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:
4317
Service:
FM
Call Sign:
KDAQ
File Number:
0000086585
FRN:
0008229916
Eligibility Status:
Eligible
Date Submitted:
09/08/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

BD SUPERVISORS, LOUISIANA STATE UNIVERSITY & A&M COLLEGE

Doing Business As: BD SUPERVISORS, LOUISIANA STATE UNIVERSITY & A&M COLLEGE

ONE UNIVERSITY PLACE

SHREVEPORT, LA 71115

United States

+1 (318) 797-5000 BARBIE.CANNON@LSUS.EDU Government Entity

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

Troy Jarred Jones

Engineer

Red River Radio (KDAQ)

Troy Jones

One University Place

Shreveport, LA 71115

United States

+1 (318) 655-3230 troy.jones@lsus.edu

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 2-bay antenna and line to be placed at approx. 500 feet fed by a separate transmitter, IP STL, importer/exporter on same tower from same building.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model HTHD
Year 2007
Type Other Type
Other Transmitter Type Tube
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 VS 2.5 Hybrid
Transmitter Type Solid State
Solid State Cooling Air Cooled
Model Type Hybrid
Solid State Power capacity 2.5 kW
Justification for New Transmitter Primary transmitter is connected to main 12 bay array and will be unusable during construction. Also main transmitter is not designed to operate at lower power efficiently or stably at lower power per manufacturer.
Does the transmitter require the purchase of a new HD Importer? Yes
Does the transmitter require the purchase of a new HD Exporter? Yes

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs Does the transmitter installation require an Additional Exciter? No
Does the transmitter installation require any additional transmitter installation costs? Yes
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring Yes
Size 0.5 inches
Length 22.0 feet
Other Electrical Service Yes
Description The circuit for this transmitter only requires 220V single phase circuit. (180 V ac to 264 V ac, 1 phase, 50/60 Hz)
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 5.0 square feet
Other Transmitter-Related Expenses Does the replacement transmitter require a Remote Control? No
Does the replacement transmitter require an RDS Encoder? No
Does the replacement transmitter require Audio Processing? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Top
Polarization Circular
Type Other
Other Antenna Type FMH Super -Power Circularly Polarized FM Antenna
ERP: 100.0 kW
Manufacturer
Model FMH-12AC
Year 1984

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Bottom
Polarization Circular
Type Other
Other Antenna Type Ring Stub
ERP: 2.5 kW
Manufacturer
Model 6810
Year 2019
Justification for New Antenna Tower crew will be rigging within the middle of our current 12 bay array. We require an alternate antenna to transmit from that is safely away from the crew and their rigging.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes
FM Band Pass Filters Do you require an FM band pass filter? No
Notch Filter Do you require a Notch filter? No
De-Icers Do you require De-Icers? No
Radomes Do you require Radomes? No

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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 Purchase New
Use Primary (Main)
Ownership Owned
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 3 inches
Number of parallel runs 1
Length 931 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 1 5/8 inches
Number of parallel runs 1
Length 580 feet per run
Justification for New Transmission Line New line required to feed antenna at lower height.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes
Does the Installation of the Transmission Line require additional or replacement Inside RF system elbows, fitting, hangers, etc.? Yes

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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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
Coordinates (NAD83) Latitude (NAD83) 32° 40' 40.1" N-
Longitude (NAD83) 093° 55' 30.7" W-
Overall Structure Height 1080.04 feet
Support Structure Height 1006.88 feet
Ground Elevation Above Mean Sea Level (AMSL) 250.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner LOUISIANA EDUCATIONAL TELEVISION AUTHORITY DBA KLTS
Date Constructed 05/26/1978

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
38591 KLTS-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: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No 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

Name Description

Antenna Line Hang

Hang antenna and line on tower using tower crew for TV repack.

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 100
Explanation KDAQ is a university-licensed public radio station and part of a regional public radio network. The network operates with a lean staff and requires outside services to assist it with project management for its repack-related service disruptions.
Outside RF consulting Engineering Services Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility No
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility No
Prepare request for Special Temporary Authority Yes
Quantity 1
Prepare Form 601 Yes
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility No
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility No
Prepare request for Special Temporary Authority Yes
Quantity 1
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Additional Legal Fees

KDAQ is a university licensed public radio station with a lean staff and requires additional legal assistance for reimbursement project.

Temporary Tower Rent

Lease costs for temporary auxiliary antenna on tower

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No
1 pair IP-only Codecs for fiber, internet or IP microwave systems Yes

Other Expenses

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Other Expenses Not Listed

Name Description

2.5kW Transmitter Hybrid

Nautel VS 2 point 5kW Hybrid

Flange X2

Flange X 2 for coaxial line

Internal Labor

KDAQ Chief Engineer will handle many aspects of this project in-house in addition to his regular workload

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 $105,500.00 $109,400.00 N/A $290.00 N/A
Total for all systems $431,190.00 $384,990.00 N/A $35,078.25 N/A
Primary Transmitter VS 2.5 Hybrid $105,500.00 $109,400.00 $290.00
Other Electrical Service: The circuit for this transmitter only requires 220V single phase circuit. (180 V ac to 264 V ac, 1 phase, 50/60 Hz) $825.00 $825.00 Electricians to run conduit and cost of materials to run 220V circuit and receptacle to AUX transmitter location. $290.00 N/A
Air Cooled Solid State FM Transmitter 1.5 - 3 kW Hybrid $25,095.00 $25,095.00 N/A $0.00 N/A
HD Exporter $2,550.00 $4,500.00 This is half the cost of a Nautel IPR XPR HD MC STD Audio Importer Exporter combined into one unit. The other half will be shown under the HD Importer estimated cost. N/A N/A
HD Importer $2,550.00 $4,500.00 This is half the cost of a Nautel IPR XPR HD MC STD Audio Importer Exporter combined into one unit. The other half will be shown under the HD Importer estimated cost. N/A N/A
0.5" Rigid Conduit and Wiring $2,500.00 $2,500.00 Cost of supplies and materials for conduit run and wiring for AUX transmitter. N/A N/A
Other -- Building Addition Size: 5.0 $1,480.00 $1,480.00 This is for an additional A/C conduit output of our current AC unit will be run through the cinderblock wall into the adjoining room at the site where our AUX transmitter will be running. N/A N/A
Transmitter Installation $70,500.00 $70,500.00 Transmitter installation required for HD operation during repack as tower crew will be rigging within our array. N/A N/A

Components

Actual Information Description File Name
Other Electrical Service: The circuit for this transmitter only requires 220V single phase circuit. (180 V ac to 264 V ac, 1 phase, 50/60 Hz)

Component Description:
Final invoice for electrical work performed.
Amount:
$290.00
Air Cooled Solid State FM Transmitter 1.5 - 3 kW Hybrid Information not provided.
HD Exporter Information not provided.
HD Importer Information not provided.
0.5" Rigid Conduit and Wiring Information not provided.
Other -- Building Addition Size: 5.0 Information not provided.
Transmitter Installation Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $8,130.00 $8,130.00 N/A $10,796.25 N/A
Total for all systems $431,190.00 $384,990.00 N/A $35,078.25 N/A
Primary Antenna 6810 $8,130.00 $8,130.00 $10,796.25
Side Mount antenna brackets $1,000.00 $1,000.00 Brackets to be used at intervals recommended by tower crew and line manufacturer. N/A N/A
Sweep test of existing antenna $5,730.00 $5,730.00 N/A $797.25 N/A
Low Power 1 kW - 2.5 kW Circularly-polarized $1,400.00 $1,400.00 N/A $9,999.00 Interim antenna required based on work on tower. Antenna height had to be no higher than 500 feet to allow work to be performed. Wanted to get antenna that was able to radiate more energy if allowed during time tower was unoccupied.

Components

Actual Information Description File Name
Side Mount antenna brackets Information not provided.
Sweep test of existing antenna

Component Description:
Measurements of line and antenna swept.
Amount:
$797.25
Low Power 1 kW - 2.5 kW Circularly-polarized

Component Description:
Invoice for Shively Antenna
Amount:
$9,999.00

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 $20,600.00 $20,600.00 N/A $4,427.00 N/A
Total for all systems $431,190.00 $384,990.00 N/A $35,078.25 N/A
Primary Transmission Line $20,600.00 $20,600.00 $4,427.00
Interior RF Systems: Elbows, fitting, hangers, etc. $780.00 $780.00 one 90 degree elbow to plumb into existing manual antenna hanging switch. N/A N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $680.00 $680.00 Line is air filled dialectric. This expense is for dehydrator with monitoring. N/A N/A
Flexible Air Transmission Line - dielectric, 1 5/8" $19,140.00 $19,140.00 N/A $4,427.00 N/A

Components

Actual Information Description File Name
Interior RF Systems: Elbows, fitting, hangers, etc. Information not provided.
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators Information not provided.
Flexible Air Transmission Line - dielectric, 1 5/8"

Component Description:
Transmission line and connectors plus shipping.
Amount:
$4,427.00

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 $169,750.00 $169,750.00 N/A $17,065.00 N/A
Total for all systems $431,190.00 $384,990.00 N/A $35,078.25 N/A
Primary Tower TOWER $169,750.00 $169,750.00 $17,065.00
Antenna Line Hang $12,000.00 $12,000.00 cost estimate from TV Repack Tower crew. N/A N/A
Tower Rigging Tall Tower (greater than 500') $157,750.00 $157,750.00 Costs to rig for tower, antenna, and line. $17,065.00 N/A

Components

Actual Information Description File Name
Antenna Line Hang Information not provided.
Tower Rigging Tall Tower (greater than 500')

Component Description:
Temporary Auxiliary FM Antenna System Installation and Removal services as agreed in proposal.
Amount:
$17,065.00

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 $88,910.00 $38,810.00 N/A $2,500.00 N/A
Total for all systems $431,190.00 $384,990.00 N/A $35,078.25 N/A
Outside Professional Services $88,910.00 $38,810.00 $2,500.00
Temporary Tower Rent $4,000.00 $4,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $2,500.00 N/A $2,500.00 N/A
Attorney Fees - Negotiation of Lease and other matters for Shared Locations $1,280.00 $1,280.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A N/A N/A
Form 399 assistance or other Program Management costs $7,000.00 $7,000.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Additional Legal Fees $7,500.00 $7,500.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Project management of the transition $10,550.00 $10,550.00 KDAQ is a university-licensed public radio station and part of a regional public radio network. The network operates with a lean staff and requires outside services to assist it with project management for its repack-related service disruptions. N/A N/A

Components

Actual Information Description File Name
Temporary Tower Rent Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Invoice for Frequency study and contour maps
Amount:
$2,500.00
Attorney Fees - Negotiation of Lease and other matters for Shared Locations Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Form 399 assistance or other Program Management costs Information not provided.
Prepare/ Review 399 reimbursement form Information not provided.
Additional Legal Fees Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Prepare Form 601 Information not provided.
Project management of the transition 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 $38,300.00 $38,300.00 N/A $0.00 N/A
Total for all systems $431,190.00 $384,990.00 N/A $35,078.25 N/A
Other Expenses $38,300.00 $38,300.00 $0.00
Internal Labor $15,000.00 $15,000.00 KDAQ is a university-licensed public radio station and part of a regional public radio network. The network operates with a lean staff and requires outside services to assist it with project management for its repack-related service disruptions. N/A N/A
Point to Point Microwave (STL/ICR): 1 pair IP-only Codecs for fiber, internet or IP microwave systems $5,850.00 $5,850.00 N/A N/A N/A
Equipment Storage $500.00 $500.00 line and antenna must be on site prior to rigging, however no firm date has been set so storage of equipment is required. N/A N/A
Equipment Delivery and Handling Charges $500.00 $500.00 N/A N/A N/A
Flange X2 $700.00 $700.00 This is for flanges on top and bottom of coax. N/A N/A
2.5kW Transmitter Hybrid $15,750.00 $15,750.00 Cost estimate based on manufacturer list price. N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $431,190.00 $384,990.00 $35,078.25

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
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.

Troy Jarred Jones

Chief Engineer


09/08/2021

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.

Troy Jarred Jones

Chief Engineer


09/08/2021

Attachments

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