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:
8316
Service:
LPD
Call Sign:
K33NY-D
Channel:
33 (UHF)
File Number:
0000090903
FRN:
0001547462
Eligibility Status:
Eligible
Date Submitted:
09/10/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CALIFORNIA OREGON BROADCASTING, INC.

Patricia C. Smullin

PO Box 1489

MEDFORD, OR 97501

United States

+1 (541) 779-5555 cobiadmin@kobi5.com Corporation

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

The Preparer is same as the reimbursement contact.

 

 

 

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. Yes
Briefly describe transition plan Displacement requires new transmitter/modulator. Antenna system will be shared with co-owned co-located station.

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? No
Existing Transmitter Manufacturer and Type Manufacturer
Model MFP1PAU
Year 1996
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.20 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 PA200
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 0.25 kW
Justification for New Transmitter Prior transmitter was frequency sensitive and unable to retune.

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? No
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 No
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

Modulator Exciter

Single channel agile

Mask Filter

1 kW Full Service

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? 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
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type Frequency limited panel
ERP: 1.0 kW
Manufacturer
Model 1X1KBBU
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? Yes
Is antenna directional? Yes
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 Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 3
Lower Limit 470.00 MHz
Upper Limit 862.00 MHz
Design power capacity in use 12.5 %
ERP: 0.605 kW
Manufacturer
Model 750-10210
Year 2018
Justification for New Antenna Current antenna is frequency selective vertical slot. Replacement cost with same style antenna is approx $5800. It was more cost effective to use a combined panel array for this station and the co-owned, co-located FacID 183755 at $4000, saving 60%.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
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? 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? No
Power Dividers Does the panel antenna require power dividers? Yes
Number of Power Dividers 1
Cable Harness Does the panel antenna require cable harness? Yes
Number of Cable Harnesses 3

Enter a list of RF channel numbers.

RF Channel Number
33
20

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Ridgeline Broadcast Services LLC

Tower crew to add third panel .Replace mounting bracket, splitter and add third panel.

Ridgeline Broadcast Services LLC

Tower crew to remove current antenna and replace with new panel array antenna

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? No

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application No
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
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 No
Form 399 assistance or other program management costs No
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

Name Description

Ridgeline Broadcast Services LLC

Tower Services to remove current antenna and replace with new antenna array.

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 Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
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 $30,600.00 $17,110.00 N/A $12,905.50 N/A
Total for all systems $70,740.00 $40,195.00 N/A $23,309.30 N/A
Primary Transmitter PA200 $30,600.00 $17,110.00 $12,905.50
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts $24,300.00 $10,810.00 N/A $10,810.00 N/A
Mask Filter $2,800.00 $2,800.00 N/A $2,095.50 N/A
Modulator Exciter $3,500.00 $3,500.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts

Component Description:
280 Watt PA w/modulator - no filter Directional Couplers 7/16 Standard Directional Coupler w/ single :"N" Probe for Before filter Direction Coupler w/ single :N: probe for After filter
Amount:
$10,810.00
Mask Filter

Component Description:
09100-220 CTV/U/DVB8-05/HP/LT/B UHF FILTER 300 WATT 7-16 DIN FEMALE
Amount:
$2,095.50
Modulator Exciter Information not provided.

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 $25,575.00 $12,800.00 N/A $3,779.38 N/A
Total for all systems $70,740.00 $40,195.00 N/A $23,309.30 N/A
Primary Antenna 750-10210 $25,575.00 $12,800.00 $3,779.38
Ridgeline Broadcast Services LLC $2,000.00 $2,000.00 N/A $1,558.50 N/A
Cable harness (each, for panel antenna system, if not included in antenna cost) $3,000.00 $300.00 N/A N/A N/A
Power Dividers (each, for panel antenna system, if not included in antenna cost) $1,300.00 $1,000.00 N/A N/A N/A
Side Mount antenna brackets $4,625.00 $2,000.00 N/A $687.54 N/A
1 kW UHF Combiner (per channel) $9,400.00 $3,000.00 N/A N/A N/A
UHF Broadband panel antenna (per panel), horizontally-polarized $5,250.00 $4,500.00 N/A $1,533.34 N/A

Components

Actual Information Description File Name
Ridgeline Broadcast Services LLC

Component Description:
Remove 2-bay Kathrein Panel Array, replace 2-bay mount with 3-bay mount and replace 2-bay array with added 3rd panel antenna
Amount:
$798.50

Component Description:
Take down Scala SL-8 Antenna, Install pipe, install 2 bay Katrein panel Array
Amount:
$760.00
Cable harness (each, for panel antenna system, if not included in antenna cost) Information not provided.
Power Dividers (each, for panel antenna system, if not included in antenna cost) Information not provided.
Side Mount antenna brackets

Component Description:
3" Stand Off Mount
Amount:
$477.54

Component Description:
Scala Flat late Mounting Kit
Amount:
$210.00
1 kW UHF Combiner (per channel) Information not provided.
UHF Broadband panel antenna (per panel), horizontally-polarized

Component Description:
169-7702 Mounting Adapter for UHF Panel Antenna 753-10245 Mounting Kit 90-deg 3 panel UHF 45-95 mm
Amount:
$245.02

Component Description:
169 7702 Mounting Adapter for UHF Panel antenna K61301 Tilt Bracket 750 10210 UHF H-Pol Panel Antenna
Amount:
$527.39

Component Description:
1x2 750 10210 Array wih 5-deg mechanical tilt
Amount:
$760.93

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Information not provided.

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 $13,925.00 $9,550.00 N/A $6,079.42 N/A
Total for all systems $70,740.00 $40,195.00 N/A $23,309.30 N/A
Outside Professional Services $13,925.00 $9,550.00 $6,079.42
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $600.00 N/A $283.17 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $1,500.00 N/A $746.25 N/A
Ridgeline Broadcast Services LLC $2,000.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $4,470.00 $400.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $450.00 N/A $450.00 N/A
Perform engineering study for displacement application $1,800.00 $4,600.00 Fees charged are a flat fee for the displacement and are inclusive of the engineering study, STA prep and CP engineering. The antenna system needed to be modified due to a terrain shielding issue, so an additional engineering study had to modify the CP. $4,600.00 N/A

Components

Actual Information Description File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Calls concerning expiring displacement STAs and covering license applications Launch K33NY-D license application Finalize and file K33NY-D license application
Amount:
$283.17
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Discussion, Finalize and file K41JQ-d displacement Applications and STA request
Amount:
$196.00

Component Description:
Research translator modification issues Discussing regarding options for Roseburg translator Launch amendment to K41JQ-D displacment applicatins and launch STAs
Amount:
$348.25

Component Description:
Calls concerning expiring displacement STAs and covering license applications Finalize and File K33NY-D license applications
Amount:
$266.00

Component Description:
Research, Discussion regarding LPTV/translator displacement issues
Amount:
$202.00
Ridgeline Broadcast Services LLC Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
FCC License Application Engineering
Amount:
$450.00
Perform engineering study for displacement application

Component Description:
New Channel Search FCC Construction Permit Application & Waiver Request
Amount:
$2,500.00

Component Description:
Antenna Pattern Modification FCC Construction Permit Amendment Special Temporary Authorization
Amount:
$2,100.00

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 $640.00 $735.00 N/A $545.00 N/A
Total for all systems $70,740.00 $40,195.00 N/A $23,309.30 N/A
Other Expenses $640.00 $735.00 $545.00
FCC Filing Fees - Special Temporary Authorization request $305.00 $400.00 Two legal STA's had to be filed due to a modification of the Construction Permit due to an unexpected terrain shielding issue. $380.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A $165.00 N/A

Components

Actual Information Description File Name
FCC Filing Fees - Special Temporary Authorization request

Component Description:
LPTV Legal STA Application
Amount:
$190.00

Component Description:
LPTV Legal STA Application
Amount:
$190.00
FCC Filing Fees - Form 2100 license to cover application

Component Description:
License To Cover LPTV Station Application
Amount:
$165.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $70,740.00 $40,195.00 $23,309.30

Reimbursement Status

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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

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.

Karl D Sargent

Director of Engineering


09/10/2020

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.

Karl D Sargent

Director of Engineering


09/10/2020

Certification

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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.

  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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

  5. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. 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.

Karl D Sargent

Director of Engineering


09/10/2020

Attachments

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