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:
84225
Service:
DTV
Call Sign:
KOCM
Channel:
16 (UHF)
File Number:
0000028061
FRN:
0001843697
Date Submitted:
07/29/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WORD OF GOD FELLOWSHIP, INC.

Doing Business As: WORD OF GOD FELLOWSHIP, INC.

Arnold Torres

3901 HIGHWAY 121 SOUTH

BEDFORD, TX 76021

United States

+1 (817) 571-1229 ARNOLD.TORRES@DAYSTAR.COM Not-for-Profit

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

Samuel Hariton

Widelity, Inc.

Samuel Hariton

4031 University Drive

Ste 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.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. Yes
Briefly describe transition plan KOCM will move to a leased Broadband Array on another tower. It will share antenna, combiner, transmission line with two other stations. This will be a new facility build. See attachment for SOW and tower and other costs provided by tower owner.

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 Vissionary
Year 2008
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 25 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 ELETXUD3600AC
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3.6 kW
Justification for New Transmitter Current transmitter cannot be retuned to new antenna at allotted power level. Existing transmitter will continue to be used on pre-auction channel to maintain presence during transition.

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) Yes
Transformer (480V) Yes
Power 500 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 250.0 feet
Other Electrical Service Yes
Description Minimal electric services not listed above will be needed to implement new facility.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 15 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 2058.0 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

Mask Filter

Mask Filter

Transmitter Installation

Transmitter Installation Costs

New Electrical Sub-Panels

New Electrical Sub-Panels required to support repack equipment.

Primary Transmitter - Demolition

Primary Transmitter - Demolition

Ice Shield for HVAC equipment

Ice protection for all the additional outdoor equipment over the 55' x 18' mechanical slab equipment for new HVAC units to be installed, Total estimated area requiring ice protection is 990' sq. ft

Internal Transmission Line

Internal Transmission Line

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 Lease 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 Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
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: 50.0 kW
Manufacturer
Model SWHP16OI -46
Year 2004

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 Lease New
Is this a request for upgraded equipment? Yes
Ownership Leased
Owner American Tower Corporation
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 4
Number of Panels/Bays 56
Lower Limit 470.00 MHz
Upper Limit 700.00 MHz
Design power capacity in use 58.0 %
Other Antenna Type N/A
ERP: 26.6 kW
Manufacturer
Model PEPL56D VPT
Year 2017
Justification for New Antenna Existing antenna is non-tunable to new channel.

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 3
Frequencies of channels supported Upper and lower frequency
Frequency 470.0 MHz - 698.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
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

Elbow complex broadband at antenna input per 7.1875 inch feedline

7 3/16" Broadband Elbow Complex required due to repack

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 Lease New
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? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 5 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 1500 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Lease New
Is this a request for upgraded equipment? Yes
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1725 feet per run
Justification for New Transmission Line The repacked station will be located on a new tower. The pre-transition station will continue to operate from the current tower site during the transition as an interim facility.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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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Add 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? Candelabra
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1253490
Coordinates (NAD83) Latitude (NAD83) 35° 33' 36.9" N-
Longitude (NAD83) 097° 29' 07.6" W-
Overall Structure Height 1604.31 feet
Support Structure Height 1604.31 feet
Ground Elevation Above Mean Sea Level (AMSL) 1145.00 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 06/21/2007

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
54418 KOKF FM
50169 KYLV FM
8798 KYIS FM
8797 KATT-FM FM
77480 KTUZ-TV DTV
72469 KOMA FM
37435 WWLS-FM FM
16851 KRXO-FM FM
55708 KMGL FM

Other Types of Users

Users
K221FQ

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 Candelabra
Helicopter Services Required Are helicopter services required? Yes

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1045226
Coordinates (NAD83) Latitude (NAD83) 35° 35' 52.1" N-
Longitude (NAD83) 097° 29' 23.2" W-
Overall Structure Height 1646.96 feet
Support Structure Height 1549.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 1102.02 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC.
Date Constructed 02/01/1999

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
50182 KAUT-TV DTV
50205 KETA-TV DTV
58390 KTST FM
66222 KFOR-TV DTV
25382 KWTV-DT DTV
11918 KJYO FM
11964 KBRU FM
58389 KXXY-FM FM
2566 KOPX-TV DTV
38214 KSBI DTV

Other Types of Users

Users
K213EM
KBZC-LD
KGNE-LD

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Candelabra
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 595
Explanation Project management fee for pre-construction services including initial antenna placement and RF compatibility review, zoning and permitting requirements review; leasing application services to support the transition of a single broadcaster.
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 Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 Yes
Additional Field Engineering Service Yes
Number of Days 7
Justification Installation of transmitter and supervision of antenna installation.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Tower Permit Drawing Package

Tower Permit Drawing Package

Construction project management Tower Modification reinforcements and facilties

One-hundred-sixty hours for RF installation project management.

Ground and Building A and E Permit Drawing Package

Ground and Building A and E Permit Drawing Package

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 Yes
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

Name Description

Migratory Bird Assessment and Permitting

Migratory Bird Assessment and Permitting

RF System Test

Testing of the combiner to ensure all frequencies are tuned for optimal patterns.

Site Coordination Meeting

Site coordination meetings with all broadcasters, contractors and vendors involved with the site deliveries and construction.

Internal Labor

Internal Labor

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 $488,972.96 $463,079.46 N/A $372,453.69 N/A
Total for all systems $3,963,099.53 $2,619,947.38 N/A $1,721,905.70 N/A
Primary Transmitter ELETXUD3600AC $488,972.96 $463,079.46 $372,453.69
Internal Transmission Line $2,846.12 $2,846.12 Please see KOCM RF Specialties quote P26883, plus shipping costs from RF Specialties invoice 21328 $2,846.12 N/A
Ice Shield for HVAC equipment $54,552.40 $54,552.40 see Estimated Cost Justification KOCM-110-1st Primary Transmitter - Ice Shield for HVAC Equipment v0 $54,552.40 N/A
Primary Transmitter - Demolition $2,407.99 $2,407.99 Please see KOCM Primary Transmitter - Demolition Budget Revision Justification Letter.pdf $2,396.67 N/A
New Electrical Sub-Panels $5,282.20 $5,282.20 Please see KOCM American Tower Customer Project Cost Estimate $5,282.20 N/A
Transmitter Installation $3,741.75 $3,741.75 Please see Estimated Cost Justification KOCM-110-1st Primary Transmitter - Transmitter Installation v1 $3,741.75 N/A
Other -- Building Addition Size: 2058.0 $78,481.00 $78,481.00 Per ATC Oklahoma City Cost Estimation $58,860.75 N/A
15 Ton system $55,800.00 $87,000.00 ATC Oklahoma City Cost Estimation plus tax and freight est $69,606.60 N/A
Other Electrical Service: Minimal electric services not listed above will be needed to implement new facility. $10,000.00 $10,000.00 N/A $0.00 N/A
4" Rigid Conduit and Wiring (Cost per foot) $25,250.00 $16,800.00 see Estimated Cost Justification KOCM-110-1st Primary Transmitter - 4_ Rigid Conduit and Wiring v0 $16,800.00 N/A
Mask Filter $8,411.50 $8,411.50 N/A $6,729.20 N/A
Transformer 3 phase/480v - 500 KVA $48,400.00 $32,200.00 see Estimated Cost Justification KOCM-110-1st Primary Transmitter - 3 Phase, 480 V, 500 KVA Transformer v0 $32,200.00 N/A
Switchgear - industrial 800 amp $38,200.00 $25,410.00 see Estimated Cost Justification KOCM-110-1st Primary Transmitter - 800 Amp Industrial Switchgear v0 $25,410.00 N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $135,946.50 Electronika quote #6006, $125,946.50 plus est. $10,000.00 in tax and freight. Please see KOCM IOT Headroom Analysis 201110 for justification of full reimbursement eligibility. $94,028.00 N/A

Components

Actual Information Description File Name
Internal Transmission Line

Component Description:
1-5/8" Cellflex
Amount:
$2,846.12
Ice Shield for HVAC equipment

Component Description:
KOCM-110-1st Primary Transmitter - Ice Shield for HVAC Equipment
Amount:
$19,800.00

Component Description:
5. KOCM-110-1st Primary Transmitter - Ice Shield for HVAC Equipment
Amount:
$24,852.40

Component Description:
KOCM-110-1st Primary Transmitter - Ice Shield for HVAC Equipment
Amount:
$9,900.00
Primary Transmitter - Demolition

Component Description:
Repack travel expenses and supplies
Amount:
$2,396.67
New Electrical Sub-Panels

Component Description:
KOCM-110-1st Primary Transmitter -New Electrical Sub-Panels
Amount:
$5,282.20
Transmitter Installation

Component Description:
Henry Turner Mileage
Amount:
$262.74

Component Description:
Travel Expense
Amount:
$376.25

Component Description:
Repack travel expenses and supplies
Amount:
$375.64

Component Description:
Repack travel expenses and supplies
Amount:
$197.12

Component Description:
Repack travel expenses and supplies
Amount:
$1,487.04

Component Description:
Repack travel expenses and supplies
Amount:
$1,042.96
Other -- Building Addition Size: 2058.0

Component Description:
KOCM-110-1st Primary Transmitter - Building Addition, 2,058 sq. ft.
Amount:
$39,240.50

Component Description:
KOCM-110-1st Primary Transmitter - Building Addition, 2,058 sq. ft.
Amount:
$19,620.25
15 Ton system

Component Description:
KOCM-110-1st Primary Transmitter - 15 Ton System
Amount:
$29,856.60

Component Description:
KOCM-110-1st Primary Transmitter - 15 Ton System
Amount:
$26,500.00

Component Description:
KOCM-110-1st Primary Transmitter - 15 Ton System
Amount:
$13,250.00
Other Electrical Service: Minimal electric services not listed above will be needed to implement new facility. Information not provided.
4" Rigid Conduit and Wiring (Cost per foot)

Component Description:
KOCM-110-1st Primary Transmitter - 4" Rigid Conduit and Wiring
Amount:
$7,800.00

Component Description:
KOCM-110-1st Primary Transmitter - 4"" Rigid Conduit and Wiring
Amount:
$3,000.00

Component Description:
KOCM-110-1st Primary Transmitter - 4"" Rigid Conduit and Wiring
Amount:
$6,000.00
Mask Filter

Component Description:
KOCM-110-1st Primary Transmitter - Mask Filter
Amount:
$6,729.20
Transformer 3 phase/480v - 500 KVA

Component Description:
KOCM-110-1st Primary Transmitter - 3 Phase, 480 V, 500 KVA Transformer
Amount:
$11,500.00

Component Description:
KOCM-110-1st Primary Transmitter - 3 Phase, 480 V, 500 KVA Transformer
Amount:
$14,950.00

Component Description:
KOCM-110-1st Primary Transmitter - 3 Phase, 480 V, 500 KVA Transformer
Amount:
$5,750.00
Switchgear - industrial 800 amp

Component Description:
CAPITAL CONTRIBUTION
Amount:
$4,537.50

Component Description:
CAPITAL CONTRIBUTION - OKLAHOMA CITY OK
Amount:
$11,797.50

Component Description:
CAPITAL CONTRIBUTION - OKLAHOMA CITY OK
Amount:
$9,075.00
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Invoice moved to correct budget category
Amount:
N/A

Component Description:
Invoice moved to correct budget category
Amount:
N/A

Component Description:
EKA TXUD3600AC D UHF Digital TV Transmitter
Amount:
$94,028.00

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 $1,212,359.25 $307,359.50 N/A $305,325.90 N/A
Total for all systems $3,963,099.53 $2,619,947.38 N/A $1,721,905.70 N/A
Primary Antenna PEPL56D VPT $1,212,359.25 $307,359.50 $305,325.90
Elbow complex broadband at antenna input per 7.1875 inch feedline $17,729.25 $17,729.25 Please see KOCM American Tower Customer Project Cost Estimate $17,729.25 N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $17,729.25 see Estimated Cost Justification KOCM-210-Primary Antenna - 6 1_8_ Broadband Elbow Complex v0 $17,729.25 N/A
New combiner, cost per channel (without antenna) $84,200.00 $45,000.00 N/A $42,966.40 N/A
Sweep test of existing antenna $6,730.00 $7,000.00 see Estimated Cost Justification KOCM-210-Primary Antenna - Sweep Test v0 $7,000.00 N/A
UHF - High Power Top Mount (200-1000 kW), Four Station broadband panel antenna, elliptically or circularly polarized $1,090,000.00 $219,901.00 see Estimated Cost Justification KOCM-210-Primary Antenna - UHF High Power Top Mount, Broadband, 4 Station, E-POL v0 $219,901.00 N/A

Components

Actual Information Description File Name
Elbow complex broadband at antenna input per 7.1875 inch feedline

Component Description:
9. KOCM-210-Primary Antenna - 7 3/16" Broadband Elbow Complex
Amount:
$17,729.25
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
10. KOCM-210-Primary Antenna - 6 1/8" Broadband Elbow Complex
Amount:
$7,979.25

Component Description:
KOCM-210-Primary Antenna - 6 1/8"" Broadband Elbow Complex
Amount:
$6,500.00

Component Description:
KOCM-210-Primary Antenna - 6 1/8"" Broadband Elbow Complex
Amount:
$3,250.00
New combiner, cost per channel (without antenna)

Component Description:
KOCM-210-Primary Antenna - New Combiner
Amount:
$11,250.00

Component Description:
7. KOCM-210-Primary Antenna - New Combiner
Amount:
$9,216.40

Component Description:
KOCM-210-Primary Antenna - New Combiner
Amount:
$22,500.00
Sweep test of existing antenna

Component Description:
8. KOCM-210-Primary Antenna - Sweep Test
Amount:
$3,250.00

Component Description:
KOCM-210-Primary Antenna - Sweep Test
Amount:
$1,250.00

Component Description:
KOCM-210-Primary Antenna - Sweep Test
Amount:
$2,500.00
UHF - High Power Top Mount (200-1000 kW), Four Station broadband panel antenna, elliptically or circularly polarized

Component Description:
KOCM-210-Primary Antenna - UHF High Power Top Mount, Broadband, 4 Station, E-POL
Amount:
$74,500.00

Component Description:
KOCM-210-Primary Antenna - UHF High Power Top Mount, Broadband, 4 Station, E-POL
Amount:
$37,250.00

Component Description:
6. KOCM-210-Primary Antenna - UHF High Power Top Mount, Broadband, 4 Station, E-POL
Amount:
$108,151.00

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 $688,275.00 $337,108.10 N/A $337,108.10 N/A
Total for all systems $3,963,099.53 $2,619,947.38 N/A $1,721,905.70 N/A
Primary Transmission Line $688,275.00 $337,108.10 $337,108.10
Rigid Transmission Line - copper, 8 3/16" broadband $688,275.00 $337,108.10 Estimated Cost Justification KOCM-310-Primary Transmission Line - 8 3_16_ Rigid Copper, Broadband v0 $337,108.10 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 8 3/16" broadband

Component Description:
KOCM-310-Primary Transmission Line - 8 3/16"" Rigid Copper, Broadband
Amount:
$103,500.00

Component Description:
11. KOCM-310-Primary Transmission Line - 8 3/16" Rigid Copper, Broadband
Amount:
$181,858.10

Component Description:
KOCM-310-Primary Transmission Line - 8 3/16"" Rigid Copper, Broadband
Amount:
$51,750.00

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 $1,263,100.00 $1,202,500.00 N/A $510,124.25 N/A
Total for all systems $3,963,099.53 $2,619,947.38 N/A $1,721,905.70 N/A
Primary Tower GTOWER $605,300.00 $575,000.00 $457,624.25
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A $368,244.25 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $67,480.00 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 $21,900.00 N/A
Primary Tower GTOWER $657,800.00 $627,500.00 $52,500.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A $0.00 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 $0.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $0.00 N/A
Tower Helicopter Lift $52,500.00 $52,500.00 Please see KOCM American Tower Customer Project Cost Estimate $52,500.00 N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
September 9, 2019 - Night Work - 5 Men x 6 Hours @ $105.00 Per Man Per Hour
Amount:
$9,300.00

Component Description:
Antenna & Line
Amount:
$24,450.00

Component Description:
14. KOCM-410-Existing Primary Tower - Tower Rigging, Complex Tower
Amount:
$169,494.25

Component Description:
KOCM-410-Existing Primary Tower - Tower Rigging, Complex Tower
Amount:
$110,000.00

Component Description:
KOCM-410-Existing Primary Tower - Tower Rigging, Complex Tower
Amount:
$55,000.00
Minor tower reinforcement/modifications

Component Description:
13. KOCM-410-Existing Primary Tower - Minor Tower Reinforcement/Modifications
Amount:
$29,980.00

Component Description:
KOCM-410-Existing Primary Tower - Minor Tower Reinforcement/Modifications
Amount:
$25,000.00

Component Description:
KOCM-410-Existing Primary Tower - Minor Tower Reinforcement/Modifications
Amount:
$12,500.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
12. KOCM-410-Existing Primary Tower - Tower Mapping, Undocumented Tower
Amount:
$5,475.00

Component Description:
KOCM-410-Existing Primary Tower - Tower Mapping, Undocumented Tower
Amount:
$10,950.00

Component Description:
KOCM-410-Existing Primary Tower - Tower Mapping, Undocumented Tower
Amount:
$5,475.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) 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 Information not provided.
Tower Helicopter Lift

Component Description:
15. KOCM-410-Existing Primary Tower - Tower helicopter lift
Amount:
$52,500.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $223,745.80 $229,630.80 N/A $137,221.75 N/A
Total for all systems $3,963,099.53 $2,619,947.38 N/A $1,721,905.70 N/A
Outside Professional Services $223,745.80 $229,630.80 $137,221.75
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $5,000.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $2,500.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $786.00 N/A
Project management of the transition $94,010.00 $109,155.00 see Estimated Cost Justification KOCM-510-Project Management v0 $90,428.45 N/A
Ground and Building A and E Permit Drawing Package $4,812.50 $4,812.50 see Estimated Cost Justification KOCM-590-Ground and Building Permit Drawing Package v0 $4,812.50 N/A
Construction project management Tower Modification reinforcements and facilties $28,100.80 $28,100.80 Estimated Cost Justification KOCM-590-Construction Project Management - Tower and Facilities v0 $28,100.80 N/A
Tower Permit Drawing Package $4,812.50 $4,812.50 see Estimated Cost Justification KOCM-590-Tower Permit Drawing Package v0 $4,812.50 N/A
Additional Field Engineering Service, 7 Days $15,000.00 $15,000.00 N/A N/A N/A
RF Exposure Measurements $21,050.00 $15,000.00 N/A N/A N/A
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 N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $781.50 N/A

Components

Actual Information Description File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
21. KOCM-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$1,250.00

Component Description:
KOCM-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$1,250.00

Component Description:
KOCM-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$2,500.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
KOCM-590-Transition Timing and Coordination
Amount:
$1,250.00

Component Description:
KOCM-590-Transition Timing and Coordination
Amount:
$625.00

Component Description:
20. KOCM-590-Transition Timing and Coordination
Amount:
$625.00
Prepare and or review reimbursement form

Component Description:
Total Professional Services
Amount:
$786.00
Project management of the transition

Component Description:
Project Management
Amount:
$609.10

Component Description:
Project Management
Amount:
$2,016.70

Component Description:
Project Management
Amount:
$1,620.15

Component Description:
Project Management
Amount:
$4,119.85

Component Description:
Project Management
Amount:
$2,343.10

Component Description:
Project Management
Amount:
$4,899.45

Component Description:
Project Management
Amount:
$3,439.00

Component Description:
Project Management
Amount:
$3,027.60

Component Description:
Project Management
Amount:
$1,379.25

Component Description:
Project Management
Amount:
$3,052.45

Component Description:
KOCM-510-Project Management
Amount:
$4,740.00

Component Description:
Project Management
Amount:
$2,922.95

Component Description:
Project Management
Amount:
$1,514.90

Component Description:
Project Management
Amount:
$1,803.40

Component Description:
Project Management
Amount:
$7,233.85

Component Description:
Project Management
Amount:
$3,285.85

Component Description:
Project Management
Amount:
$1,991.00

Component Description:
KOCM-510-Project Management
Amount:
$2,370.00

Component Description:
Project Management
Amount:
$1,528.75

Component Description:
Project Management
Amount:
$787.65

Component Description:
Project Management
Amount:
$2,044.40

Component Description:
Project Management
Amount:
$5,727.45

Component Description:
19. KOCM-510-Project Management
Amount:
$2,370.00

Component Description:
Project management
Amount:
$2,102.90

Component Description:
Project Management
Amount:
$4,980.15

Component Description:
Project Management
Amount:
$2,403.65

Component Description:
Project management
Amount:
$1,540.50

Component Description:
Project Management
Amount:
$26.40

Component Description:
Project Management
Amount:
$3,546.05

Component Description:
Project Management
Amount:
$6,749.20

Component Description:
Project Management
Amount:
$2,733.45

Component Description:
Project Management
Amount:
$1,519.30
Ground and Building A and E Permit Drawing Package

Component Description:
KOCM-590-Ground and Building Permit Drawing Package
Amount:
$2,350.00

Component Description:
17. KOCM-590-Ground and Building Permit Drawing Package
Amount:
$1,287.50

Component Description:
KOCM-590-Ground and Building Permit Drawing Package
Amount:
$1,175.00
Construction project management Tower Modification reinforcements and facilties

Component Description:
KOCM-590-Construction Project Management - Tower and Facilities
Amount:
$5,000.00

Component Description:
KOCM-590-Construction Project Management - Tower and Facilities
Amount:
$2,500.00

Component Description:
18. KOCM-590-Construction Project Management - Tower and Facilities
Amount:
$20,600.80
Tower Permit Drawing Package

Component Description:
16. KOCM-590-Tower Permit Drawing Package
Amount:
$1,287.50

Component Description:
KOCM-590-Tower Permit Drawing Package
Amount:
$2,350.00

Component Description:
KOCM-590-Tower Permit Drawing Package
Amount:
$1,175.00
Additional Field Engineering Service, 7 Days Information not provided.
RF Exposure Measurements Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Total Professional Services
Amount:
$139.00

Component Description:
Total Professional Services
Amount:
$69.50

Component Description:
Total Professional Services
Amount:
$131.00

Component Description:
Total Professional Services
Amount:
$69.50

Component Description:
Total Professional Services
Amount:
$223.50

Component Description:
Total Professional Services
Amount:
$149.00

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 $86,646.52 $80,269.52 N/A $59,672.01 N/A
Total for all systems $3,963,099.53 $2,619,947.38 N/A $1,721,905.70 N/A
Other Expenses $86,646.52 $80,269.52 $59,672.01
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $5,228.00 see Justifying Quote KOCM DTVNotification Quote 001495 $5,228.00 N/A
Internal Labor $19,129.24 $19,129.24 Please see KOCM Internal Labor Budget Revision Justification Letter.pdf $19,128.99 N/A
Site Coordination Meeting $3,750.00 $3,750.00 N/A $2,812.50 N/A
RF System Test $5,000.00 $5,000.00 N/A $5,000.00 N/A
Migratory Bird Assessment and Permitting $1,000.00 $1,000.00 N/A N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A $1,543.00 N/A
Develop and air announcement of upcoming channel change $500.00 $500.00 N/A N/A N/A
Equipment Storage $3,500.00 $3,500.00 N/A N/A N/A
Equipment Delivery and Handling Charges $25,577.28 $25,577.28 see Estimated Cost Justification KOCM-610-Equipment Delivery and Handling v0 $22,188.28 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A $2,721.24 N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Local Zoning $2,500.00 $2,500.00 N/A $1,050.00 N/A

Components

Actual Information Description File Name
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
DTV Notification Service
Amount:
$5,228.00
Internal Labor

Component Description:
Internal Labor for Rick Goetz
Amount:
$429.10

Component Description:
Internal Labor for Eddy Liesdyanto
Amount:
$1,089.48

Component Description:
Internal Labor for Bud Cantrell
Amount:
$2,586.52

Component Description:
Internal Labor for Henry Turner
Amount:
$1,177.54

Component Description:
Internal Labor for Dave Thompson
Amount:
$11,519.43

Component Description:
Internal Labor for Arnold Torres
Amount:
$2,326.92
Site Coordination Meeting

Component Description:
KOCM-610-Site Coordination Meeting
Amount:
$1,875.00

Component Description:
KOCM-610-Site Coordination Meeting
Amount:
$937.50
RF System Test

Component Description:
KOCM-610-RF System Test
Amount:
$1,250.00

Component Description:
KOCM-610-RF System Test
Amount:
$2,500.00

Component Description:
22. KOCM-610-RF System Test
Amount:
$1,250.00
Migratory Bird Assessment and Permitting Information not provided.
MVPD Notification of Channel Change

Component Description:
MVPD Notification Services
Amount:
$1,543.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
SHOOTING BOON FORKLIFT
Amount:
$695.52

Component Description:
SHOOTING BOOM FORKLIFT
Amount:
$2,269.33

Component Description:
SHOOTING BOOM FORKLIFT
Amount:
$2,046.62

Component Description:
8k-9k 42' Shooting Boom Forklift
Amount:
$839.42

Component Description:
State Recovery
Amount:
$1,025.90

Component Description:
State Recovery
Amount:
$773.90

Component Description:
Labor
Amount:
$288.08

Component Description:
SHOOTING BOOM FORKLIFT
Amount:
$2,269.33

Component Description:
State Recovery
Amount:
$364.54

Component Description:
KOCM-610-Equipment Delivery and Handling
Amount:
$5,000.00

Component Description:
Invoice moved to correct budget category per NMI message.
Amount:
N/A

Component Description:
Forklift Variable Reach
Amount:
$754.57

Component Description:
KOCM-610-Equipment Delivery and Handling
Amount:
$2,500.00

Component Description:
SHOOTING BOOM FORKLIFT
Amount:
$789.38

Component Description:
Invoice moved to correct budget category per NMI message.
Amount:
N/A

Component Description:
Invoice moved to correct budget category per NMI message.
Amount:
N/A

Component Description:
SHOOTING BOOM FORKLIFT
Amount:
$2,571.69

Component Description:
Invoice moved to correct budget category per NMI message.
Amount:
N/A
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Fuel
Amount:
$94.68

Component Description:
Disposal
Amount:
$340.02

Component Description:
Disposal
Amount:
$566.70

Component Description:
Disposal
Amount:
$188.90

Component Description:
Bill Tolls
Amount:
$16.18

Component Description:
Fuel
Amount:
$128.05

Component Description:
Labor
Amount:
$650.00

Component Description:
Disposal
Amount:
$736.71
Non-zoning permits Information not provided.
Local Zoning

Component Description:
KOCM-610-Local Zoning
Amount:
$375.00

Component Description:
KOCM-610-Local Zoning
Amount:
$187.50

Component Description:
KOCM-610-Local Zoning
Amount:
$487.50

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,963,099.53 $2,619,947.38 $1,721,905.70

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. 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.

Arnold Torres

Business Administrator


07/29/2021

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.

Arnold Torres

Business Administrator


07/29/2021

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.

Arnold Torres

Business Administrator


07/29/2021

Attachments

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