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:
68581
Service:
DTV
Call Sign:
KTVD
Channel:
31 (UHF)
File Number:
0000027983
FRN:
0001887363
Date Submitted:
03/30/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MULTIMEDIA HOLDINGS CORPORATION

Law Department

TEGNA Inc.

8350 Broad Street, Suite 2000

Tysons, VA 22107

United States

+1 (703) 873-6600 lawdept@tegna.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

Gary Davis

Regional Head of Technology and Operations

TEGNA

Gary Davis

8350 Broad Street

Suite 2000

Tysons, VA 22102

United States

+1 (404) 873-9199 gadavis@tegna.com

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 KTVD will be moving to channel 31 from channel 19. It plans to repurpose the current broadband antenna and transmission line. It requires a new combiner port and a new transmitter. It would cost more to re-tune the existing TX than to purchase a new.

Transmitters

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Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Auxiliary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Low Power Backup transmitter
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 Ranger
Year 2003
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE 2R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter The old transmitter cannot be re-tuned.

Auxiliary 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 Yes
Size 2 inches
Length 100.0 feet
Other Electrical Service Yes
Description Additional electrical services required for transmitter installation.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 PWR 60 P2
Year 2007
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 60 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 ULXT 60
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 51 kW
Justification for New Transmitter It will cost more to re-tune the old transmitter with interim transmitter lease pricing than purchasing a new one.

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 Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service Yes
Description Additional electrical services required for transmitter installation, including heat exchangers, transformers, cooling pumps, etc.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 100.0 square feet
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

Combiner Install and Testing

Combiner Install and Testing

Transmitter installation

Transmitter installation

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 Retune Existing
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? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels 48
Design power capacity in use 50.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer Dielectric
Model TUC-C4SP-12/48U-4-T
Year 2008

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
47903 KCNC-TV

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

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 Additional Module
Number of channels supported 3
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
19
31
35

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Mask Filter

New mask filter required for new channel.

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Retune Existing
Antenna Use Auxiliary (Backup)
Description of Use AUX Antenna
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels 36
Design power capacity in use 50.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Other Antenna Type N/A
ERP: 987.0 kW
Manufacturer Dielectric
Model TUA-C3-12/36-1-S
Year 2008

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
47903 KCNC-TV

Auxiliary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

Auxiliary 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 Additional Module
Number of channels supported 3
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
19
31
35

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

Mask Filter

New mask filter required for new channel.

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 Owned
Owner N/A
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 Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1000 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
47903 KCNC-TV

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Miscellaneous Parts

Miscellaneous Parts

TX Line Sweep

Sweep required to verify post-transition channel measures well on existing line.

Switch

Switch

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Auxiliary (Backup)
Description of Use AUX Line
Ownership Owned
Owner N/A
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 Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1000 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
47903 KCNC-TV

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

TX Line Sweep

Sweep required to verify post-transition channel measures well on existing line.

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 Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1058328
Coordinates (NAD83) Latitude (NAD83) 39° 43' 50.6" N-
Longitude (NAD83) 105° 13' 55.6" W-
Overall Structure Height 734.24 feet
Support Structure Height 620.40 feet
Ground Elevation Above Mean Sea Level (AMSL) 7115.40 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner LAKE CEDAR GROUP, L.L.C.
Date Constructed 06/01/2009

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
47903 KCNC-TV DTV

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 N/A
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? Yes
Number of Hours 200
Explanation Fewer PM tasks are needed & OES & 399 work are needed, so the PM total has been reduced to $150x200hrs($30000), a new OES component has been created & funded with part of the $ removed from PM, & "Prepare & or review reimbursement form" has been increased
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 10
Justification $2,500 per site visit including expenses x 10 days. It is necessary to survey the site, plan the equipment, develop specifications for purchasing, & oversee multiple vendor RF projects. Station does not have available personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Legal Services

Other Legal Services related to the DTV Repack

Pre filing site review

outside engineering to review all facilitues

Other Engineering Services

Fewer PM tasks are needed & OES & 399 work are needed, so the PM total has been reduced to $150x200hrs($30000), a new OES component has been created & funded with part of the $ removed from PM, & "Prepare & or review reimbursement form" has been increased

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 Yes
Non-zoning permits Yes
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? 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

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 $1,519,274.02 $1,489,706.12 N/A $1,362,407.27 N/A
Total for all systems $2,663,908.71 $2,657,018.83 N/A $1,693,805.80 N/A
Primary Transmitter ULXT 60 $1,365,674.02 $1,365,374.02 $1,265,575.17
Transmitter installation $18,345.45 $18,345.45 Transmitter installation $18,345.45 N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Other -- Building Addition Size: 100.0 $25,000.00 $25,000.00 New pad required for heat exchangers, transformers, pumps, etc. Equipment must also be shielded. $301.42 N/A
Other Electrical Service: Additional electrical services required for transmitter installation, including heat exchangers, transformers, cooling pumps, etc. $122,153.30 $122,153.30 See Encore Electric Quote. The total is 50 cents higher than originally thought due to the "cents" being lopped off on the vendor's quote. $121,891.33 N/A
UHF - Liquid Cooled Solid State Transmitter 51 kW $1,176,500.27 $1,176,500.27 See attached GatesAir quotes and invoices. Also, see Dielectric LLC quotes and invoices. Also, Majestic Rigging and Transportation invoices & quotes. $1,106,561.97 The Actual Cost exceeds the Estimated Cost due in part to the inclusion of the Combiner & RF System in this category, as well as sales tax.
Combiner Install and Testing $18,475.00 $18,475.00 Combiner Install & Testing;See attached / uploaded PDF file titled, "Majestic HN-630001222 v200310pmv1" $18,475.00 N/A
Auxiliary Transmitter UAXTE 2R37 $153,600.00 $124,332.10 $96,832.10
Other Electrical Service: Additional electrical services required for transmitter installation. $25,000.00 $25,000.00 Additional electrical services required for transmitter installation. N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $2,600.00 $2,500.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $96,832.10 See attached GatesAir invoices GO10004858-1 and US0322514, with corresponding Quotes and Change Orders. $96,832.10 N/A

Components

Actual Information Description File Name
Transmitter installation

Component Description:
Gates inv #US0321815 Stage 1 Filter line install UL20190416jgv1
Amount:
$18,345.45
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other -- Building Addition Size: 100.0

Component Description:
Inv 148630459 KTVD Equipment rental UL20180601jgv1
Amount:
$301.42
Other Electrical Service: Additional electrical services required for transmitter installation, including heat exchangers, transformers, cooling pumps, etc.

Component Description:
Gates US0328257 v191007pmv1
Amount:
$28,916.10

Component Description:
Amazon 31165 v190611pmv1
Amount:
$25.73

Component Description:
Amazon 30622 v190611pmv1
Amount:
$262.00

Component Description:
KTVD Encore Elec inv #43123 Electrical work UL20180806jg v2
Amount:
$92,949.50
UHF - Liquid Cooled Solid State Transmitter 51 kW

Component Description:
Inv US0307626 KTVD ULXT-60 TX change order UL20180515jgv1
Amount:
$23,246.71

Component Description:
Inv MAN00386 KTVD Combiner and RF System 45 percent payment 2 UL20180424jg v1
Amount:
$92,291.63

Component Description:
Inv MAN00269 KTVD Combiner and RF System 45 percent down payment UL20180424jg v1
Amount:
$92,291.63

Component Description:
Inv GO10004699-1 KTVD ULXT-60 transmitter 50 percent down payment UL20180424jg v1
Amount:
$390,798.01

Component Description:
Inv US0307804 KTVD ULXT-60 TX balance due UL20180515jgv2
Amount:
$456,327.97

Component Description:
Die 323010 v191025pmv4
Amount:
$14,028.00

Component Description:
Die 323010 v191025pmv4
Amount:
$672.00

Component Description:
Die 323010 v191025pmv4
Amount:
$1,272.00

Component Description:
Majestic 1203232 v190923pmv1
Amount:
$2,050.00

Component Description:
Majestic 1203333 v190923pmv1
Amount:
$1,642.50

Component Description:
Die 235024 v191219pmv5
Amount:
$13,184.24

Component Description:
Die 323010 v191025pmv4
Amount:
$276.00

Component Description:
Majestic HN-630000252 v190923pmv1
Amount:
N/A

Component Description:
Gates inv #US0320805 Various transmitter parts UL20190416jgv1
Amount:
$2,042.67

Component Description:
Die 235024 v191025pmv4
Amount:
$6,592.12

Component Description:
Die 332003 v190712pmv1
Amount:
$280.00

Component Description:
Die 242072 v190820pmv2
Amount:
$7,325.00

Component Description:
Die 332003 v190820pmv2
Amount:
$1,250.00

Component Description:
Majestic 630000097 v190530pmv1
Amount:
$1,760.00

Component Description:
Die 323010 v190712pmv1
Amount:
$274.05

Component Description:
Die 323010 v190712pmv1
Amount:
$27.60

Component Description:
Die 332003 v190712pmv1
Amount:
$125.00

Component Description:
Die 323010 v191025pmv4
Amount:
$36.00

Component Description:
Die 323010 v190712pmv1
Amount:
$350.00

Component Description:
Die 325036 v190712pmv1
Amount:
$25.00

Component Description:
Die 323010 v190712pmv1
Amount:
$3.60

Component Description:
Die 332003 v190820pmv2
Amount:
$2,800.00

Component Description:
Deposit on Transmitter
Amount:
$144,324.64

Component Description:
Die 325036 v190820pmv2
Amount:
$250.00

Component Description:
Transmitter/Components-GatesAir
Amount:
$422,226.60

Component Description:
Die 242072 v190712pmv1
Amount:
$7,325.00

Component Description:
Die 323010 v190712pmv1
Amount:
$127.20

Component Description:
Die 235024 v191025pmv4
Amount:
$6,592.12

Component Description:
Gates inv #US0320664 Various transmitter parts UL20190416jgv1
Amount:
$3,017.61

Component Description:
Die 235024 v1900820pmv2
Amount:
N/A

Component Description:
Majestic HN-630000622 v190923pmv1
Amount:
N/A

Component Description:
Die 332003 v190712pmv1
Amount:
$104.64

Component Description:
Die 323010 v190917pmv3
Amount:
$3,500.00

Component Description:
Die 323010 v190712pmv1
Amount:
$67.20

Component Description:
Die 323010 v190712pmv1
Amount:
$1,402.80

Component Description:
Amazon 31900 v190530pmv1
Amount:
$52.56

Component Description:
Majestic HN-630000532 v190923pmv1
Amount:
N/A
Combiner Install and Testing

Component Description:
H and D 47443 v190628jgv1
Amount:
$16,465.00

Component Description:
Majestic HN-630001222 v200310pmv1
Amount:
$2,010.00
Other Electrical Service: Additional electrical services required for transmitter installation. Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Gates US0321035 v190918pmv1
Amount:
$984.13

Component Description:
Gates US0322514 v190918pmv2
Amount:
$23,717.32

Component Description:
Gates inv #GO10004858-1 Aux TX 50 pct pmt 1 UL20181030jgv1
Amount:
$44,168.95

Component Description:
Gates US0317124 v190918pmv1
Amount:
$27,875.58

Component Description:
Gates US0321036 v190918pmv1
Amount:
$86.12

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 $318,010.00 $309,224.01 N/A $113,110.04 N/A
Total for all systems $2,663,908.71 $2,657,018.83 N/A $1,693,805.80 N/A
Primary Antenna TUC-C4SP-12/48U-4-T $183,130.00 $179,796.26 $99,003.54
Mask Filter $73,250.00 $73,250.00 New mask filter required for new post-transition channel. See attached Dielectric quote. N/A N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $18,000.00 N/A $16,857.30 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Adding a module to existing combiner (without antenna) $84,200.00 $82,146.26 3-channel manifold combiner required in order to repurpose existing broadband antenna and broadband transmission line. See attached Dielelctric quote. $82,146.24 N/A
Auxiliary Antenna TUA-C3-12/36-1-S $134,880.00 $129,427.75 $14,106.50
Mask Filter $25,000.00 $25,000.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $18,000.00 N/A N/A N/A
Adding a module to existing combiner (without antenna) $84,200.00 $80,027.75 3-channel manifold combiner required in order to repurpose existing broadband antenna and broadband transmission line. See attached Dielelctric quote. $14,106.50 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
Mask Filter Information not provided.
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
Die 499005 v190610pmv1
Amount:
$4,085.00

Component Description:
Die ST563025 v190930pmv1
Amount:
$78.40

Component Description:
Die 563025 v190930pmv1
Amount:
$1,960.00

Component Description:
Gates US0325614 v200413pmv1
Amount:
$8,241.44

Component Description:
Die ST499005 v190617jgv1
Amount:
$339.46

Component Description:
Die inv #US0320792 Swivel Hanger and tax UL20190405jgv1
Amount:
$2,153.00
Sweep test of existing antenna Information not provided.
Adding a module to existing combiner (without antenna)

Component Description:
Die 235024 v190604pmv1
Amount:
N/A

Component Description:
Die MAN01015 v190806pmv1
Amount:
$37,673.12

Component Description:
Die 445002 v190503jgv2
Amount:
$6,800.00

Component Description:
Die MAN01016 v190806pmv1
Amount:
$37,673.12
Mask Filter Information not provided.
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) Information not provided.
Adding a module to existing combiner (without antenna)

Component Description:
Die 235024 v190604pmv1
Amount:
$65,921.25

Component Description:
Electron D 201812007 v190507jgv2
Amount:
$14,106.50

Component Description:
Electron D inv #201812007 Manifold Aux Combiner Install UL20190402jgv1
Amount:
$14,106.50
Sweep test of existing antenna Information not provided.

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 $19,619.76 $19,619.76 N/A $6,819.76 N/A
Total for all systems $2,663,908.71 $2,657,018.83 N/A $1,693,805.80 N/A
Primary Transmission Line $13,219.76 $13,219.76 $6,819.76
TX Line Sweep $6,400.00 $6,400.00 N/A N/A N/A
Miscellaneous Parts $669.76 $669.76 N/A $669.76 N/A
Switch $6,150.00 $6,150.00 See attached / uploaded PDF file titled, "Die 760040 v200608pmv1" $6,150.00 N/A
Auxiliary Transmission Line $6,400.00 $6,400.00 $0.00
TX Line Sweep $6,400.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
TX Line Sweep Information not provided.
Miscellaneous Parts

Component Description:
Die ST573039 v191007pmv1
Amount:
$25.76

Component Description:
Die 573039 v191007pmv1
Amount:
$644.00
Switch

Component Description:
Die 760040 v200608pmv1
Amount:
$6,150.00
TX Line Sweep 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 $394,800.00 $375,000.00 N/A $31,372.90 N/A
Total for all systems $2,663,908.71 $2,657,018.83 N/A $1,693,805.80 N/A
Primary Tower TOWER $394,800.00 $375,000.00 $31,372.90
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $31,372.90 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500') Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study Information not provided.
Minor tower reinforcement/modifications

Component Description:
Majestic HN-630000252 v190923pmv1
Amount:
$2,230.80

Component Description:
Majestic HN-630000532 v190923pmv1
Amount:
$10,357.30

Component Description:
Majestic HN-630000622 v190923pmv1
Amount:
$18,784.80

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 $283,288.16 $335,117.17 N/A $145,224.06 N/A
Total for all systems $2,663,908.71 $2,657,018.83 N/A $1,693,805.80 N/A
Outside Professional Services $283,288.16 $335,117.17 $145,224.06
Project management of the transition $31,600.00 $61,857.51 The cost estimate includes Form 399 submissions including ongoing Actual Cost invoice prep and submission by KGA, and amendments as needed. $61,857.51 See invoices
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A $550.00 N/A
Other Engineering Services $30,132.50 $30,132.50 The Estimated Cost includes other engineering services such as RF calculations, evolving transition plan calculations, bid spec prep / distribution / award recommendation / etc and discussion, etc. $30,132.50 N/A
Pre filing site review $23,500.00 $23,500.00 N/A N/A N/A
Other Legal Services $19,260.66 $19,260.66 Other Legal Services related to the DTV Repack $12,892.55 N/A
Additional Field Engineering Service, 10 Days $25,000.00 $25,000.00 $2,500 per site visit including expenses x 10 days. It is necessary to survey the site, plan the equipment, develop specifications for purchasing, & oversee multiple vendor RF projects. Station does not have available personnel trained in such services. N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $0.00 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 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 $4,100.00 $3,000.00 N/A $3,000.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $0.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $675.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,500.00 See attached / uploaded PDF file titled "Osborn 33860 v191226jgv1.pdf" $2,500.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $33,616.50 The cost estimate includes the initial 399 amendment, anticipated subsequent 399 amendments, and ongoing Actual Cost invoice prep and submission by KGA. $33,616.50 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

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Inv 29216 KTVD Proj Mgt 180428-180525 UL20180706jg v1
Amount:
$4,350.00

Component Description:
Osborn 40289 v201215pmv1
Amount:
$237.00

Component Description:
Osborn 41441 v210330pmv1
Amount:
$79.00

Component Description:
Osborn 39381 v201116pmv1
Amount:
$1,424.50

Component Description:
Osborn 31150 v191223jgv1
Amount:
$2,475.00

Component Description:
Osborn 31794 v191226jgv1
Amount:
$5,400.00

Component Description:
Osborn 32836 v190613pmv1
Amount:
$1,200.00

Component Description:
Osborn 34126 v191226jgv1
Amount:
$2,062.50

Component Description:
Osborn 30488 v191223jgv1
Amount:
$675.00

Component Description:
Osborn 35815 v191226jgv1
Amount:
$150.00

Component Description:
Osborn 34596 v190730jgv1
Amount:
$1,425.00

Component Description:
Osborn 35006 v191226jgv1
Amount:
$450.00

Component Description:
Osborn 31613 v191226jgv1
Amount:
$1,650.00

Component Description:
Osborn 37928 v210330pmv1
Amount:
$671.50

Component Description:
Osborn 36192 v191226jgv1
Amount:
$2,765.00

Component Description:
Osborn 30011 v191223jgv1
Amount:
$1,350.00

Component Description:
Osborn 37434 v210330pmv1
Amount:
$158.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$4,987.50

Component Description:
Osborn 39676 v201215pmv1
Amount:
$287.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$150.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$300.00

Component Description:
Osborn inv #26018 Proj Mgt 170530-170728 UL20181107jg v1
Amount:
$20,669.99

Component Description:
Osborn inv #28999 Proj mgt 180331-180427 UL20190321jgv1
Amount:
$1,725.00

Component Description:
Osborn 36544 v200511pmv2
Amount:
$474.00

Component Description:
Osborn 30691 v191223jgv1
Amount:
$1,500.00

Component Description:
Osborn inv #29838 Proj mgt 180526-180629 UL20190322jgv1
Amount:
$2,362.50

Component Description:
Osborn 32206 v191226jgv1
Amount:
$1,639.02

Component Description:
Osborn 40955 v201215pmv1
Amount:
$79.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$150.00

Component Description:
Osborn 39992 v201223jgv2
Amount:
$237.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$300.00

Component Description:
Osborn 36565 V200427pmv1
Amount:
$474.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase

Component Description:
Osborn 37033 v210330pmv1
Amount:
$550.00
Other Engineering Services

Component Description:
MSW 7312 v210319jgv1
Amount:
$13,515.00

Component Description:
Osborn 31150 v191223jgv1
Amount:
$775.00

Component Description:
Osborn 35401 v190114jgv1
Amount:
$12,435.00

Component Description:
Osborn 37033 v210330pmv1
Amount:
$792.50

Component Description:
Osborn 38616 v200824pmv2
Amount:
$140.00

Component Description:
Osborn inv #29838 Other Eng Srvcs UL20190322jgv1
Amount:
$2,475.00
Pre filing site review Information not provided.
Other Legal Services

Component Description:
Covington 60805585 v190513pmv1
Amount:
$4,655.68

Component Description:
Covington 60801032 v190530jgv2
Amount:
$1,958.17

Component Description:
Covington 60801029 v190712jgv2
Amount:
$144.71

Component Description:
Covington 60801029 v190513pmv1
Amount:
$164.44

Component Description:
Covington inv #60805588 Various legal thru 180531 UL20190410jgv1
Amount:
$1,756.37

Component Description:
Covington inv #60808553 Various legal thru 180630 UL20190410jgv1
Amount:
$235.69

Component Description:
Covington 60801029 v190508pmv1
Amount:
$164.44

Component Description:
Covington inv #60796723 Various Legal UL20181024jgv1
Amount:
$4,141.93

Component Description:
Covington 60805585 v190508pmv1
Amount:
$4,655.68

Component Description:
Covington 60801032 v190508pmv1
Amount:
$1,521.69
Additional Field Engineering Service, 10 Days Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Osborn 38637 v200716pmv1
Amount:
$1,397.50
ASR modification (prepare FCC Form 854) Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License 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

Component Description:
Osborn 33860 v191226jgv1
Amount:
$1,500.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$1,500.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
Osborn 39992 v201223jgv2
Amount:
N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Osborn 33860 v191226jgv1
Amount:
$675.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Osborn 33860 v191226jgv1
Amount:
$2,500.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
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

Component Description:
Osborn 39676 v201215pmv1
Amount:
$590.00

Component Description:
Osborn 40651 v201215pmv1
Amount:
$50.00

Component Description:
Osborn 38616 v200824pmv2
Amount:
$1,160.00

Component Description:
Osborn 40289 v201215pmv1
Amount:
$180.00

Component Description:
Osborn 41441 v210330pmv1
Amount:
$280.00

Component Description:
Osborn 38978 v200716pmv1
Amount:
$605.00

Component Description:
Osborn 39381 v201116pmv1
Amount:
$1,370.00

Component Description:
Osborn 31150 v191223jgv1
Amount:
$875.00

Component Description:
Osborn 35815 v191226jgv1
Amount:
$2,745.00

Component Description:
Osborn 35006 v191226jgv1
Amount:
$3,495.00

Component Description:
Osborn 35401 v190114jgv1
Amount:
$1,800.00

Component Description:
Osborn 37033 v210330pmv1
Amount:
$120.00

Component Description:
Osborn 37928 v210330pmv1
Amount:
$515.00

Component Description:
Osborn 36192 v191226jgv1
Amount:
$3,185.00

Component Description:
Osborn 41737 v210330pmv1
Amount:
$395.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$1,000.00

Component Description:
Osborn 36544 v200511pmv2
Amount:
$1,700.00

Component Description:
Osborn inv #28999 Amend 399 Form UL20190301jgv2
Amount:
$3,200.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$2,746.00

Component Description:
Osborn 38318 v200724pmv1
Amount:
$235.00

Component Description:
Osborn 37434 v210330pmv1
Amount:
$2,070.00

Component Description:
Osborn 30011 v191223jgv1
Amount:
$797.50

Component Description:
Osborn inv #29838 Actual Cost Invoices UL20190322jgv1
Amount:
$437.50

Component Description:
Osborn 39992 v201223jgv2
Amount:
$1,020.00

Component Description:
Osborn 33860 v191226jgv1
Amount:
$1,327.50

Component Description:
Osborn 34586 v190730jgv1
Amount:
$1,718.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application 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 $128,916.77 $128,351.77 N/A $34,871.77 N/A
Total for all systems $2,663,908.71 $2,657,018.83 N/A $1,693,805.80 N/A
Other Expenses $128,916.77 $128,351.77 $34,871.77
MVPD Notification of Channel Change $6,000.00 $6,000.00 40 hours at $150 per hour to shoot, edit . write and produce promotional information. $1,865.00 N/A
Develop and air announcement of upcoming channel change $6,000.00 $6,000.00 40 hours at $150 per hour to shoot, edit . write and produce promotional information. $3,270.00 N/A
Equipment Delivery and Handling Charges $29,086.77 $29,086.77 See attached / uploaded PDF files titled, "Johnson L26-138-9 2-16-19 v200310pmv1" and "Johnson C130-110762 v200310pmv1" and "Die ST523007 v200317pmv1". See attached / updated PDF file titled,"Gates US0325634 v200413pmv1". $25,986.77 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A N/A N/A
Non-zoning permits $25,000.00 $25,000.00 N/A N/A N/A
Local Zoning $750.00 $750.00 3 cents per $100 of construction cost. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Equipment Storage $25,000.00 $25,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,750.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
Osborn 33860 v191226jgv1
Amount:
$1,865.00
Develop and air announcement of upcoming channel change

Component Description:
2C Media inv #203806 Creation of channel change announcement UL20181016jgv1
Amount:
$3,270.00
Equipment Delivery and Handling Charges

Component Description:
Johnson L26-138-9 2-16-19 v200310pmv1
Amount:
$3,155.00

Component Description:
Die 523007 v190807pmv1
Amount:
$59.01

Component Description:
Die 466005 V191219pmv1
Amount:
$4,485.00

Component Description:
Die 459012 V191219pmv1
Amount:
$4,104.00

Component Description:
Die 452006 v190806pmv1
Amount:
$764.93

Component Description:
Die 235024 v191219pmv5
Amount:
$8,032.50

Component Description:
Die 323010 v191025pmv4
Amount:
$2,740.52

Component Description:
Johnson C130-110762 v200310pmv1
Amount:
$3,100.00

Component Description:
Die ST523007 v200317pmv1
Amount:
$4.90

Component Description:
Die 235024 v191025pmv4
Amount:
$8,032.50

Component Description:
Die 567025 v191007pmv1
Amount:
$363.27

Component Description:
Die 564024 v190930pmv1
Amount:
$383.43

Component Description:
Gates US0325634 v200413pmv1
Amount:
$847.72

Component Description:
Die 332003 v190820pmv2
Amount:
$1,046.49

Component Description:
Die 235024 v190604pmv1
Amount:
N/A
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits Information not provided.
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Equipment Storage Information not provided.
DTV Medical Facility Notification

Component Description:
RF Notifications inv #1052 Medical Notifications UL20181029jg v1
Amount:
$3,750.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,663,908.71 $2,657,018.83 $1,693,805.80

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.

Jeffrey C Gehman

Engineering Associate


03/30/2021

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.

Jeffrey C Gehman

Engineering Associate


03/30/2021

Attachments

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