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:
70112
Service:
LPD
Call Sign:
WTNC-LD
Channel:
11 (High VHF)
File Number:
0000089601
FRN:
0005008305
Eligibility Status:
Eligible
Date Submitted:
07/15/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WUVC LICENSE PARTNERSHIP, G.P.

Doing Business As: WUVC LICENSE PARTNERSHIP, G.P.

CHRISTOPHER G. WOOD

5999 CENTER DRIVE

LOS ANGELES, CA 90045

United States

+1 (310) 348-3600 CWOOD@UNIVISION.NET General Partnership

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

Gregory Scott Coburn

Director NextGen TV

Univision Communications, Inc

FCC Repack Reimbursement - Greg Coburn

5999 Center Drive

Los Angeles, CA 90045

United States

+1 (304) 952-8816 gcoburn@univision.net

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. No
Briefly describe transition plan WUVC-DT constructed an interim facility on channel 19, and will construct a permanent facility on channel 11 by replacing existing transmitter and antenna.

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? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Atlas DVL 3000
Year 2004
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 3 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 TMV9-2
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.45 kW
Justification for New Transmitter Existing transmitter is UHF and incapable of operation on assigned H-VHF channel.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service Yes
Description Additional Breakers and new conduit in the transmitter building
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Channel RF Interconnect Components

Myat Rigid transmission line, elbows,couplers and flanges for Channel 19

Channel 19 Mask Filter

Mask filter for interim operation on channel 19 prior to displacement window under STA

Channel 11 Mask Filter

Mask filter for channel 11 operation

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? Yes
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 Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ALP16M2-HSO-40
Year 2010

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? No
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 Elliptical
Type Slotted Coaxial
ERP: 3.0 kW
Manufacturer
Model ATC-BCE4O-V3-11
Year 2019
Justification for New Antenna Existing CH 40 UHF antenna is not capable of operation on channel HVHF channel 11

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Interim CH 19 Antenna

CH 19 antenna for interim operation prior to displacement window.

Transmission Line

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

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 Move Equipment
Tower Use Primary (Main)
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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1002990
Coordinates (NAD83) Latitude (NAD83) 36° 03' 33.3" N-
Longitude (NAD83) 078° 57' 10.2" W-
Overall Structure Height 482.93 feet
Support Structure Height 459.97 feet
Ground Elevation Above Mean Sea Level (AMSL) 449.80 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Global Tower, LLC. through American Towers, LLC
Date Constructed 09/23/1994


Other Types of Users

Users
W243DK LP FM

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

Name Description

Landlord Structural assesment and Professional Engineer Letter for Channel 11 ant

American Tower as landlord charges for structural assessment of proposed changes.

Landlord Structural assesment and Professional Engineer Letter for Channel 19 ant

American Tower as landlord charges for structural assessment of proposed changes.

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 120
Explanation Local station is not staffed to perform antenna and transmitter replacement or tower projects.
Outside RF consulting Engineering Services Perform engineering study for displacement application 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 2
Prepare Form 601 No
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 2
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
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

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change 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? No
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 No
New Point to Point Microwave System No

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 $127,510.27 $86,028.27 N/A $78,461.97 N/A
Total for all systems $286,818.65 $236,306.65 N/A $199,438.24 N/A
Primary Transmitter TMV9-2 $127,510.27 $86,028.27 $78,461.97
Transmitter Building Site Survey/Installation $10,000.00 $20,518.00 Installation is more complex than anticipated $15,567.25 Additional cost for parts and freight.
Channel 19 Mask Filter $3,334.33 $3,334.33 Estimate now includes freight charges and taxes $3,334.33 total includes $210.84 in tax and $356.76 in shipping costs.
Channel RF Interconnect Components $4,302.94 $4,302.94 N/A $4,302.94 N/A
Channel 11 Mask Filter $5,473.00 $5,473.00 N/A $3,557.45 N/A
High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW $101,000.00 $49,000.00 N/A $49,000.00 N/A
Other Electrical Service: Additional Breakers and new conduit in the transmitter building $3,400.00 $3,400.00 N/A $2,700.00 N/A

Components

Actual Information Description File Name
Transmitter Building Site Survey/Installation

Component Description:
First milestone payment for Install transmitter
Amount:
$4,243.50

Component Description:
Invoice for additional parts necessary for installation and freight. Items 53 and 54 on invoice
Amount:
$6,373.00

Component Description:
Final Invoice for Installation commission
Amount:
$4,950.75

Component Description:
Second Invoice for Installation
Amount:
$4,950.75
Channel 19 Mask Filter

Component Description:
Includes Shipping and Taxes
Amount:
$3,334.33
Channel RF Interconnect Components

Component Description:
invoiced amount
Amount:
$4,302.94
Channel 11 Mask Filter

Component Description:
First Milestone Payment for mask filter
Amount:
$1,641.90

Component Description:
Final invoiced payment of mask filter
Amount:
$1,915.55

Component Description:
Second Invoice portion for Maskfilter
Amount:
$1,915.55
High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW

Component Description:
Item 42 on invoice. First milestone payment for transmitter
Amount:
$14,700.00

Component Description:
Final 35% payment for Transmitter
Amount:
$17,150.00

Component Description:
Second Invoiced portion for Transmitter
Amount:
$17,150.00
Other Electrical Service: Additional Breakers and new conduit in the transmitter building

Component Description:
Invoice for installing Subpannle, 3 phase circuit and twist lock receptacle
Amount:
$1,800.00

Component Description:
Invoice for #8/5 cord with cord cap for transmitter
Amount:
$900.00

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 $57,910.88 $55,930.88 N/A $53,680.88 N/A
Total for all systems $286,818.65 $236,306.65 N/A $199,438.24 N/A
Primary Antenna ATC-BCE4O-V3-11 $57,910.88 $55,930.88 $53,680.88
High VHF-Low Power, Side Mount, Slotted Coaxial, 3.0kW input, Elliptical $39,525.00 $39,525.00 Estimate includes an additional $2025.00 in shipping charges not included in the quote or purchase orders $39,525.00 Total includes $2025 in shipping charges that were not included in the initial quote used to generate the estimated cost.
Interim CH 19 Antenna $12,655.88 $12,655.88 Estimate includes freight cost $12,655.88 Purchase orders used to determine estimated cost did not include freight charges.
Sweep test of transmission line and antenna $5,730.00 $3,750.00 Sweep test for Chan 19 to Chan 11. No sweep test conducted for Chan 40 to Chan 19 move $1,500.00 N/A

Components

Actual Information Description File Name
High VHF-Low Power, Side Mount, Slotted Coaxial, 3.0kW input, Elliptical

Component Description:
Invoiced amount for Horizontal component
Amount:
$18,750.00

Component Description:
Invoiced amount for H-POL only and Shipping Charges
Amount:
$20,775.00
Interim CH 19 Antenna

Component Description:
second of two invoices for Channel 19 interim antenna. Includes Freight cost, less V pol of 1355.25. Cover letter attached
Amount:
$7,103.25

Component Description:
First of two invoices for Channel 19 interim antenna with cover letter attached
Amount:
$5,552.63
Sweep test of transmission line and antenna

Component Description:
Amount invoiced for Sweep test
Amount:
$1,500.00

Cost Information

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Transmission Line

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 $60,690.00 $37,545.00 N/A $36,695.00 N/A
Total for all systems $286,818.65 $236,306.65 N/A $199,438.24 N/A
Primary Tower GTOWER $60,690.00 $37,545.00 $36,695.00
Tower Rigging Short Tower (less than 500') $56,190.00 $33,045.00 Two separate tower riggings were required. the first for Channel 19 antenna, in the amount 9545.00 and the second for Channel 11 quoted from vendor at $23500 $33,045.00 existing side arms had to be removed and were not included in the original quote and PO
Landlord Structural assesment and Professional Engineer Letter for Channel 11 ant $2,250.00 $2,250.00 N/A $2,150.00 N/A
Landlord Structural assesment and Professional Engineer Letter for Channel 19 ant $2,250.00 $2,250.00 N/A $1,500.00 N/A

Components

Actual Information Description File Name
Tower Rigging Short Tower (less than 500')

Component Description:
Invoice 1of 1 for Channel 19 Tower Rigging. Cover letter added
Amount:
$9,545.00

Component Description:
Remove Channel 19 antenna, install Channel 11 and remove side arm mounts
Amount:
$23,500.00
Landlord Structural assesment and Professional Engineer Letter for Channel 11 ant

Component Description:
Landlord SA
Amount:
$1,500.00

Component Description:
Tower Survey of American Tower site 372918 to document current upper and lower Antenna elevation for sizing of new antenna
Amount:
$650.00
Landlord Structural assesment and Professional Engineer Letter for Channel 19 ant

Component Description:
Landlord structural analysis for channel 19 ant. PE letter has not been invoiced
Amount:
$1,500.00

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 $32,207.50 $48,302.50 N/A $30,600.39 N/A
Total for all systems $286,818.65 $236,306.65 N/A $199,438.24 N/A
Outside Professional Services $32,207.50 $48,302.50 $30,600.39
Attorney Fees - Prepare and File request for Special Temporary Authorization $4,470.00 $4,470.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $2,250.00 Estimate base on work invoiced for previous repacked CD stations N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $2,500.00 Estimate base on work invoiced for previous repacked CD stations N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,500.00 Estimate base on work invoiced for previous repacked CD stations N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $3,000.00 Estimate base on work invoiced for previous repacked CD stations N/A N/A
Perform engineering study for displacement application $1,800.00 $3,750.00 Search for in-band channel due to early displacement. Had to also prepare an amendment to the application to specify Channel in 11 and not conflict with and adjacent station application. $3,750.00 N/A
Form 399 assistance or other Program Management costs $1,250.00 $1,250.00 N/A $1,018.34 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 Estimate base on work invoiced for previous repacked CD stations N/A N/A
Project management of the transition $12,660.00 $24,332.50 WTNC was moved to an interim Channel 19 and then to its final Channel 11 resulting in additional PM costs. Purchase orders recently submitted by Project Managers providing an more accurate estimate. See PO 50959, 53085 , 57894, 64207,54902, 53085, 50959 $24,332.05 WTNC was moved to an interim Channel 19 before it was able to move to its permanent assigned channel 11. This doubled the complexity and caused additional Project Management actions
Prepare request for Special Temporary Authorization $2,560.00 $2,750.00 Displacement Consultation for STA was more extensive due to early displacement from Channel 40 to 19 and then 19 to 11. $1,500.00 N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization 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 Information not provided.
Perform engineering study for displacement application

Component Description:
to prepare technical poertion of amendment to Pending WTNC-LD channel 19 displacement app to avoid conflict with adjacent station application
Amount:
$1,250.00

Component Description:
Alt in-band channel search for early displacement from Channel 41
Amount:
$2,500.00
Form 399 assistance or other Program Management costs

Component Description:
PM Services
Amount:
$428.34

Component Description:
PM Services
Amount:
$590.00
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition

Component Description:
PM Services
Amount:
$167.70

Component Description:
PM Services
Amount:
$198.00

Component Description:
PM Services
Amount:
$562.50

Component Description:
PM Services
Amount:
$78.00

Component Description:
PM Services
Amount:
$338.75

Component Description:
PM Services
Amount:
$552.50

Component Description:
PM Services
Amount:
$3,841.50

Component Description:
Project Management Services
Amount:
$244.50

Component Description:
PM Services
Amount:
$493.50

Component Description:
PM Services
Amount:
$315.00

Component Description:
PM Services
Amount:
$268.75

Component Description:
PM Services
Amount:
$567.00

Component Description:
PM Services
Amount:
$183.95

Component Description:
PM Services
Amount:
$173.55

Component Description:
Project Management Services
Amount:
$262.50

Component Description:
PM Services
Amount:
$573.75

Component Description:
Project Management Services.
Amount:
$1,687.50

Component Description:
PM Services
Amount:
$730.50

Component Description:
PM Services
Amount:
$272.50

Component Description:
PM Services
Amount:
$292.50

Component Description:
PM Services
Amount:
$187.20

Component Description:
PM Services
Amount:
$365.00

Component Description:
PM Services
Amount:
$702.00

Component Description:
PM Services
Amount:
$234.00

Component Description:
PM Services
Amount:
$657.50

Component Description:
PM Services
Amount:
$670.00

Component Description:
PM Services
Amount:
$243.75

Component Description:
PM Services
Amount:
$694.50

Component Description:
PM Services
Amount:
$243.75

Component Description:
PM Services
Amount:
$278.75

Component Description:
PM Services
Amount:
$308.10

Component Description:
PM Services
Amount:
$21.00

Component Description:
PM Services
Amount:
$363.00

Component Description:
Project Management Services
Amount:
$78.00

Component Description:
Project Management Services
Amount:
$1,263.00

Component Description:
Project Management Services
Amount:
$1,900.50

Component Description:
PM Services
Amount:
$292.50

Component Description:
PM Services
Amount:
$765.00

Component Description:
PM Services
Amount:
$125.00

Component Description:
Pm Services
Amount:
$442.00

Component Description:
PM Services
Amount:
$1,902.00

Component Description:
PM Services
Amount:
$791.05
Prepare request for Special Temporary Authorization

Component Description:
STA prep for early displacement to Channel 19
Amount:
$1,500.00

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 $8,500.00 $8,500.00 N/A $0.00 N/A
Total for all systems $286,818.65 $236,306.65 N/A $199,438.24 N/A
Other Expenses $8,500.00 $8,500.00 $0.00
Disposal Costs (for equipment and other waste, net of any salvage value) $8,500.00 $8,500.00 To remove and dispose of Channel 19 interim equipment. N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $286,818.65 $236,306.65 $199,438.24

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.

JOSE E FRANCHI , FRANCHI .

VP FINANCE


07/15/2020

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.

JOSE E FRANCHI , FRANCHI .

VP FINANCE


07/15/2020

Attachments

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