| Applicant | Address | Phone | Applicant Type | |
|---|---|---|---|---|
|
STATE OF WISCONSIN - EDUCATIONAL COMMUNICATIONS BOARD Doing Business As: STATE OF WISCONSIN - EDUCATIONAL COMMUNICATIONS BOARD |
Steve Bauder 3319 W. BELTLINE HWY. MADISON, WI 53713 United States |
+1 (608) 264-9746 | steve.bauder@wi.gov | Government Entity |
| Applicant | Address | Phone | |
|---|---|---|---|
|
[Confidential] |
|
|
|
| Applicant | Address | Phone | |
|---|---|---|---|
|
The Preparer is same as the reimbursement contact. |
|
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| Question | Response |
|---|---|
| Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. | Yes |
| Briefly describe transition plan | Install new transmitter, filter and combiner. |
| Question | Response |
|---|---|
| Sharee Station Facility ID | 74417 |
| Call Sign | WBAY-TV |
| Type | Commercial |
| Licensee Name | GRAY TELEVISION LICENSEE, LLC |
| Status | LICENSED |
| DTS | No |
| Community of License | GREEN BAY, WI |
| Pre-auction RF Channel | 23 |
| Post-auction RF Channel | 23 |
| Neilsen DMA | Green Bay-Appleton |
| Network Affiliation |
| 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 | Diamond DHD60P2 | |
| Year | 2002 | |
| Type | Solid State | |
| Solid State Cooling | Air Cooled | |
| Solid State Power Capacity | 15.0 kW |
| Section | Question | Response |
|---|---|---|
| New Transmitter | Use | Primary (Main) |
| Change Type | Purchase New | |
| Is this a request for upgraded equipment? | No | |
| Manufacturer | ||
| Model | TMU9 | |
| Transmitter Type | Solid State | |
| Solid State Cooling | Air Cooled | |
| Solid State Power capacity | 13.0 kW | |
| Justification for New Transmitter | The existing Harris Diamond transmitter, which currently operates on channel 42, cannot be modified to perform correctly on channel 25. |
| 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 | 2.5 inches | |
| Length | 100.0 feet | |
| Other Electrical Service | Yes | |
| Description | Reconfigure existing 100kVA UPS to feed new transmitter; install temporary service for existing transmitter to facilitate use of existing service for new transmitter | |
| HVAC Service | Does the replacement transmitter require HVAC Service? | Yes |
| Type | Cooling Only | |
| Size | 15 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 | Retune Existing |
| Antenna Use | Primary (Main) | |
| Description of Use | N/A | |
| Ownership | Leased | |
| Owner | WBAY-TV | |
| Site | N/A | |
| Is this antenna currently shared with any other stations? | Yes | |
| Is this 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 | Class | Full Power |
| Mounting | Top Mount | |
| Antenna position in stack | Bottom | |
| Polarization | Horizontal | |
| Type | Broadband Panel | |
| Number of Stations Supported | 3 | |
| Number of Panels | 70 | |
| Design power capacity in use | 75.0 % | |
| Lower Limit | 470.00 MHz | |
| Upper Limit | 860.00 MHz | |
| Other Antenna Type | N/A | |
| ERP: | 212.0 kW | |
| Manufacturer | Dielectric | |
| Model | TUD-05-14/70H-B | |
| Year | 2002 |
| Facility ID | Call Sign |
|---|---|
| 74417 | WBAY-TV |
| Section | Question | Response |
|---|---|---|
| Sweep Test of Existing Antenna | Do you need a sweep test of existing antenna? | Yes |
| Section | Question | Response |
|---|---|---|
| Combiner for Shared Antenna | Do you need a Combiner for a Shared Antenna? | Yes |
| Type | New | |
| Number of channels supported | 3 | |
| Frequencies of channels supported | RF channel | |
| Frequency | N/A |
| RF Channel Number |
|---|
| 42 |
| 23 |
| 25 |
| Section | Question | Response |
|---|---|---|
| New Antenna Description | Use | Interim |
| Description of Use | N/A | |
| Change Type | Purchase New | |
| 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? | No | |
| New Antenna Manufacturer and Type | Class | Full Power |
| Mounting | Side Mount | |
| Antenna position in stack | Not in Stack | |
| Polarization | Horizontal | |
| Type | Broadband Slot | |
| Number of Stations Supported | 2 | |
| Number of Panels/Bays | 8 | |
| Lower Limit | 470.00 MHz | |
| Upper Limit | 698.00 MHz | |
| Design power capacity in use | 75.0 % | |
| Other Antenna Type | N/A | |
| ERP: | 162.0 kW | |
| Manufacturer | ||
| Model | TFU-8WB-1-R | |
| Year | 2017 | |
| Justification for New Antenna | This antenna is to be used by one station during replacement of the combiner. The other station will use the main antenna during combiner replacement. |
| 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 an 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 |
| Name | Description |
|---|---|
Waveguide and Coaxial adapters |
Various adapters will be required to connect existing WBAY waveguide and WPNE 4" coaxial outputs to coaxial input for each antenna. |
| 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 | Leased | |
| Owner | WBAY-TV | |
| Site | N/A | |
| Is the existing transmission line shared with another station or stations? | Yes | |
| Is Transmission Line in operating condition? | Yes | |
| Existing Transmission Line Manufacturer and Type | Manufacturer | Dielectric |
| Type | Rigid | |
| Diameter | 8 3/16 inches | |
| Other Diameter | N/A | |
| Segment Length | Other | |
| Other Segment Length | 19.312 feet | |
| Number of parallel runs | 0 | |
| Length | 1200 feet per run |
| Facility ID | Call Sign |
|---|---|
| 74417 | WBAY-TV |
| Name | Description |
|---|---|
Sweep line |
Confirm no flange-stacking issues on new channel |
| 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 | No | |
| 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 | 1035536 | |
| Coordinates (NAD83) | Latitude (NAD83) | 44° 24' 34.6" N- |
| Longitude (NAD83) | 088° 00' 06.7" W- | |
| Overall Structure Height | 1148.94 feet | |
| Support Structure Height | 1040.01 feet | |
| Ground Elevation Above Mean Sea Level (AMSL) | 899.92 feet | |
| Structure Type | TOWER - Free Standing or Guyed Structure | |
| Tower Owner | Gray Television Group, Inc. | |
| Date Constructed | 04/11/2002 |
| Facility ID | Call Sign | Service |
|---|---|---|
| 74417 | WBAY-TV | DTV |
| 63060 | WPNE | FM |
| 42087 | WIXX | FM |
| 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 |
|---|---|
Install interim antenna |
Install interim antenna, connect to existing 4" line |
| Section | Question | Response |
|---|---|---|
| Outside Project Management Services | Do you require outside project management services? | No |
| Number of Hours | N/A | |
| Explanation | N/A | |
| 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 | No | |
| RF Field Engineering Services | Comprehensive coverage verification via field study | No |
| RF exposure measurements | No | |
| Additional Field Engineering Service | Yes | |
| Number of Days | 3 | |
| Justification | Consulting services related to the design and specifications of the replacement combiner |
| 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? | Yes |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $423,652.74 | $420,852.74 | N/A | $369,006.49 | N/A |
| Total for all systems | $1,068,817.83 | $680,282.83 | N/A | $466,829.26 | N/A |
| Primary Transmitter TMU9 | $423,652.74 | $420,852.74 | $369,006.49 | ||
| UHF - Air Cooled Solid State Transmitter 13.0 kW | $357,949.74 | $357,949.74 | Actual cost based on attached quote | $357,949.74 | N/A |
| 2.5" Rigid Conduit and Wiring | $7,500.00 | $7,500.00 | N/A | $8,653.75 | Estimated costs were exceeded because heat exchangers needed to be located on ground-mounted pad instead of roof as previously planned. Pad installation was performed by electrical contractor sub'd by Rohde and Schwarz |
| Other Electrical Service: Reconfigure existing 100kVA UPS to feed new transmitter; install temporary service for existing transmitter to facilitate use of existing service for new transmitter | $2,403.00 | $2,403.00 | Re-locate and re-wire existing 100kVA UPS to feed new transmitter. Install temporary service to feed existing transmitter to facilitate use of existing service to feed new transmitter. | $2,403.00 | N/A |
| 15 Ton system | $55,800.00 | $53,000.00 | N/A | N/A | N/A |
| Actual Information Description | File Name |
|---|---|
| UHF - Air Cooled Solid State Transmitter 13.0 kW | |
| 2.5" Rigid Conduit and Wiring | |
| Other Electrical Service: Reconfigure existing 100kVA UPS to feed new transmitter; install temporary service for existing transmitter to facilitate use of existing service for new transmitter | |
| 15 Ton system | Information not provided. |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $182,725.09 | $185,180.09 | N/A | $90,970.09 | N/A |
| Total for all systems | $1,068,817.83 | $680,282.83 | N/A | $466,829.26 | N/A |
| Interim Antenna TFU-8WB-1-R | $91,795.09 | $91,465.09 | $5,065.09 | ||
| UHF - High Power, Side Mount, basic slot antenna, 8 bay,, 162 kW input, directional,, horizontally polarized | $80,000.00 | $80,000.00 | N/A | N/A | N/A |
| Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | N/A | N/A |
| Waveguide and Coaxial adapters | $5,065.09 | $5,065.09 | ***System Notice: Estimate adjusted and locked because line has been superseded.***multiple adapters to facilitate connections between old/new transmitters and old/new combiners and main/temporary antennas. | $5,065.09 | N/A |
| Primary Antenna TUD-05-14/70H-B | $90,930.00 | $93,715.00 | $85,905.00 | ||
| Sweep test of existing antenna | $6,730.00 | $6,400.00 | N/A | ($1,410.00) | N/A |
| New combiner, cost per channel (without antenna) | $84,200.00 | $87,315.00 | The existing combiner is 3 channel. Negotiations with mfg resulted in costs for new 3 channel combiner at or below maximum catalog costs for 2 channel combiner. | $87,315.00 | Unable to edit or delete previous initial payment request for which additional information was requested. Amount is unchanged. |
| Actual Information Description | File Name |
|---|---|
| UHF - High Power, Side Mount, basic slot antenna, 8 bay,, 162 kW input, directional,, horizontally polarized | Information not provided. |
| Sweep test of existing antenna | Information not provided. |
| Waveguide and Coaxial adapters | |
| Sweep test of existing antenna | |
| New combiner, cost per channel (without antenna) |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $3,000.00 | $3,000.00 | N/A | $1,390.18 | N/A |
| Total for all systems | $1,068,817.83 | $680,282.83 | N/A | $466,829.26 | N/A |
| Primary Transmission Line | $3,000.00 | $3,000.00 | $1,390.18 | ||
| Sweep line | $3,000.00 | $3,000.00 | N/A | $1,390.18 | N/A |
| Actual Information Description | File Name |
|---|---|
| Sweep line |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $381,100.00 | $0.00 | N/A | $0.00 | N/A |
| Total for all systems | $1,068,817.83 | $680,282.83 | N/A | $466,829.26 | N/A |
| Primary Tower TOWER | $381,100.00 | $0.00 | $0.00 | ||
| Structural engineering tower load study for well documented tower | $12,600.00 | $0.00 | No structural study required | N/A | N/A |
| Tall Tower (greater than 500') | $210,500.00 | $0.00 | No structural modifications required | N/A | N/A |
| Minor tower reinforcement/modifications | $158,000.00 | $0.00 | No structural modifications required | N/A | N/A |
| Install interim antenna | $0.00 | $0.00 | no interim antenna required | N/A | N/A |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $36,790.00 | $30,250.00 | N/A | $4,862.50 | N/A |
| Total for all systems | $1,068,817.83 | $680,282.83 | N/A | $466,829.26 | N/A |
| Outside Professional Services | $36,790.00 | $30,250.00 | $4,862.50 | ||
| 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 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 |
| Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,000.00 | N/A | $3,000.00 | N/A |
| Perform engineering study for new channel assignment and antenna development | $7,360.00 | $2,500.00 | N/A | $750.00 | N/A |
| Additional Field Engineering Service, 3 Days | $4,500.00 | $4,500.00 | $1500/day | $712.50 | N/A |
| Attorney Fees - Prepare and File request for Special Temporary Authorization | $3,680.00 | $3,500.00 | N/A | N/A | N/A |
| Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | $400.00 | N/A |
| Actual Information Description | File Name |
|---|---|
| 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. |
| Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | |
| Perform engineering study for new channel assignment and antenna development | |
| Additional Field Engineering Service, 3 Days | |
| Attorney Fees - Prepare and File request for Special Temporary Authorization | Information not provided. |
| Prepare and or review reimbursement form |
| Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
|---|---|---|---|---|---|
| Sub-total | $41,550.00 | $41,000.00 | N/A | $600.00 | N/A |
| Total for all systems | $1,068,817.83 | $680,282.83 | N/A | $466,829.26 | N/A |
| Other Expenses | $41,550.00 | $41,000.00 | $600.00 | ||
| 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 | $2,500.00 | $2,500.00 | N/A | N/A | N/A |
| Equipment Storage | $2,500.00 | $2,500.00 | N/A | N/A | N/A |
| Equipment Delivery and Handling Charges | $15,000.00 | $15,000.00 | N/A | $600.00 | N/A |
| Disposal Costs (for equipment and other waste, net of any salvage value) | $8,000.00 | $8,000.00 | N/A | N/A | N/A |
| DTV Medical Facility Notification | $11,550.00 | $11,000.00 | N/A | N/A | N/A |
| Actual Information Description | File Name |
|---|---|
| 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. |
| DTV Medical Facility Notification | Information not provided. |
| Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
|---|---|---|---|
| Total for all systems | $1,068,817.83 | $680,282.83 | $466,829.26 |
| Question | Response |
|---|---|
| The facility has ceased operating on its pre-auction channel. | Yes |
| Construction of final facilities or all necessary modifications are complete. | Yes |
| 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. | Yes |
| 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. | Marta Bechtol Executive Director 05/12/2020 |
| Section | Question | Response |
|---|---|---|
| Submission of Final Allocation or Accounting Information 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. | Marta Bechtol Executive Director 05/12/2020 |
