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:
168662
Service:
DCA
Call Sign:
WMEU-CD
Channel:
18 (UHF)
File Number:
0000028288
FRN:
0002855179
Date Submitted:
12/28/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WEIGEL BROADCASTING CO.

Doing Business As: WEIGEL BROADCASTING CO.

Norman H. Shapiro

26 NORTH HALSTED STREET

CHICAGO, IL 60661

United States

+1 (312) 705-2675 nshapiro@wciu.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 WMEU broadcasts from Willis Tower in Chicago, IL. WMEU plans to operate on its current licensed facility until the time of transition. A new antenna and transmitter will be installed due to the channel change.

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)
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 TDU2 4K00 AV
Year 2011
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 5 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? Yes
Manufacturer
Model THU9evo-4
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.4 kW
Justification for New Transmitter The current mask filter is channel-specific and must be replaced. The current transmitter is no longer supported by the manufacturer and as a result, is unable to be retuned.

Primary Transmitter

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Other Transmitter Costs

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 No
Size N/A
Length N/A
Other Electrical Service Yes
Description Retrofit of existing electrical service for WMEU Primary Transmitter
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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Structural Analysis

WMEU's transmission facility is located on floor 101 of Willis Tower. Willis Tower requires a detailed analysis of all equipment loads with respect to the structural aspects of the building.

Structural Modifications

As a result of the structural analysis, modifications may be required.

Transmitter Installation

Willis Tower has unique labor requirements. Standard transmitter installation practices are not allowed due to labor agreements. Only building electrical and plumbing contractors may perform any electric or plumbing work related to the installation.

Transmitter Plumbing

Willis Tower requires Union labor from approved contractors for all cooling related work.

State and City Taxes

Sate and city taxes are required for equipment that is purchased, but not services.

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)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class 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 N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model TLP-4M/VP
Year 2011

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class 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: 11.0 kW
Manufacturer
Model ATC-BCE04CMS-V3-18
Year 2019
Justification for New Antenna The current WMEU antenna is a slot antenna designed for channel 32. An equivalent replacement antenna is being proposed for channel 18.

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?
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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

State and City Taxes

State and city taxes are required for equipment that is purchased, but not services.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations?
Is Transmission Line in operating condition?
Existing Transmission Line Manufacturer and Type Manufacturer
Type
Diameter
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs
Length

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

New Connectors

WMEU reused the existing Andrew HJ8-50 coax, but new connectors were required due to cutbacks made to the line for the new transmitter and antenna installation.

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 Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Located on Building
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1032959
Coordinates (NAD83) Latitude (NAD83) 41° 52' 44.1" N-
Longitude (NAD83) 087° 38' 10.2" W-
Overall Structure Height 1729.97 feet
Support Structure Height 1435.35 feet
Ground Elevation Above Mean Sea Level (AMSL) 595.14 feet
Structure Type BTWR - Building with Tower
Tower Owner 233 Broadcast, LLC
Date Constructed 01/01/2002

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
71283 WCFS-FM FM
9613 WBBM-FM FM
73228 WLS-FM FM
72115 WGN-TV DTV
9617 WBBM-TV DTV
10802 WTTW DTV
70042 WLIT-FM FM
70119 WSNS-TV DTV
6377 WTMX FM
66978 WEDE-CD DTV
48772 WPWR-TV DTV
71425 WWME-CD DTV
10801 WFMT FM
22211 WFLD DTV
28621 WJMK FM
47905 WMAQ-TV DTV
71428 WCIU-TV DTV

Other Types of Users

Users
LD TV Services
FX FM Services
LM Land Mobile

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Located on Building
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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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 Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

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
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 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)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? No
Does this relocation require MVPD Notification of a Channel Change? Yes

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 $401,244.45 $360,756.23 N/A $282,265.23 N/A
Total for all systems $1,098,995.47 $470,361.25 N/A $314,917.75 N/A
Primary Transmitter THU9evo-4 $401,244.45 $360,756.23 $282,265.23
State and City Taxes $18,491.00 $18,491.00 State and city taxes are required for equipment that is purchased, but not services. $0.00 N/A
10 Ton system $38,900.00 $37,000.00 N/A N/A N/A
Other Electrical Service: Retrofit of existing electrical service for WMEU Primary Transmitter $21,937.45 $21,937.45 Due to the proximity of the transmitter to the electrical portion of the room, the transmitter's step down transformer and transmitter were far apart. Union labor is required at Willis Tower. $21,937.45 N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $234,911.78 N/A $234,911.78 N/A
Structural Modifications $17,500.00 $17,500.00 Willis Tower requires loading studies for heavy equipment that is installed in the building. As a result, it is anticipated that additional reinforcement will be required. Actual costs to be determined once final equipment selection has been made. N/A N/A
Structural Analysis $5,500.00 $5,500.00 Willis Tower requires loading studies for equipment that exceeds the normal tenant office loads, such as broadcast equipment. Actual costs to be determined once the final equipment selection has been made. N/A N/A
Transmitter Plumbing $5,416.00 $5,416.00 Willis Tower requires Union labor from approved contractors for all cooling related work. $5,416.00 N/A
Transmitter Installation $20,000.00 $20,000.00 Willis Tower requires union labor for all electric and cooling connections. This is a general allowance to cover the additional labor fees for union labor to perform the transmitter installation and building water connections. $20,000.00 N/A

Components

Actual Information Description File Name
State and City Taxes Information not provided.
10 Ton system Information not provided.
Other Electrical Service: Retrofit of existing electrical service for WMEU Primary Transmitter

Component Description:
WMEU Primary transmitter electrical final payment
Amount:
$2,193.74

Component Description:
WMEU Primary transmitter downpayment binder
Amount:
$19,743.71
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
WMEU Primary Transmitter Shipping
Amount:
$5,312.50

Component Description:
WMEU Primary Transmitter Final Payment
Amount:
$175,251.41

Component Description:
WMEU Primary Transmitter Downpayment
Amount:
$53,923.50

Component Description:
WMEU Primary Transmitter Fittings
Amount:
$424.37
Structural Modifications Information not provided.
Structural Analysis Information not provided.
Transmitter Plumbing

Component Description:
WMEU Primary Transmitter Plumbing Final Payment
Amount:
$5,416.00
Transmitter Installation

Component Description:
WMEU Primary transmitter install
Amount:
$20,000.00

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 $35,592.50 $18,212.50 N/A $15,650.00 N/A
Total for all systems $1,098,995.47 $470,361.25 N/A $314,917.75 N/A
Primary Antenna ATC-BCE04CMS-V3-18 $35,592.50 $18,212.50 $15,650.00
State and City Taxes $2,562.50 $2,562.50 State and city taxes are required for equipment that is purchased, but not services. N/A N/A
Sweep test of existing antenna $6,730.00 $2,000.00 N/A $2,000.00 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $13,650.00 WMEU currently utilizes an elliptically polarized antenna. The proposed elliptically polarized antenna is slightly more than the FCC estimated amount. $13,650.00 N/A

Components

Actual Information Description File Name
State and City Taxes Information not provided.
Sweep test of existing antenna

Component Description:
WMEU Primary Antenna System Sweep
Amount:
$2,000.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
WMEU Primary Antenna Downpayment
Amount:
$5,875.00

Component Description:
WMEU Primary Antenna Final Payment
Amount:
$7,775.00

Cost Information

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Transmission Line

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 $1,083.52 $1,083.52 N/A $1,083.52 N/A
Total for all systems $1,098,995.47 $470,361.25 N/A $314,917.75 N/A
Primary Transmission Line $1,083.52 $1,083.52 $1,083.52
New Connectors $1,083.52 $1,083.52 WMEU reused the existing Andrew HJ8-50 coax, but new connectors were required due to cutbacks made to the line for the new transmitter and antenna installation. $1,083.52 N/A

Components

Actual Information Description File Name
New Connectors

Component Description:
WMEU Primary Transmission Line Connectors
Amount:
$1,083.52

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 $605,300.00 $72,500.00 N/A $0.00 N/A
Total for all systems $1,098,995.47 $470,361.25 N/A $314,917.75 N/A
Primary Tower BTWR $605,300.00 $72,500.00 $0.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $12,500.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $25,000.00 N/A N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $35,000.00 N/A N/A N/A

Components

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 $34,920.00 $7,019.00 N/A $5,644.00 N/A
Total for all systems $1,098,995.47 $470,361.25 N/A $314,917.75 N/A
Outside Professional Services $34,920.00 $7,019.00 $5,644.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,268.00 N/A $2,268.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $0.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $751.00 N/A $751.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $1,500.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $125.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $1,000.00 N/A $1,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $0.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $0.00 This was handled in-house N/A N/A
Prepare and or review reimbursement form $2,630.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
WMEU Attorney fees, license to cover
Amount:
$2,268.00
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
WMEU Attorney fees, STA 1
Amount:
$499.00

Component Description:
WMEU Attorney fees, STA 2
Amount:
$252.00
Prepare request for Special Temporary Authorization

Component Description:
WMEU Engineering fees, STA 2
Amount:
$750.00

Component Description:
WMEU Engineering fees, STA 1
Amount:
$750.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
WMEU Engineering fees, license to cover
Amount:
$125.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
WMEU Engineering fees, construction permit
Amount:
$1,000.00
Perform engineering study for new channel assignment and antenna development Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form Information not provided.

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 $20,855.00 $10,790.00 N/A $10,275.00 N/A
Total for all systems $1,098,995.47 $470,361.25 N/A $314,917.75 N/A
Other Expenses $20,855.00 $10,790.00 $10,275.00
MVPD Notification of Channel Change $0.00 $0.00 This was managed in-house N/A N/A
Equipment Delivery and Handling Charges $0.00 $0.00 Willis Tower loading dock after hours fees. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $8,775.00 $8,775.00 Removal of WMEU solid state transmitter cabinet, RF system, electrical system, and cooling system. $8,775.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $1,500.00 N/A $1,500.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
WMEU Disposal Costs
Amount:
$8,775.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
WMEU Medical Notification Invoice
Amount:
$1,500.00
FCC Filing Fees - Special Temporary Authorization request Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,098,995.47 $470,361.25 $314,917.75

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. 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.

Kyle Walker

VP, Technology


12/28/2020

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.

Kyle Walker

VP, Technology


12/28/2020

Attachments

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