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:
19707
Service:
DTV
Call Sign:
WFXP
Channel:
26 (UHF)
File Number:
0000028332
FRN:
0004284899
Date Submitted:
10/12/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Mission Broadcasting, Inc.

Dennis Thatcher

901 Indiana Avenue

Suite 375

Wichita Falls, TX 76301

United States

+1 (940) 228-7861 missionbroadcasting@gmail.com Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Henry Gola

Wiley Rein LLP

1776 K Street, N.W.

Washington, DC 20006

United States

+1 (202) 719-7561 hgola@wiley.law

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 WJET & WFXP are co-located. The initial 399 requested to share the same antenna and line; however, the azimuth patterns are directional and significantly different. Accordingly, both facilities are filing amendments to budget and operate independently.

Question Response
Sharee Station Facility ID 65749
Call Sign WJET-TV
Type Commercial
Licensee Name Nexstar Media Inc.
Status LICENSED
DTS No
Community of License ERIE, PA
Pre-auction RF Channel 28
Post-auction RF Channel 28
Neilsen DMA Erie
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 QXD1U Quantum
Year 2008
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 30 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9evo-12
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 19.0 kW
Justification for New Transmitter Existing transmitter cannot be converted to repacked channel per manufacturer. Station has greater than 10% TPO Headroom and is eligible for the 1-Step-Up Allowance.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 500 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 300.0 feet
Other Electrical Service Yes
Description See attached electrical quotes for new building addition. NOTE: New building addition and associated costs will be shared with WJET.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
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 900.0 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

Transmitter Site Security System

Transmitter Site Key Card Entry and Video Surveillance

Transmitter Building Permit

Transmitter Building Permit

Wiring and Signal Cabling

Wiring and signal cabling from one building to the transmitter building and internal signal wiring

Transmitter Electrical and Installation

Transmitter Electrical and Installation

Additional Transmitter Costs

Additional transmitter costs

Halo Ground System

Grounding and Surge Suppression for New Transmitter Building. Shared Cost with WJET

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
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: 850.0 kW
Manufacturer
Model TFU-24DSB-E
Year 2008

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types 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: 930.0 kW
Manufacturer
Model TFU-24DSB-E/VP-R
Year 2019
Justification for New Antenna Existing coaxial slot antenna is not designed to operate on repacked 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?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
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? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
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

Additional Antenna Costs

Additional Antenna Costs

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 Horizontal
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: 1000.0 kW
Manufacturer
Model TFU-16DSB-E-R BB
Year 2019
Justification for New Antenna An interim antenna is necessary to keep the station on air during primary antenna replacement and for the duration of the assigned phase. Licensed ERP is 850 kW but 1,000 kW will be required for replication due to lower height of interim antenna.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? S
Feed Line Size 6 1/8 inches
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? Yes
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

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 Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 805 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Additional Line

Additional transmission line required from new building addition to base of tower.

Transmission Line Sweep

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

Additional Transmission Line Components

Additional Transmission Line Components

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 4 1/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 550 feet per run
Justification for New Transmission Line New interim transmission line is required for operation of the new interim facility since the existing line will be repurposed for post-transition operation.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Additional Transmission Line Components

Additional Transmission Line Components

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1033280
Coordinates (NAD83) Latitude (NAD83) 42° 02' 25.0" N-
Longitude (NAD83) 080° 04' 08.0" W-
Overall Structure Height 816.59 feet
Support Structure Height 750.98 feet
Ground Elevation Above Mean Sea Level (AMSL) 1305.10 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Nexstar Broadcasting, Inc.
Date Constructed 01/01/1997

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
65749 WJET-TV DTV

Primary Tower

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Tower Modification Costs

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

Ice Bridge

Ice bridge from new building addition to base of tower required (see attached PCI quote)

Rerouting of Transmission Lines feeding Main Antenna

Extend 4' Feedline to main antenna, and removal of 300' of 3' transmission line Please see Addendum to Proposal 19364-5ADD attached

Tower Crew Weather Delay Costs

Tower Crew Weather Delay Costs June and July 2019

Weather Delays, Additional Charges

Weather Delays, Additional Charges

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 750
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 15
Justification It is necessary to survey the site, plan the equipment, develop specifications for purchasing, & oversee multiple vendor RF projects. Station does not have available personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Sales and Use Tax Due

Sales and Use Tax Due

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 $1,118,462.00 $746,537.00 N/A $621,882.88 N/A
Total for all systems $2,724,864.00 $2,069,337.20 N/A $1,607,260.94 N/A
Primary Transmitter THU9evo-12 $1,118,462.00 $746,537.00 $621,882.88
Halo Ground System $15,000.00 $15,000.00 N/A $13,674.00 N/A
Additional Transmitter Costs $28,158.00 $28,158.00 See Rohde & Schwarz quote 199622.2 $28,158.00 N/A
Transmitter Electrical and Installation $76,300.00 $76,300.00 See Land Communications quote 1020 $76,300.00 N/A
Wiring and Signal Cabling $5,000.00 $5,000.00 N/A $325.00 N/A
Transmitter Building Permit $354.00 $354.00 Summit Township permit fee, 50% shared cost with WJET $354.00 N/A
Transmitter Site Security System $1,650.00 $1,650.00 Transmitter Site Security Key Card Entry and Video Surveillance. Please see Mobilecom TX Site Security Quote attached $1,627.50 N/A
Other -- Building Addition Size: 900.0 $73,500.00 $73,500.00 Insufficient space in existing building for new RF systems. New building addition is required. Total costs for new building addition is $118,300; however, costs are shared with WJET. See attached Quote (Frontier General Contracting), change orders, paint $73,467.50 N/A
15 Ton system $88,400.00 $10,125.00 Insufficient space in existing building for new RF systems. HVAC required for new building addition. Total costs for new HVAC is 20,250; however, costs are shared with WJET. See attached Building Addition HVAC Quote (KEEP Heating & Cooling). $10,125.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $15,600.00 $15,000.00 N/A N/A N/A
Transformer 3 phase/480v - 500 KVA $48,400.00 $47,100.00 N/A $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $37,150.00 N/A $0.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $14,050.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $393,650.00 Cost reduced from $666000 to $393650; see Rohde & Schwarz quote 133636.2 $393,650.00 N/A
Other Electrical Service: See attached electrical quotes for new building addition. NOTE: New building addition and associated costs will be shared with WJET. $29,500.00 $29,500.00 Total electrical costs for new building addition is $59,000; however, costs are shared with WJET. See attached Building Addition Electrical Quote (Connecto Electric). $24,201.88 N/A

Components

Actual Information Description File Name
Halo Ground System

Component Description:
Halo ground system, 50% shared cost with WJET
Amount:
$13,674.00
Additional Transmitter Costs

Component Description:
Additional transmitter parts
Amount:
$28,158.00
Transmitter Electrical and Installation

Component Description:
Transmitter electrical and installation, 50% down payment
Amount:
$38,150.00

Component Description:
Transmitter electrical and installation, 50% due on completion
Amount:
$38,150.00
Wiring and Signal Cabling

Component Description:
Transmitter building electrical work, 50% shared cost with WJET
Amount:
$325.00
Transmitter Building Permit

Component Description:
Transmitter building construction permit
Amount:
$354.00
Transmitter Site Security System

Component Description:
Transmitter building security, 50% shared cost with WJET
Amount:
$1,627.50
Other -- Building Addition Size: 900.0

Component Description:
Transmitter building, installment #3, 50% shared cost with WJET
Amount:
$16,975.00

Component Description:
Transmitter building, installment #1, 50% shared cost with WJET
Amount:
$5,000.00

Component Description:
Transmitter building, installment #4, 50% shared cost with WJET
Amount:
$21,335.00

Component Description:
Transmitter building, installment #5, 50% shared cost with WJET
Amount:
$17,432.50

Component Description:
Transmitter building, installment #2
Amount:
$10,440.00

Component Description:
Transmitter building paint interior; 50% shared cost with WJET
Amount:
$2,285.00
15 Ton system

Component Description:
HVAC and installation, installment #3, 50% shared cost with WJET FAC ID 65749
Amount:
$3,375.00

Component Description:
HVAC and installation, installment #2, 50% shared cost with WJET FAC ID 65749
Amount:
$3,375.00

Component Description:
HVAC and installation, installment #1, 50% shared cost with WJET FAC ID 65749
Amount:
$3,375.00
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 500 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
Service entrance 3 phase/800 amp/208 volt Information not provided.
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
Transmitter, installment #1
Amount:
$98,412.50

Component Description:
Transmitter, installment #2
Amount:
$295,237.50
Other Electrical Service: See attached electrical quotes for new building addition. NOTE: New building addition and associated costs will be shared with WJET.

Component Description:
Transmitter building electrical work, 50% shared cost with WJET
Amount:
$18,600.00

Component Description:
Transmitter building electrical work, 50% shared cost with WJET
Amount:
$1,250.00

Component Description:
Transmitter building electrical work, 50% shared cost with WJET
Amount:
$2,150.00

Component Description:
Transmitter building electric work, 50% shared cost with WJET
Amount:
$1,075.00

Component Description:
Wiring and distribution amps, 50% shared cost with WJET
Amount:
$1,126.88

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 $270,072.00 $239,042.00 N/A $216,319.00 N/A
Total for all systems $2,724,864.00 $2,069,337.20 N/A $1,607,260.94 N/A
Interim Antenna TFU-16DSB-E-R BB $109,480.00 $89,715.00 $72,445.00
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $4,005.00 Cost reduced from $22500 to $4005; see Dielectric quote 900048CMZ-2. $4,005.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, horizontally polarized $62,040.00 $62,040.00 Cost Catalog Pricing - Waiting on quote from Dielectric; cost reduced from $185500 to $62040. See Dielectric quote 900048CMZ-2 $62,040.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,120.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $12,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,550.00 N/A $6,400.00 N/A
Primary Antenna TFU-24DSB-E/VP-R $160,592.00 $149,327.00 $143,874.00
Additional Antenna Costs $23,650.00 $23,650.00 See Dielectric order confirmations 1770120,1929271,1929343 and quote 1929458 $23,638.90 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $12,017.00 See Dielectric Quote (Quote No. DMS173-4) ELBOW COMPLEX: $10,298.00 T/L 6-75 EIA LENGTH: $1,719.00 TOTAL: $12,017.00 $11,845.10 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $12,488.00 See Dielectric Quote (Quote No. DMS173-4) $12,488.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 930 kW input, directional,, elliptically or circularly polarized $89,502.00 $89,502.00 See Dielectric Quote (Quote No. DMS173-4); total antenna cost $98,502 less vpol cost ($9,000) which is not reimbursable $89,502.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,120.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,550.00 N/A $6,400.00 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Leg mounts, balance due
Amount:
$400.50

Component Description:
Leg mounts, installment #2, line 3 of invoice
Amount:
$1,802.25

Component Description:
Leg Mounts, installment #1, line 3 of invoice
Amount:
$1,802.25
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, horizontally polarized

Component Description:
Interim antenna, installment #2, line 2 of invoice
Amount:
$27,918.00

Component Description:
Interim antenna, installment #1, line 2 of invoice
Amount:
$27,918.00

Component Description:
Interim antenna, balance due
Amount:
$6,204.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
Interim antenna sweep test
Amount:
$6,400.00
Additional Antenna Costs

Component Description:
Additional antenna components
Amount:
$4,606.00

Component Description:
Additional anchors
Amount:
$764.00

Component Description:
Additional antenna components
Amount:
$17,560.15

Component Description:
Additional antenna component
Amount:
$472.50

Component Description:
Manifold, 50% shared cost with WJET
Amount:
$236.25
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow complex, balance due
Amount:
$1,029.80

Component Description:
Elbow complex, installment #2, line 4 of invoice
Amount:
$4,634.10

Component Description:
T/L Length, installment #1, line 5 of invoice
Amount:
$773.55

Component Description:
Elbow complex, installment #1, line 4 of invoice
Amount:
$4,634.10

Component Description:
T/L Length, installment #2, line 5 of invoice
Amount:
$773.55
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Side mount brackets, balance due
Amount:
$1,248.80

Component Description:
Side mount brackets, installment #1, line 3 of invoice
Amount:
$5,619.60

Component Description:
Side mount brackets, installment #2, line 3 of invoice
Amount:
$5,619.60
UHF - High Power, Side Mount, basic slot antenna, 930 kW input, directional,, elliptically or circularly polarized

Component Description:
Main antenna, balance due
Amount:
$8,950.20

Component Description:
Main antenna, installment #1, line 1 of invoice
Amount:
$40,275.90

Component Description:
Main antenna, installment #2, line 1 of invoice
Amount:
$40,275.90
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna

Component Description:
Main antenna sweep test
Amount:
$6,400.00

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 $151,000.00 $139,106.70 N/A $128,667.00 N/A
Total for all systems $2,724,864.00 $2,069,337.20 N/A $1,607,260.94 N/A
Interim Transmission Line $89,600.00 $77,706.70 $75,099.70
Additional Transmission Line Components $11,500.00 $11,500.00 See Dielectric order confirmation 1698398 $11,175.00 N/A
Rigid Transmission Line - copper, 4 1/16" $78,100.00 $66,206.70 Cost reduced from $75900 to $66206.70; see Dielectric quote 900048CMZ-2 $63,924.70 N/A
Primary Transmission Line $61,400.00 $61,400.00 $53,567.30
Transmission Line Sweep $6,400.00 $6,400.00 N/A N/A N/A
Additional Transmission Line Components $30,000.00 $30,000.00 See Dielectric order confirmations $29,117.30 N/A
Additional Line $25,000.00 $25,000.00 Additional transmission line required from new building addition to base of tower. $24,450.00 N/A

Components

Actual Information Description File Name
Additional Transmission Line Components

Component Description:
Additional transmission line components
Amount:
$2,101.00

Component Description:
Additional transmission line components
Amount:
$5,395.50

Component Description:
Additional transmission line components
Amount:
$3,678.50
Rigid Transmission Line - copper, 4 1/16"

Component Description:
Transmission line, installment #2, line 8 of invoice
Amount:
$1,540.35

Component Description:
Transmission line, installment #1, line 4 of invoice
Amount:
$28,252.67

Component Description:
Transmission line, installment #4
Amount:
$1,141.00

Component Description:
Transmission line, installment #1, line 8 of invoice
Amount:
$1,540.35

Component Description:
Transmission line, installment #3
Amount:
$3,197.66

Component Description:
Transmission line, installment #2, line 4 of invoice
Amount:
$28,252.67
Transmission Line Sweep Information not provided.
Additional Transmission Line Components

Component Description:
Additional transmission line components
Amount:
$8,470.00

Component Description:
Additional transmission line components
Amount:
$9,858.60

Component Description:
Additional transmission line component
Amount:
$9,120.00

Component Description:
Additional transmission line costs
Amount:
$1,668.70
Additional Line

Component Description:
Additional transmission line
Amount:
$24,450.00

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 $778,690.00 $545,738.50 N/A $545,660.00 N/A
Total for all systems $2,724,864.00 $2,069,337.20 N/A $1,607,260.94 N/A
Primary Tower TOWER $778,690.00 $545,738.50 $545,660.00
Ice Bridge $59,315.00 $59,315.00 A new building addition is required which necessitates an ice bridge from the new building addition to the base of the tower. Total costs for new Ice Bridge and Shield is $118,630; however, costs are shared with WJET. See attached Ice Bridge Quotes PCI $59,315.00 N/A
Major tower reinforcement/modifications $421,000.00 $147,588.50 See PCI quote 19350-5; proposal is WFXP 50% share of cost with WJET; see also FDH Infrastructure P19_170813_001 for modification materials; proposal is 100% cost which will be split with WJET. $147,588.50 N/A
Tall Tower (greater than 500') $210,500.00 $263,260.00 Interim antenna installation- see PCI quote 19351-5; main antenna installation - see PCI quote 19364-5 $263,260.00 N/A
Weather Delays, Additional Charges $7,000.00 $7,000.00 See PCI Addendum to Proposal 19338-5; 50% shared cost with WJET $6,987.00 N/A
Rerouting of Transmission Lines feeding Main Antenna $39,575.00 $39,575.00 Extend 4' Feedline to main antenna, and removal of 300' of 3' transmission line Please see Addendum to Proposal 19364-5ADD attached $39,575.00 N/A
Tower Crew Weather Delay Costs $15,000.00 $15,000.00 N/A $15,000.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $14,000.00 See related invoices $13,934.50 N/A

Components

Actual Information Description File Name
Ice Bridge

Component Description:
Ice Bridge additional work, installment #1, 50% shared cost with WJET FAC ID 65749
Amount:
$21,650.00

Component Description:
Ice Bridge, installment #1, 50% shared cost with WJET FAC ID 65749
Amount:
$8,937.50

Component Description:
Ice bridge, installment #3, 50% shared cost with WJET
Amount:
$8,940.00

Component Description:
Ice bridge, installment #2, 50% shared cost with WJET
Amount:
$8,937.50

Component Description:
Ice Bridge, installment #2, 50% shared cost with WJET FAC ID 65749
Amount:
$8,937.50

Component Description:
Ice bridge additional costs, installment #2, 50% shared cost with WJET
Amount:
$10,850.00
Major tower reinforcement/modifications

Component Description:
Tower modification materials, installment #1, 50% shared cost with WJET FAC ID 65749
Amount:
$25,094.25

Component Description:
Tower modifications, installment #2
Amount:
$32,465.00

Component Description:
Tower modification materials, installment #2, 50% shared cost with WJET FAC ID 65749
Amount:
$25,094.25

Component Description:
Tower modifications, installment #3
Amount:
$32,470.00

Component Description:
Tower modifications, installment #1
Amount:
$32,465.00
Tall Tower (greater than 500')

Component Description:
Interim antenna installation, installment #3
Amount:
$59,840.00

Component Description:
Interim antenna installation, installment #1
Amount:
$59,830.00

Component Description:
Main antenna installation
Amount:
$83,760.00

Component Description:
Interim antenna installation, installment #2
Amount:
$59,830.00
Weather Delays, Additional Charges

Component Description:
Weather delays and additional charges; 50% shared cost with WJET
Amount:
$6,987.00
Rerouting of Transmission Lines feeding Main Antenna

Component Description:
Reroute transmission lines
Amount:
$39,575.00
Tower Crew Weather Delay Costs

Component Description:
Tower modifications weather delays, 50% shared cost with WJET
Amount:
$15,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Structural analysis, 50% of shared cost with WJET FAC ID 65749
Amount:
$1,375.00

Component Description:
Structural analysis, installment #2, 50% shared cost with WJET
Amount:
$1,375.00

Component Description:
Tower mapping, 50% of shared cost with WJET FAC ID 65749
Amount:
$2,017.25

Component Description:
Climatic study, 50% shared cost with WJET
Amount:
$400.00

Component Description:
Structural analysis, 50% shared cost with WJET
Amount:
$750.00

Component Description:
Structural analysis, 50% shared cost with WJET
Amount:
$3,000.00

Component Description:
Tower mapping, 50% of shared cost with WJET FAC ID 65749
Amount:
$2,017.25

Component Description:
Structural analysis, installment #2, 50% shared cost with WJET
Amount:
$1,500.00

Component Description:
Structural analysis, installment #1, 50% shared cost with WJET
Amount:
$1,500.00

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 $234,420.00 $233,005.00 N/A $40,570.65 N/A
Total for all systems $2,724,864.00 $2,069,337.20 N/A $1,607,260.94 N/A
Outside Professional Services $234,420.00 $233,005.00 $40,570.65
Additional Field Engineering Service, 15 Days $81,000.00 $81,000.00 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 $2,050.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,585.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,305.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,120.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $4,500.00 See related invoices $4,500.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,535.00 N/A $625.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,070.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,170.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,560.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,560.00 N/A $2,100.00 N/A
Project management of the transition $118,500.00 $115,500.00 N/A $33,345.65 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,050.00 N/A N/A N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 15 Days Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase 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.
Prepare request for Special Temporary Authorization

Component Description:
Prepare request for STA
Amount:
$1,500.00

Component Description:
Prepare request for STA
Amount:
$1,500.00

Component Description:
Prepare request for STA
Amount:
$1,500.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare License to Cover application
Amount:
$625.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
See cover letter item 2 - Prepare and or review reimbursement form. Services provided by contractor Kesller and Gehman Associates for Form 399 Amendment.
Amount:
$1,275.00

Component Description:
Prepare and or review reimbursement form. Services provided by contractor Kessler and Gehman Associates for Form 399 Amendment.
Amount:
$825.00
Project management of the transition

Component Description:
Project management services May 2019
Amount:
$84.50

Component Description:
Project management services April 2019
Amount:
$40.00

Component Description:
Project management services
Amount:
$237.00

Component Description:
Project management services 3.2.19 through 3.29.19
Amount:
$7,525.00

Component Description:
Project management services
Amount:
$6,728.15

Component Description:
Project management services July 2017
Amount:
$1,575.00

Component Description:
Project management services May 2019
Amount:
$90.00

Component Description:
Project management services October 2018
Amount:
$65.00

Component Description:
Project management services 3.30.19 through 4.26.19
Amount:
$375.00

Component Description:
Project management services 9.29.18 through 10.26.18 including subcontractor invoice from Kessler and Gehman Associates for Form 387 Transition Plan Progress Report 2018 Q3 preparation.
Amount:
$975.00

Component Description:
Project management services Mar 2019
Amount:
$117.00

Component Description:
Project management services 5.26.18 through 6.29.18
Amount:
$975.00

Component Description:
Project management services Jun 2019
Amount:
$422.50

Component Description:
Project management services, 50% shared cost with WJET
Amount:
$462.50

Component Description:
Project management services
Amount:
$4,909.00

Component Description:
Project management services Nov 2019
Amount:
$50.00

Component Description:
Project management services
Amount:
$150.00

Component Description:
Project management services December 2018
Amount:
$100.00

Component Description:
Project management services
Amount:
$1,902.50

Component Description:
Project management services March 2019
Amount:
$130.00

Component Description:
Project management services
Amount:
$675.00

Component Description:
Project Management for Structural Analysis and Tower Modifications for dates January 1, 2019 through January 31, 2019 including consultants Kessler and Gehman Associates.
Amount:
$225.00

Component Description:
Project management services Jul 2019
Amount:
$230.00

Component Description:
Project management services
Amount:
$387.00

Component Description:
See cover letter item 1 - Project Management of the transition for services October 27, 2018 through November 30, 2018.
Amount:
$1,350.00

Component Description:
Project management services 7.28.18 through 9.28.18.
Amount:
$825.00

Component Description:
Project management services 2.24.18 through 3.30.18
Amount:
$450.00

Component Description:
Project management services Apr 2019
Amount:
$78.00

Component Description:
Project management services Jun 2019
Amount:
$375.00

Component Description:
Project management services Sep 2019
Amount:
$130.00

Component Description:
Project management services 6.30.18 through 7.27.18
Amount:
$300.00

Component Description:
Project management services
Amount:
$1,407.50
ASR modification (prepare FCC Form 854) 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 $172,220.00 $165,908.00 N/A $54,161.41 N/A
Total for all systems $2,724,864.00 $2,069,337.20 N/A $1,607,260.94 N/A
Other Expenses $172,220.00 $165,908.00 $54,161.41
Sales and Use Tax Due $200.00 $200.00 Estimated tax due $97.65 N/A
MVPD Notification of Channel Change $3,500.00 $3,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,500.00 $1,500.00 Costs to develop and produce spots and crawls for viewer notifications. N/A N/A
Equipment Storage $25,000.00 $25,000.00 N/A $1,595.00 N/A
Equipment Delivery and Handling Charges $50,500.00 $50,500.00 See related invoices $50,480.76 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A N/A N/A
Non-zoning permits $25,000.00 $25,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $333.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $6,000.00 N/A $1,988.00 N/A
AM Pattern Disturbance -- Remedy $21,050.00 $20,500.00 N/A N/A N/A
Local Zoning $500.00 $500.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $195.00 N/A N/A N/A
AM Pattern Disturbance -- Impact study $7,890.00 $7,680.00 N/A N/A N/A

Components

Actual Information Description File Name
Sales and Use Tax Due

Component Description:
Tax on transmitter building security, 50% shared cost with WJET
Amount:
$97.65
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Main antenna storage cost
Amount:
$1,595.00
Equipment Delivery and Handling Charges

Component Description:
Transmitter consolidation services
Amount:
$16,924.00

Component Description:
Antenna shipping cost
Amount:
$1,149.49

Component Description:
Transmission line shipping cost
Amount:
$5,865.47

Component Description:
Antenna shipping costs
Amount:
$2,317.19

Component Description:
Transmission line shipping costs
Amount:
$6,128.43

Component Description:
Manifold shipping, 50% shared cost with WJET
Amount:
$231.80

Component Description:
Transmission line freight cost
Amount:
$3,541.25

Component Description:
Transmission line shipping cost
Amount:
$2,393.06

Component Description:
Transmission line shipping cost
Amount:
$433.54

Component Description:
Main antenna freight cost
Amount:
$3,341.25

Component Description:
Antenna shipping cost
Amount:
$146.77

Component Description:
Main antenna parts freight and shipping
Amount:
$412.86

Component Description:
Freight on ice bridge materials, 50% shared cost with WJET
Amount:
$1,200.00

Component Description:
Antenna shipping cost
Amount:
$2,733.95

Component Description:
Anchor shipping cost
Amount:
$229.76

Component Description:
Freight costs on additional ice bridge materials, 50% shared cost with WJET
Amount:
$250.00

Component Description:
Wiring and distribution amp shipping
Amount:
$88.65

Component Description:
Interim freight and shipping costs
Amount:
$2,822.07

Component Description:
Antenna shipping cost
Amount:
$271.22
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
Notification of medical facilities
Amount:
$1,988.00
AM Pattern Disturbance -- Remedy Information not provided.
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
AM Pattern Disturbance -- Impact study Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,724,864.00 $2,069,337.20 $1,607,260.94

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. Yes

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.

Dennis P. Thatcher

President


10/12/2021

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.

Dennis P. Thatcher

President


10/12/2021

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.

Dennis P. Thatcher

President


10/12/2021

Attachments

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