQB | FM |
60144 | KLRD | FM |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
Section | Question | Response |
---|---|---|
Outside Project Management Services | Do you require outside project management services? | Yes |
Number of Hours | 2000 | |
Explanation | KPOM does not have sufficient resource capacity and expertise in house to handle all of the Project Management related tasks necessary to facility on-time completion of the station's build by the Construction Deadline. | |
Outside RF consulting Engineering Services | Perform engineering study for new channel assignment and antenna development | Yes |
Prepare engineering section of Form FCC Construction Permit Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare engineering section of Form FCC License to Cover Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare request for Special Temporary Authority | No | |
Quantity | N/A | |
Do you have Distributed Transmission System engineering services? | N/A | |
Critical Facility | N/A | |
Terrain-Shielded Facility | N/A | |
Attorney and Other Outside Consulting Services | Prepare and file Form FCC Construction Permit Application | Yes |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare and file Form FCC License to Cover Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare request for Special Temporary Authority | No | |
Quantity | N/A | |
NEPA Section 106 environmental review | No | |
Environmental Assessment | No | |
ASR Modification | No | |
FAA Consultation (including preparation of FAA Form 7460) | No | |
Negotiation of Lease and other Matter for Shared Locations | Yes | |
Prepare or Review FCC Form 399 for Reimbursement | Yes | |
Address transition timing and coordination issues w/ other stations and wireless providers | Yes | |
RF Field Engineering Services | Comprehensive coverage verification via field study | Yes |
RF exposure measurements | Yes | |
Additional Field Engineering Service | Yes | |
Number of Days | 8 | |
Justification | RF Project management of tower and transmitter installs |
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 | Yes |
Non-zoning permits | Yes | |
BLM or NFS Coordination | No | |
FCC Construction Permit Minor Change | Yes | |
FCC License to Cover Application | Yes | |
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 |
---|---|
Vehicle Rentals |
Required for equipment delivery. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $405,520.00 | $258,883.22 | N/A | $105,017.08 | N/A |
Total for all systems | $1,167,610.00 | $990,618.72 | N/A | $157,744.80 | N/A |
Primary Transmitter THU9EVO-2 | $405,520.00 | $258,883.22 | $105,017.08 | ||
2" Rigid Conduit and Wiring (Cost per foot) | $520.00 | $500.00 | N/A | N/A | N/A |
Other Electrical Service: The new main 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. | $20,000.00 | $20,000.00 | N/A | N/A | N/A |
UHF - Liquid Cooled Solid State Transmitter 3.3 kW | $155,600.00 | $155,600.00 | N/A | $59,233.86 | N/A |
10 Ton system | $38,900.00 | $37,000.00 | N/A | N/A | N/A |
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW | $155,600.00 | $10,883.22 | ***System Notice: Estimate adjusted and locked because line has been superseded.*** | $10,883.22 | N/A |
UHF - Air Cooled Solid State Transmitter 3.0 kW | $34,900.00 | $34,900.00 | ***System Notice: Estimate adjusted and locked because line has been superseded.*** | $34,900.00 | N/A |
Actual Information Description | File Name |
---|---|
2" Rigid Conduit and Wiring (Cost per foot) | Information not provided. |
Other Electrical Service: The new main 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. |
UHF - Liquid Cooled Solid State Transmitter 3.3 kW | |
10 Ton system | Information not provided. |
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW | |
UHF - Air Cooled Solid State Transmitter 3.0 kW |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $33,030.00 | $31,400.00 | N/A | $7,217.97 | N/A |
Total for all systems | $1,167,610.00 | $990,618.72 | N/A | $157,744.80 | N/A |
Primary Antenna AL4M-27-E | $33,030.00 | $31,400.00 | $7,217.97 | ||
UHF - Lower Power Side Mount, Class A One Station antenna -- basic | $26,300.00 | $25,000.00 | N/A | $7,217.97 | N/A |
Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
UHF - Lower Power Side Mount, Class A One Station antenna -- basic | |
Sweep test of existing antenna | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $4,125.00 | $7,690.50 | N/A | $7,690.50 | N/A |
Total for all systems | $1,167,610.00 | $990,618.72 | N/A | $157,744.80 | N/A |
Primary Transmission Line | $4,125.00 | $7,690.50 | $7,690.50 | ||
Flexible Air Transmission Line - dielectric, 1 5/8" | $4,125.00 | $7,690.50 | The transmission line itself costs less than the pre-determined cost estimate, but the dehydrator and associated hardware adds additional cost. Also the transmission line connector from AAT was an unanticipated cost. | $7,690.50 | The Transmission Line Connector was an unanticipated expense that was purchased during construction. |
Actual Information Description | File Name |
---|---|
Flexible Air Transmission Line - dielectric, 1 5/8" |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $181,000.00 | $172,000.00 | N/A | $1,500.00 | N/A |
Total for all systems | $1,167,610.00 | $990,618.72 | N/A | $157,744.80 | N/A |
Primary Tower LTOWER | $96,800.00 | $92,000.00 | $1,500.00 | ||
Structural engineering tower load study for well documented tower | $12,600.00 | $12,000.00 | N/A | $1,500.00 | N/A |
Short Tower (less than 500') | $84,200.00 | $80,000.00 | N/A | N/A | N/A |
Primary Tower LTOWER | $84,200.00 | $80,000.00 | $0.00 | ||
Short Tower (less than 500') | $84,200.00 | $80,000.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
Structural engineering tower load study for well documented tower | |
Short Tower (less than 500') | Information not provided. |
Short Tower (less than 500') | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $466,440.00 | $443,750.00 | N/A | $24,478.20 | N/A |
Total for all systems | $1,167,610.00 | $990,618.72 | N/A | $157,744.80 | N/A |
Outside Professional Services | $466,440.00 | $443,750.00 | $24,478.20 | ||
Additional Field Engineering Service, 8 Days | $16,000.00 | $16,000.00 | N/A | N/A | N/A |
RF Exposure Measurements | $21,050.00 | $20,000.00 | N/A | N/A | N/A |
Comprehensive coverage verification via field study, if needed | $84,200.00 | $80,000.00 | N/A | N/A | N/A |
Attorney Fees - Negotiation of lease and other matters for shared locations | $4,210.00 | $4,000.00 | N/A | N/A | N/A |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $2,250.00 | N/A | N/A | N/A |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | N/A | 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 |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | $1,750.00 | See: S&F FCC Repack Consulting Engineering Proposal.pdf |
Perform engineering study for new channel assignment and antenna development | $7,360.00 | $7,000.00 | N/A | $950.00 | See: S&F FCC Repack Consulting Engineering Proposal.pdf |
Address transition timing and coordination issues w/ other stations and wireless | $2,630.00 | $2,500.00 | N/A | N/A | N/A |
Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | $1,266.45 | N/A |
Project management of the transition | $316,000.00 | $300,000.00 | N/A | $20,511.75 | N/A |
Actual Information Description | File Name |
---|---|
Additional Field Engineering Service, 8 Days | Information not provided. |
RF Exposure Measurements | Information not provided. |
Comprehensive coverage verification via field study, if needed | Information not provided. |
Attorney Fees - Negotiation of lease and other matters for shared locations | Information not provided. |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | Information not provided. |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | |
Perform engineering study for new channel assignment and antenna development | |
Address transition timing and coordination issues w/ other stations and wireless | Information not provided. |
Prepare and or review reimbursement form | |
Project management of the transition |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $77,495.00 | $76,895.00 | N/A | $11,841.05 | N/A |
Total for all systems | $1,167,610.00 | $990,618.72 | N/A | $157,744.80 | N/A |
Other Expenses | $77,495.00 | $76,895.00 | $11,841.05 | ||
Vehicle Rentals | $5,000.00 | $5,000.00 | N/A | N/A | N/A |
MVPD Notification of Channel Change | $2,000.00 | $2,000.00 | N/A | N/A | N/A |
Develop and air announcement of upcoming channel change | $15,000.00 | $15,000.00 | N/A | N/A | N/A |
Equipment Storage | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
Equipment Delivery and Handling Charges | $15,000.00 | $15,000.00 | N/A | $3,186.05 | N/A |
Disposal Costs (for equipment and other waste, net of any salvage value) | $10,000.00 | $10,000.00 | N/A | N/A | N/A |
Non-zoning permits | $2,500.00 | $2,500.00 | N/A | N/A | N/A |
Local Zoning | $5,000.00 | $5,000.00 | N/A | $0.00 | N/A |
FCC Filing Fees - Form 2100 license to cover application | $335.00 | $325.00 | N/A | N/A | N/A |
FCC Filing Fees - Form 2100 minor change CP application | $1,110.00 | $1,070.00 | N/A | N/A | N/A |
DTV Medical Facility Notification | $11,550.00 | $11,000.00 | N/A | $8,655.00 | Disregard COMB KPOM DTVNotification INV-001930.pdf |
Actual Information Description | File Name |
---|---|
Vehicle Rentals | Information not provided. |
MVPD Notification of Channel Change | Information not provided. |
Develop and air announcement of upcoming channel change | Information not provided. |
Equipment Storage | Information not provided. |
Equipment Delivery and Handling Charges | |
Disposal Costs (for equipment and other waste, net of any salvage value) | Information not provided. |
Non-zoning permits | Information not provided. |
Local Zoning | Information not provided. |
FCC Filing Fees - Form 2100 license to cover application | Information not provided. |
FCC Filing Fees - Form 2100 minor change CP application | Information not provided. |
DTV Medical Facility Notification |
Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
---|---|---|---|
Total for all systems | $1,167,610.00 | $990,618.72 | $157,744.80 |
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. |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Andy Wilcoxson General Manager 06/26/2020 |
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). |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Andy Wilcoxson General Manager 06/26/2020 |