Applicant | Address | Phone | Applicant Type | |
---|---|---|---|---|
KENTUCKY AUTHORITY FOR EDUCATIONAL TV |
600 COOPER DR LEXINGTON, KY 40502 United States |
+1 (859) 258-7000 | SHOPKINS@KET.ORG | Government Entity |
Applicant | Address | Phone | |
---|---|---|---|
[Confidential] |
|
|
|
Applicant | Address | Phone | |
---|---|---|---|
Greg Best Consulting Engineer Greg Best Consulting, Inc. |
16100 Outlook Avenue Stilwell, KS 66085 United States |
+1 (816) 792-2913 | gbconsulting54@gmail.com |
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 | WKPC and WKMJ are on the same tower. Please see attached repack plan exhibit for details. |
Section | Question | Response |
---|---|---|
Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
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 | DHD20P1 | |
Year | 2001 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power Capacity | 5 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | No | |
Manufacturer | ||
Model | Maxiva UAXTE-8 | |
Transmitter Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power capacity | 5 kW | |
Justification for New Transmitter | Pre-auction transmitter no longer supported by supplier; not re-tunable. |
Section | Question | Response |
---|---|---|
Electrical Service | Service Entrance (3 phases 800A 208V) | Yes |
Switchgear (industrial 800 amp) | Yes | |
Transformer (480V) | No | |
Power | N/A | |
Rigid Conduit and Wiring | Yes | |
Size | 3 inches | |
Length | 50.0 feet | |
Other Electrical Service | No | |
Description | N/A | |
HVAC Service | Does the replacement transmitter require HVAC Service? | Yes |
Type | Cooling Only | |
Size | 5 tons | |
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 |
Section | Question | Response |
---|---|---|
Antenna Related Expenses | Do you have antenna related expenses? | Yes |
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: | 61.6 kW | |
Manufacturer | ||
Model | TLP-16B(38) | |
Year | 2001 |
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? | No | |
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: | 40.0 kW | |
Manufacturer | ||
Model | ALP16M3-ESO-34 | |
Year | 2019 | |
Justification for New Antenna | Primary antenna is not broadband or able to be tuned to a new channel. |
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? | 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 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 |
Section | Question | Response |
---|---|---|
Transmission Line Related Expenses | Do you have transmission line related expenses? | Yes |
Section | Question | Response |
---|---|---|
Existing Transmission Line Description | Type of change | Purchase New |
Use | Primary (Main) | |
Description of Use | N/A | |
Ownership | Owned | |
Owner | N/A | |
Site | N/A | |
Is the existing transmission line shared with another station or stations? | No | |
Is Transmission Line in operating condition? | Yes | |
Existing Transmission Line Manufacturer and Type | Manufacturer | |
Type | Flexible Air | |
Diameter | 3 inches | |
Other Diameter | N/A | |
Segment Length | N/A | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 436 feet per run |
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? | Yes | |
Type | Rigid | |
Diameter | 3 1/8 inches | |
Other Diameter | N/A | |
Segment Length | Broadband | |
Other Segment Length | N/A | |
Number of parallel runs | 1 | |
Length | 550 feet per run | |
Justification for New Transmission Line | Run of new line is required to replace the existing run that is too short. See cover letter regarding transmission line. Licensee acknowledges it is responsible for cost difference between rigid line and flex line. |
Section | Question | Response |
---|---|---|
Tower Equipment or Rigging Costs Changes | Do you have tower equipment or rigging costs changes? | Yes |
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? | No | |
Existing Tower Structure Registration | Do you have a tower registration number? | Yes |
ASR Number | 1036023 | |
Coordinates (NAD83) | Latitude (NAD83) | 38° 22' 01.0" N- |
Longitude (NAD83) | 085° 49' 54.0" W- | |
Overall Structure Height | 547.89 feet | |
Support Structure Height | 501.96 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 977.02 feet | |
Structure Type | TOWER - Free Standing or Guyed Structure | |
Tower Owner | KENTUCKY AUTHORITY FOR EDUCATIONAL TELEVISION | |
Date Constructed | 01/01/1969 |
Facility ID | Call Sign | Service |
---|---|---|
21432 | WKPC-TV | DTV |
Section | Question | Response |
---|---|---|
Engineering Study | Please what type of engineering study is required, if any: | Study needed for undocumented/poorly documented tower |
Tower Reinforcements | Please select whether tower reinforcements are needed: | Minor Reinforcements needed |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
Section | Question | Response |
---|---|---|
Outside Project Management Services | Do you require outside project management services? | Yes |
Number of Hours | 80 | |
Explanation | KET Staff require outside services to manage the upgrades. | |
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 | No | |
Quantity | N/A | |
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 | No | |
Quantity | N/A | |
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 | No | |
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 |
Name | Description |
---|---|
Progress and Transition Reports |
progress and quarterly reports |
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 | No | |
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? | No | |
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 |
Name | Description |
---|---|
Internal Labor |
FCC Reimbursement Clerk hired for repack reimbursement ONLY |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $311,950.00 | $296,700.00 | N/A | $133,877.27 | N/A |
Total for all systems | $1,416,672.40 | $1,127,920.15 | N/A | $506,686.11 | N/A |
Primary Transmitter Maxiva UAXTE-8 | $311,950.00 | $296,700.00 | $133,877.27 | ||
UHF - Air Cooled Solid State Transmitter 4 - 6 kW | $236,500.00 | $225,000.00 | N/A | $133,877.27 | N/A |
5 Ton system | $20,250.00 | $19,250.00 | N/A | N/A | N/A |
3" Rigid Conduit and Wiring (Cost per foot) | $2,600.00 | $2,450.00 | N/A | N/A | N/A |
Switchgear - industrial 800 amp | $38,200.00 | $36,300.00 | N/A | N/A | N/A |
Service entrance 3 phase/800 amp/208 volt | $14,400.00 | $13,700.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
---|---|
UHF - Air Cooled Solid State Transmitter 4 - 6 kW | |
5 Ton system | Information not provided. |
3" Rigid Conduit and Wiring (Cost per foot) | Information not provided. |
Switchgear - industrial 800 amp | Information not provided. |
Service entrance 3 phase/800 amp/208 volt | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $286,542.40 | $83,383.65 | N/A | $83,383.65 | N/A |
Total for all systems | $1,416,672.40 | $1,127,920.15 | N/A | $506,686.11 | N/A |
Primary Antenna ALP16M3-ESO-34 | $286,542.40 | $83,383.65 | $83,383.65 | ||
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) | $5,260.00 | $6,987.50 | ***System Notice: Estimate adjusted and locked because line has been superseded.***Greg Best edited Sept 2019 - KB | $6,987.50 | Greg Best submitting explanation 6/23/19 KB |
Side mount brackets for high power antennas (if not included in antenna base cost) | $23,150.00 | $0.00 | Antenna mounts are included in the estimated costs of the antenna. | N/A | N/A |
Sweep test of existing antenna | $6,730.00 | $13,750.00 | GB edited Sept 2019 - KB | $13,750.00 | The additional cost for sweep is due to using existing line for the interim services that required sweep testing before using. |
UHF - High Power, Side Mount, basic slot antenna, 40 kW input, elliptically or circularly polarized | $61,902.40 | $61,902.40 | The total cost of the antenna is $48895 including the Vpol component. The cost above is the Hpol comparable amount. Applicant recognizes it is responsible for the Vpol amount. | $61,902.40 | N/A |
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized | $189,500.00 | $743.75 | ***System Notice: Estimate adjusted and locked because line has been superseded.*** | $743.75 | N/A |
Actual Information Description | File Name |
---|---|
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) | |
Side mount brackets for high power antennas (if not included in antenna base cost) | Information not provided. |
Sweep test of existing antenna | |
UHF - High Power, Side Mount, basic slot antenna, 40 kW input, elliptically or circularly polarized | |
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $66,000.00 | $88,844.00 | N/A | $62,136.68 | N/A |
Total for all systems | $1,416,672.40 | $1,127,920.15 | N/A | $506,686.11 | N/A |
Primary Transmission Line | $66,000.00 | $88,844.00 | $62,136.68 | ||
Rigid Transmission Line - copper, 3 1/8" broadband | $66,000.00 | $88,844.00 | Cost includes 3" rigid line and dehydrator. See cover letter for transmission line. Licensee acknowledges it is responsible for cost difference between rigid line and flex line. | $62,136.68 | N/A |
Actual Information Description | File Name |
---|---|
Rigid Transmission Line - copper, 3 1/8" broadband |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $394,800.00 | $370,000.00 | N/A | $189,321.05 | N/A |
Total for all systems | $1,416,672.40 | $1,127,920.15 | N/A | $506,686.11 | N/A |
Primary Tower TOWER | $394,800.00 | $370,000.00 | $189,321.05 | ||
Tall Tower (greater than 500') | $210,500.00 | $365,000.00 | Though WKMJ and WKPC share a tower, the rigging work will be done separately. KET obtained quotation of realistic scope of tower rigging work from reputable supplier. Please see attached Tower Work exhibit. | $188,636.67 | N/A |
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | $26,300.00 | $0.00 | WKMJ costs are allocated to WKPC. Please see attached Repack Plan Exhibit for details. | N/A | N/A |
Minor tower reinforcement/modifications | $158,000.00 | $5,000.00 | WKMJ costs are allocated to WKPC. Please see attached Repack Plan Exhibit for details. | $684.38 | N/A |
Actual Information Description | File Name |
---|---|
Tall Tower (greater than 500') | |
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study | Information not provided. |
Minor tower reinforcement/modifications |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $123,190.00 | $63,092.50 | N/A | $34,827.18 | N/A |
Total for all systems | $1,416,672.40 | $1,127,920.15 | N/A | $506,686.11 | N/A |
Outside Professional Services | $123,190.00 | $63,092.50 | $34,827.18 | ||
Progress and Transition Reports | $4,000.00 | $4,000.00 | Engineering consultant costs not otherwise listed. | $262.50 | N/A |
Comprehensive coverage verification via field study, if needed | $84,200.00 | $25,000.00 | N/A | $22,648.28 | N/A |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | $2,365.00 | $2,792.50 | Estimated costs were based on catalog, and actual costs exceeded estimates. | $2,792.50 | N/A |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | $5,260.00 | $5,000.00 | N/A | $1,172.50 | N/A |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | $1,580.00 | $1,500.00 | N/A | N/A | N/A |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $3,155.00 | $3,300.00 | During the antenna evaluation, some concerns were expressed by the engineering team about the coverage pattern. Those concerns required additional engineering during the antenna design phase. | $3,237.50 | N/A |
Perform engineering study for new channel assignment and antenna development | $7,360.00 | $7,000.00 | N/A | $1,596.87 | N/A |
Prepare and or review reimbursement form | $2,630.00 | $2,500.00 | N/A | $1,662.50 | N/A |
Project management of the transition | $12,640.00 | $12,000.00 | KET Staff require outside services to manage the upgrades. | $1,454.53 | N/A |
Actual Information Description | File Name |
---|---|
Progress and Transition Reports | |
Comprehensive coverage verification via field study, if needed | |
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application | |
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application | |
Prepare engineering section of FCC Form 2100 (main), License to Cover Application | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | |
Perform engineering study for new channel assignment and antenna development | |
Prepare and or review reimbursement form | |
Project management of the transition |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $19,050.00 | $12,500.00 | N/A | $3,140.28 | N/A |
Total for all systems | $1,416,672.40 | $1,127,920.15 | N/A | $506,686.11 | N/A |
Other Expenses | $19,050.00 | $12,500.00 | $3,140.28 | ||
Internal Labor | $2,000.00 | $2,000.00 | N/A | $434.03 | N/A |
MVPD Notification of Channel Change | $1,500.00 | $1,500.00 | KET estimate to search for and notify all cable companies. | $1,118.75 | N/A |
Develop and air announcement of upcoming channel change | $1,500.00 | $1,500.00 | KET estimate for developing and airing announcement. | N/A | N/A |
Equipment Storage | $500.00 | $500.00 | GBC estimate | N/A | N/A |
Disposal Costs (for equipment and other waste, net of any salvage value) | $2,000.00 | $2,000.00 | KET estimate based on known costs. | N/A | N/A |
DTV Medical Facility Notification | $11,550.00 | $5,000.00 | GBC estimate based on known quotations | $1,587.50 | N/A |
Actual Information Description | File Name |
---|---|
Internal Labor | |
MVPD Notification of Channel Change | |
Develop and air announcement of upcoming channel change | Information not provided. |
Equipment Storage | Information not provided. |
Disposal Costs (for equipment and other waste, net of any salvage value) | Information not provided. |
DTV Medical Facility Notification |
Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
---|---|---|---|
Total for all systems | $1,416,672.40 | $1,127,920.15 | $506,686.11 |
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 |
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. |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Shae Hopkins Executive Director 03/16/2022 |
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). |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Shae Hopkins Executive Director 03/16/2022 |
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. |
|
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | She Hopkins Executive Director 03/16/2022 |