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:
24582
Service:
DTV
Call Sign:
WHLV-TV
Channel:
32 (UHF)
File Number:
0000027962
FRN:
0004346060
Date Submitted:
09/09/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TRINITY BROADCASTING OF TEXAS, INC.

Doing Business As: TRINITY BROADCASTING NETWORKS

13600 Heritage Parkway

Suite 200

Fort Worth, TX 76177

United States

+1 (855) 826-2255 CMMAY@MAYLAWOFFICES.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

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Reduce TPO to 50% and remove 1/2 of the xmitter system. Install new SS xmitter system. Add AUX antenna & line to the tower & feed it with a reduced signal from the current xmitter. Remove & replace antenna. Test.

Question Response
Sharee Station Facility ID 128367
Call Sign WOFT-LD
Type
Licensee Name BUDD BROADCASTING CO., INC.
Status LICENSED
DTS No
Community of License OCALA, FL
Pre-auction RF Channel 8
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 60018
Call Sign WACX
Type Commercial
Licensee Name ASSOCIATED CHRISTIAN TELEVISION SYSTEM, INC.
Status LICENSED
DTS No
Community of License LEESBURG, FL
Pre-auction RF Channel 7
Post-auction RF Channel 7
Neilsen DMA Orlando-Daytona Bch-Melbrn
Network Affiliation
Question Response
Sharee Station Facility ID 41375
Call Sign WDYB-CD
Type
Licensee Name LATINA BROADCASTERS OF DAYTONA BEACH, LLC
Status LICENSED
DTS No
Community of License DAYTONA BEACH, FL
Pre-auction RF Channel 21
Post-auction RF Channel 21
Neilsen DMA Orlando-Daytona Bch-Melbrn
Network Affiliation
Question Response
Sharee Station Facility ID 9881
Call Sign WTGL
Type Noncommercial Educational
Licensee Name GOOD LIFE BROADCASTING, INC.
Status LICENSED
DTS No
Community of License LEESBURG, FL
Pre-auction RF Channel 34
Post-auction RF Channel 23
Neilsen DMA ORLANDO-DAYTONA BCH-MELBRN
Network Affiliation
Question Response
Sharee Station Facility ID 53465
Call Sign WKCF
Type Commercial
Licensee Name Hearst Properties Inc.
Status LICENSED
DTS No
Community of License CLERMONT, FL
Pre-auction RF Channel 23
Post-auction RF Channel 23
Neilsen DMA Orlando-Daytona Bch-Melbrn
Network Affiliation
Question Response
Sharee Station Facility ID 5802
Call Sign WVEN-TV
Type Commercial
Licensee Name UNIMAS ORLANDO, INC.
Status LICENSED
DTS No
Community of License MELBOURNE, FL
Pre-auction RF Channel 22
Post-auction RF Channel 22
Neilsen DMA Orlando-Daytona Bch-Melbrn
Network Affiliation
Question Response
Sharee Station Facility ID 21173
Call Sign W21AU-D
Type
Licensee Name CENTRAL FLORIDA BROADCAST, INC.
Status LICENSED
DTS No
Community of License ORLANDO, FL
Pre-auction RF Channel 21
Post-auction RF Channel
Neilsen DMA
Network Affiliation

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 Sigma
Year 2005
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 50 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 HPTV-PRLX-U18
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 30 kW
Justification for New Transmitter Harris no longer supports the Sigma. see attached

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description breakers, labor
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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

install

xmitter 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 Leased
Owner American Tower
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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 4
Number of Panels 12
Design power capacity in use 80.0 %
Lower Limit 470.00 MHz
Upper Limit 800.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer Dielectric
Model TUD-C5SP-16/56H-2-B
Year 2000

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 1
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
32

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

combiner install

Combiner install

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 240.0 kW
Manufacturer
Model TFU-24WB
Year 2017
Justification for New Antenna REMAIN ON THE AIR DURRING TESTING

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Install

Combiner Install

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)
Description of Use N/A
Ownership Leased
Owner American Tower
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 Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1000 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 Purchase New
Is this a request for upgraded equipment? No
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 1000 feet per run
Justification for New Transmission Line required

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 8 3/16 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 1000 feet per run
Justification for New Transmission Line remains on the air during testing

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

FIELD CUT

field cut

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? No

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 10
Explanation American Tower
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 3
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 3
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations 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 No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits Yes
BLM or NFS Coordination 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)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? No
Does this relocation require MVPD Notification of a Channel Change? No

Other Expenses

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Other Expenses Not Listed

Name Description

Core drilling

Core drill a hole for coax

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 $1,032,000.00 $978,005.00 N/A $834,977.58 N/A
Total for all systems $2,359,360.00 $1,293,419.00 N/A $1,040,242.74 N/A
Primary Transmitter HPTV-PRLX-U18 $1,032,000.00 $978,005.00 $834,977.58
Other Electrical Service: breakers, labor $50,000.00 $50,000.00 quoted $18,076.58 N/A
install $35,000.00 $35,000.00 quoted installation $35,000.00 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $893,005.00 N/A $781,901.00 N/A

Components

Actual Information Description File Name
Other Electrical Service: breakers, labor

Component Description:
xmitter electric
Amount:
$18,076.58
install

Component Description:
xmitter install
Amount:
$35,000.00
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
35% deposit, 30% 60 days and 30% prior to shipping
Amount:
$742,805.95

Component Description:
5% proof
Amount:
$39,095.05

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 $376,110.00 $183,200.00 N/A $123,860.40 N/A
Total for all systems $2,359,360.00 $1,293,419.00 N/A $1,040,242.74 N/A
Interim Antenna TFU-24WB $262,880.00 $77,700.00 $49,733.51
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $15,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,700.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized $227,000.00 $50,000.00 N/A $45,758.51 N/A
Combiner Install $6,000.00 $6,000.00 N/A $3,975.00 Placeholder - FCC IT Technical Support
Primary Antenna TUD-C5SP-16/56H-2-B $113,230.00 $105,500.00 $74,126.89
combiner install $10,000.00 $10,000.00 N/A $1,987.50 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $4,000.00 N/A N/A N/A
Adding a module to existing combiner (without antenna) $84,200.00 $84,000.00 N/A $64,639.39 N/A
Sweep test of existing antenna $6,730.00 $7,500.00 quoted $7,500.00 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized

Component Description:
aux antenna
Amount:
$28,833.50

Component Description:
antenna cap3 plus tax
Amount:
$16,925.01
Combiner Install

Component Description:
combiner
Amount:
$3,975.00

Component Description:
Combiner install cap 1
Amount:
$1,987.50
combiner install

Component Description:
combiner install cap 3
Amount:
$1,987.50

Component Description:
combiner install
Amount:
N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Adding a module to existing combiner (without antenna)

Component Description:
combiner
Amount:
$25,000.00

Component Description:
combiner cap3
Amount:
$12,500.00

Component Description:
combiner connection
Amount:
$7,145.27

Component Description:
connect xmitter to combiner
Amount:
$7,069.48

Component Description:
connect xmitter to combiner
Amount:
$9,220.18

Component Description:
connect xmitter to combiner
Amount:
$3,704.46
Sweep test of existing antenna

Component Description:
second sweep
Amount:
$5,000.00

Component Description:
sweep cap 3
Amount:
$2,500.00

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 $803,000.00 $45,000.00 N/A $27,450.00 N/A
Total for all systems $2,359,360.00 $1,293,419.00 N/A $1,040,242.74 N/A
Interim Transmission Line $404,000.00 $45,000.00 $27,450.00
Rigid Transmission Line - copper, 8 3/16" broadband $399,000.00 $40,000.00 N/A $27,450.00 N/A
FIELD CUT $5,000.00 $5,000.00 N/A $0.00 N/A
Primary Transmission Line $399,000.00 $0.00 $0.00
Rigid Transmission Line - copper, 8 3/16" broadband $399,000.00 $0.00 N/A N/A N/A

Components

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

Component Description:
line
Amount:
$18,300.00

Component Description:
Aux line cap 3
Amount:
$9,150.00
FIELD CUT Information not provided.
Rigid Transmission Line - copper, 8 3/16" broadband Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $127,950.00 $73,250.00 N/A $44,632.00 N/A
Total for all systems $2,359,360.00 $1,293,419.00 N/A $1,040,242.74 N/A
Outside Professional Services $127,950.00 $73,250.00 $44,632.00
Comprehensive coverage verification via field study, if needed $84,200.00 $40,000.00 N/A $37,732.00 N/A
Prepare request for Special Temporary Authorization $6,150.00 $3,000.00 N/A $1,750.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $750.00 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 $4,400.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $1,580.00 $1,500.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $11,040.00 $7,000.00 N/A N/A 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
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Comprehensive coverage verification via field study, if needed

Component Description:
study
Amount:
$37,732.00
Prepare request for Special Temporary Authorization

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

Component Description:
license
Amount:
$750.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
eng
Amount:
$2,500.00

Component Description:
engineering cap 3
Amount:
$1,250.00

Component Description:
interference
Amount:
$650.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form Information not provided.
Project management of the transition Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
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.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $20,300.00 $13,964.00 N/A $9,322.76 N/A
Total for all systems $2,359,360.00 $1,293,419.00 N/A $1,040,242.74 N/A
Other Expenses $20,300.00 $13,964.00 $9,322.76
DTV Medical Facility Notification $11,550.00 $5,214.00 N/A $5,078.40 N/A
Non-zoning permits $750.00 $750.00 American Tower N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $4,000.00 $4,000.00 dispose of old transmitter $1,842.73 N/A
Equipment Delivery and Handling Charges $3,000.00 $3,000.00 foklift $1,601.63 N/A
Core drilling $1,000.00 $1,000.00 quoted $800.00 N/A

Components

Actual Information Description File Name
DTV Medical Facility Notification

Component Description:
med
Amount:
$5,078.40
Non-zoning permits Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
dumpster
Amount:
$1,011.44

Component Description:
dumpster
Amount:
$699.50

Component Description:
oil disposal
Amount:
$100.00

Component Description:
dumpster
Amount:
$31.79
Equipment Delivery and Handling Charges

Component Description:
forklift
Amount:
$1,601.63
Core drilling

Component Description:
Core Drill
Amount:
$800.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,359,360.00 $1,293,419.00 $1,040,242.74

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.

Steve Hastings

Network RF Manager


09/09/2021

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.

Steve Hastings

Network RF Manager


09/09/2021

Attachments

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