Skip to main content Skip to footer and contact information
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:
68079
Service:
LPD
Call Sign:
WDRN-LD
Channel:
32 (UHF)
File Number:
0000092892
FRN:
0001843697
Eligibility Status:
Eligible
Date Submitted:
07/13/2022

Applicant Information

Back to Top ↑

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WORD OF GOD FELLOWSHIP, INC.

3901 HIGHWAY 121

BEDFORD, TX 76021

United States

 +1 (817) 799-2138 arnold.torres@DAYSTAR.COM Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 

Preparer Contact Information

Back to Top ↑

Preparer Contact Name and Information

Applicant Address Phone Email

Samuel Hariton

Widelity, Inc.

Samuel Hariton

4031 University Drive

Ste 100

Fairfax, VA 22030

United States

 +1 (339) 222-8107 sam.hariton@widelity.com

Broadcaster Information and Transition Plan

Back to Top ↑
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. No
Briefly describe transition plan WDRN will transition from channel 40 to channel 32 by changing its antenna and transmitter. WDRN will not change tower sites.

Transmitters

Back to Top ↑
Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Primary Transmitter

Back to Top ↑

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model AT73-1k5
Year 2013
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.5 kW

Primary Transmitter

Back to Top ↑

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 TXUD1200AC
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter Moving from channel 40 to channel 32 requires the purchase of a new transmitter because the current transmitter cannot be re-channeled to meet the new channel assignment.

Primary Transmitter

Back to Top ↑

Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

Back to Top ↑

Other Transmitter Cost Not Listed

Name Description

Primary Transmitter - Mask Filter

Primary Transmitter - Mask Filter

Antennas

Back to Top ↑
Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

Back to Top ↑

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model SWLP8OI/40
Year 2013

Primary Antenna

Back to Top ↑

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 14.0 kW
Manufacturer
Model SWLP8MC SPECIAL/32
Year 2019
Justification for New Antenna Existing antenna cannot accommodate channel 32 operations.

Primary Antenna

Back to Top ↑

Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 1 5/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

Back to Top ↑

Other Antenna Cost Not Listed

Name Description

Site Specific Engineering

Site Specific Engineering

Antenna removal and installation

antenna removal and installation

Transmission Line

Back to Top ↑
Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top ↑

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? 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 1002664
Coordinates (NAD83) Latitude (NAD83) 35° 05' 08.0" N-
Longitude (NAD83) 078° 54' 24.0" W-
Overall Structure Height 252.62 feet
Support Structure Height 252.62 feet
Ground Elevation Above Mean Sea Level (AMSL) 200.13 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Daystar Television Network
Date Constructed 04/08/1997


Primary Tower

Back to Top ↑

Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

Back to Top ↑

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

Back to Top ↑

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Back to Top ↑
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 254
Explanation WDRN-LD does not have sufficient resource capacity and expertise in house to handle all activities necessary for completion of the station's build by the construction deadline. WDRN-LD will hire an outside firm to facilitate a timely transition.
Outside RF consulting Engineering Services Perform engineering study for displacement application 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
Prepare Form 601 No
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
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 6
Justification Costs incurred by the installation of the new transmitter and other engineering services required for the repack

Outside Professional Services Costs

Back to Top ↑

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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

Other Expenses

Back to Top ↑

Other Expenses Not Listed

Information not provided.

Cost Information

Back to Top ↑

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 $99,675.00 $86,675.00 N/A $63,032.44 N/A
Total for all systems $262,730.30 $204,875.60 N/A $117,863.04 N/A
Primary Transmitter TXUD1200AC $99,675.00 $86,675.00 $63,032.44
Primary Transmitter - Mask Filter $5,675.00 $5,675.00 Please see Elettronika America estimate 6406 $5,675.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $6,000.00 N/A $833.44 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $75,000.00 Please see attached Elettronika America estimate 6406 $56,524.00 N/A

Components

Actual Information Description File Name
Primary Transmitter - Mask Filter

Component Description:
WDRN-LD-110-Primary Transmitter - Mask Filter
Amount:
$2,837.50

Component Description:
WDRN-LD-110-Primary Transmitter - Mask Filter
Amount:
$2,837.50
Transmitter Building Site Survey/Installation

Component Description:
Travel Expense
Amount:
$833.44
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
EKA TXUD1200 AC D UHF Digital TV Transmitter
Amount:
$28,262.00

Component Description:
EKA TXUD1200AC D
Amount:
$28,262.00

Cost Information

Back to Top ↑

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 $40,484.95 $37,854.95 N/A $27,854.95 N/A
Total for all systems $262,730.30 $204,875.60 N/A $117,863.04 N/A
Primary Antenna SWLP8MC SPECIAL/32 $40,484.95 $37,854.95 $27,854.95
Site Specific Engineering $3,800.00 $3,800.00 Please see SWR Quote 23051 $3,800.00 N/A
Antenna removal and installation $0.00 $0.00 Previously approved antenna removal and installation budget moved to appropriate tower rigging category N/A N/A
Elbow complex, single channel, 1 5/8” input (if needed) $6,900.00 $5,000.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 14.0kW input, Horizontal $24,054.95 $24,054.95 Please see SWR Quote 23051 and actual shipping costs on SWR Invoice 21013 $24,054.95 N/A
Sweep test of transmission line and antenna $5,730.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Site Specific Engineering

Component Description:
WDRN-LD-210-Primary Antenna - Site Specific Engineering
Amount:
$3,800.00
Antenna removal and installation Information not provided.
Elbow complex, single channel, 1 5/8” input (if needed) Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 14.0kW input, Horizontal

Component Description:
Low power digital TV transmit antenna
Amount:
$24,054.95
Sweep test of transmission line and antenna Information not provided.

Cost Information

Back to Top ↑

Transmission Line

Information not provided.

Cost Information

Back to Top ↑

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 $56,190.00 $25,000.00 N/A $0.00 N/A
Total for all systems $262,730.30 $204,875.60 N/A $117,863.04 N/A
Primary Tower TOWER $56,190.00 $25,000.00 $0.00
Tower Rigging Short Tower (less than 500') $56,190.00 $25,000.00 Previously approved antenna removal and installation budget moved to appropriate tower rigging category N/A N/A

Components

Information not provided.

Cost Information

Back to Top ↑

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 $57,448.29 $46,538.59 N/A $25,603.59 N/A
Total for all systems $262,730.30 $204,875.60 N/A $117,863.04 N/A
Outside Professional Services $57,448.29 $46,538.59 $25,603.59
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,000.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $32.50 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $32.50 N/A
Project management of the transition $26,797.00 $22,802.30 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $22,802.30 N/A
Additional Field Engineering Service, 6 Days $2,768.79 $2,768.79 Please see WDRN-LD RF Eng Additional Field Engineering Service Budget Revision Justification Letter The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $2,768.79 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,000.00 N/A N/A N/A
RF Exposure Measurements $12,100.00 $7,500.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,500.00 N/A N/A N/A
Form 399 assistance or other Program Management costs $1,000.00 $1,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,200.00 N/A N/A N/A

Components

Actual Information Description File Name
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.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for displacement application

Component Description:
Engineering Study for Displacement Application
Amount:
$32.50

Component Description:
Work performed
Amount:
$32.50
Project management of the transition

Component Description:
Project Management
Amount:
$930.00

Component Description:
Project Management
Amount:
$155.00

Component Description:
Project Management
Amount:
$254.60

Component Description:
Project Management
Amount:
$232.50

Component Description:
Project Management
Amount:
$1,350.40

Component Description:
Project management
Amount:
$598.70

Component Description:
Project Management
Amount:
$1,343.85

Component Description:
Project Management
Amount:
$373.30

Component Description:
Project Management
Amount:
$1,196.30

Component Description:
Project Management
Amount:
$395.90

Component Description:
Project Management
Amount:
$321.70

Component Description:
Project Management
Amount:
$634.90

Component Description:
Project Management
Amount:
$2,661.30

Component Description:
Project Management
Amount:
$852.90

Component Description:
Project Management
Amount:
$82.50

Component Description:
Project Management
Amount:
$1,171.65

Component Description:
Project Management
Amount:
$220.55

Component Description:
Project Management
Amount:
$1,035.40

Component Description:
Project management
Amount:
$1,705.00

Component Description:
Project Management
Amount:
$1,479.40

Component Description:
Project Management
Amount:
$2,342.60

Component Description:
Project Management
Amount:
$748.50

Component Description:
Project Management
Amount:
$343.05

Component Description:
Project Management
Amount:
$1,179.25

Component Description:
Project Management
Amount:
$1,193.05
Additional Field Engineering Service, 6 Days

Component Description:
Work performed by FTM
Amount:
$1,868.75

Component Description:
Expenses incurred by: FTM
Amount:
$900.04
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Exposure Measurements Information not provided.
Prepare/ Review 399 reimbursement form Information not provided.
Form 399 assistance or other Program Management costs Information not provided.
Prepare request for Special Temporary Authorization Information not provided.

Cost Information

Back to Top ↑

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 $8,932.06 $8,807.06 N/A $1,372.06 N/A
Total for all systems $262,730.30 $204,875.60 N/A $117,863.04 N/A
Other Expenses $8,932.06 $8,807.06 $1,372.06
Equipment Delivery and Handling Charges $1,182.06 $1,182.06 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $1,182.06 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $190.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $190.00 N/A
Equipment Storage $1,000.00 $1,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,100.00 N/A N/A N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
equipment and delivery
Amount:
$1,182.06

Component Description:
Freight out going to WDRN Fayetteville NC
Amount:
$1,182.06
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request

Component Description:
FCC Filing Fee
Amount:
$190.00
Equipment Storage Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.

Cost Information

Back to Top ↑

Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $262,730.30 $204,875.60 $117,863.04

Reimbursement Status

Back to Top ↑
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

Back to Top ↑
Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  3. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

  7. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Arnold Torres

Business Administrator


07/13/2022

Certification

Back to Top ↑
Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

  3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  4. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

  6. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

  8. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  9. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Arnold Torres

Business Administrator


07/13/2022

Certification

Back to Top ↑
Section Question Response
Submission of Final Allocation or Accounting Information Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  5. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Arnold Torres

Business Administrator


07/13/2022

Attachments

Back to Top ↑