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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:
17544
Service:
DCA
Call Sign:
WYBU-CD
Channel:
26 (UHF)
File Number:
0000027787
FRN:
0010360873
Date Submitted:
06/17/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CHRISTIAN TELEVISION NETWORK, INC.

Doing Business As: CHRISTIAN TELEVISION NETWORK, INC.

PO BOX 6922

Clearwater, FL 33758

United States

 +1 (727) 535-5622 soneal@ctntv.net Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 

Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Joseph C. Chautin III

Hardy, Carey, Chautin & Balkin, LLP

1080 West Causeway Approach

Mandeville, LA 70471

United States

 +1 (985) 629-0777 jchautin@hardycarey.com

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. No
Briefly describe transition plan WYBU will be off the air for 2 or 3 days while existing antenna, transmitter and mask filter are replaced with similar equipment that is capable of operating on the new channel.

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 AT72K7
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 2.7 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model EC702-HP-BB
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.7 kW
Justification for New Transmitter Manufacturer has discontinued this model of transmitter and will not support the re-channeling of it.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
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 Class A
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: 15.0 kW
Manufacturer
Model AL8-16-PL
Year 2009

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? No
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 Class A
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: 15.0 kW
Manufacturer
Model AL8-26-PL
Year 2017
Justification for New Antenna Existing antenna cannot be re-tuned to new 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? 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? 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

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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 ERI
Type Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 350 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Primary Transmission Line - Other Parts

Primary Transmission Line - Other Parts

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 Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1255743
Coordinates (NAD83) Latitude (NAD83) 32° 27' 59.8" N-
Longitude (NAD83) 085° 03' 21.7" W-
Overall Structure Height 337.92 feet
Support Structure Height 337.92 feet
Ground Elevation Above Mean Sea Level (AMSL) 623.35 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner PMB Broadcasting, LLC
Date Constructed 01/01/1960


Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

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 605
Explanation Project management (Invoice processing, progress reporting, daisy chain monitoring and analysis, program management, and site visits as required)
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 Yes
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 No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 1
Justification Costs incurred for on-site engineering work for the primary antenna and primary transmitter installation as part of the repack.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits 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? Yes
Does this relocation require Equipment Storage? No
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

Information not provided.

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 $126,000.00 $112,977.40 N/A $112,607.33 N/A
Total for all systems $400,635.93 $353,231.23 N/A $221,217.81 N/A
Primary Transmitter EC702-HP-BB $126,000.00 $112,977.40 $112,607.33
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $112,977.40 see Estimated Cost Justification WYBU-110-1st Primary Transmitter - UHF Air Cooled Solid State, 1-2.5kw v0 $112,607.33 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
TRANSMITTER, UHF DOHERTY BROADBAND
Amount:
$59,435.00

Component Description:
TRANSMITTER, UHF DOHERTY BROADBAND
Amount:
$39,412.57

Component Description:
TRANSMITTER, UHF DOHERTY BROADBAND
Amount:
$5,630.36

Component Description:
TRANSMITTER, UHF DOHERTY BROADBAND
Amount:
$8,129.40

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 $33,030.00 $13,469.90 N/A $13,469.90 N/A
Total for all systems $400,635.93 $353,231.23 N/A $221,217.81 N/A
Primary Antenna AL8-26-PL $33,030.00 $13,469.90 $13,469.90
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $7,069.90 Please see attached DTVPros Quote JEHQ1300-03 plus shipping on DTVPros Invoice 426 $7,069.90 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
UHF Lower Power Side Mount
Amount:
$7,069.90
Sweep test of existing antenna

Component Description:
WYBU-210-Primary 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 $13,162.18 $13,162.18 N/A $13,162.18 N/A
Total for all systems $400,635.93 $353,231.23 N/A $221,217.81 N/A
Primary Transmission Line $13,162.18 $13,162.18 $13,162.18
Primary Transmission Line - Other Parts $13,162.18 $13,162.18 Please see DTVPros quotes JEHQ1300-03 and JEHQ1785, plus actual shipping on invoices 431 and 426 $13,162.18 N/A

Components

Actual Information Description File Name
Primary Transmission Line - Other Parts

Component Description:
WYBU-310-Primary Transmission Line - Other Parts
Amount:
$2,146.09

Component Description:
T/L 1-50 EIA LENGTH 5' TO 10' FIXED FLG 1 END/SWIVEL FLG 1 END
Amount:
$11,016.09

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 $84,200.00 $80,000.00 N/A $3,335.00 N/A
Total for all systems $400,635.93 $353,231.23 N/A $221,217.81 N/A
Primary Tower TOWER $84,200.00 $80,000.00 $3,335.00
Short Tower (less than 500') $84,200.00 $80,000.00 N/A $3,335.00 N/A

Components

Actual Information Description File Name
Short Tower (less than 500')

Component Description:
Removed Old Antenna, Installed interim Antenna- removed interim antenna - installed new Antenna
Amount:
$3,335.00

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 $122,293.75 $112,221.75 N/A $75,318.40 N/A
Total for all systems $400,635.93 $353,231.23 N/A $221,217.81 N/A
Outside Professional Services $122,293.75 $112,221.75 $75,318.40
Additional Field Engineering Service, 1 Days $143.75 $143.75 Please see WYBU-CD RF Eng - Additional Field Engineering Service - 1 day Budget Revision Justification Letter $0.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $78.00 Please see attached WYBU Justification Outside Professional Services -Attorney - Other Matters $78.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $628.00 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 $3,000.00 N/A $2,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $312.50 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $600.00 N/A
Project management of the transition $95,590.00 $90,750.00 N/A $71,699.90 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 1 Days

Component Description:
credit memo for funds reimbursed previously in error
Amount:
($143.75)

Component Description:
Repack travel expenses
Amount:
$143.75
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Review FCC email directing bank account association
Amount:
$78.00
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

Component Description:
Review, modify and finalize Form 2100 CP application
Amount:
$468.00

Component Description:
WYBU-550-Attorney - Construction Permit Application (Main)
Amount:
$80.00

Component Description:
Load and prepare initial draft Form 2100
Amount:
$80.00
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

Component Description:
Preparation of the engineering section of FCC Form 2100.
Amount:
$2,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$312.50
Prepare and or review reimbursement form

Component Description:
Final review, revision of initial Form 399
Amount:
$520.00

Component Description:
Draft Form 399 on LMS.
Amount:
$80.00
Project management of the transition

Component Description:
Project Management
Amount:
$1,594.55

Component Description:
Project Management
Amount:
$979.60

Component Description:
Project Management
Amount:
$478.85

Component Description:
Project management
Amount:
$3,075.85

Component Description:
Project Management
Amount:
$1,803.40

Component Description:
Project Management
Amount:
$2,689.15

Component Description:
Project Management
Amount:
$302.00

Component Description:
Project management
Amount:
$2,690.05

Component Description:
Project Management
Amount:
$2,113.00

Component Description:
Project Management
Amount:
$2,655.05

Component Description:
Project Management
Amount:
$2,729.40

Component Description:
Project Management
Amount:
$1,318.25

Component Description:
Project Management
Amount:
$1,607.40

Component Description:
Project Management
Amount:
$1,235.15

Component Description:
Project Management
Amount:
$1,779.70

Component Description:
Project Management
Amount:
$116.25

Component Description:
Project Management
Amount:
$116.25

Component Description:
Project Management
Amount:
$1,023.10

Component Description:
Project Management
Amount:
$2,431.55

Component Description:
Project Management
Amount:
$1,470.85

Component Description:
Project Management
Amount:
$1,505.60

Component Description:
Project management
Amount:
$350.30

Component Description:
Project Management
Amount:
$1,660.70

Component Description:
Project Management
Amount:
$2,126.65

Component Description:
Project Management
Amount:
$2,301.40

Component Description:
Project Management
Amount:
$1,682.70

Component Description:
Project Management
Amount:
$1,973.00

Component Description:
Project Management
Amount:
$193.75

Component Description:
Project Management
Amount:
$3,808.95

Component Description:
Project Management
Amount:
$3,528.75

Component Description:
Project Management
Amount:
$417.90

Component Description:
Project Management
Amount:
$1,120.70

Component Description:
Project Management
Amount:
$116.25

Component Description:
Project Management
Amount:
$116.25

Component Description:
Project Management
Amount:
$91.50

Component Description:
Project Management
Amount:
$1,647.05

Component Description:
Project Management
Amount:
$2,246.60

Component Description:
Project Management
Amount:
$1,916.10

Component Description:
Project Management
Amount:
$1,240.90

Component Description:
Project Management
Amount:
$2,394.25

Component Description:
Project Management
Amount:
$429.75

Component Description:
Project Management
Amount:
$1,508.10

Component Description:
Project management
Amount:
$2,435.70

Component Description:
Project Management
Amount:
$1,870.15

Component Description:
Project Management
Amount:
$1,231.60

Component Description:
Project Management
Amount:
$1,575.90

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 $21,950.00 $21,400.00 N/A $3,325.00 N/A
Total for all systems $400,635.93 $353,231.23 N/A $221,217.81 N/A
Other Expenses $21,950.00 $21,400.00 $3,325.00
MVPD Notification of Channel Change $1,500.00 $1,500.00 N/A $1,200.00 N/A
Develop and air announcement of upcoming channel change $400.00 $400.00 N/A N/A N/A
Equipment Delivery and Handling Charges $7,000.00 $7,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,500.00 $1,500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,125.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
Prepare letters to MVPDs
Amount:
$1,200.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification

Component Description:
Mailing
Amount:
$2,125.00

Cost Information

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Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $400,635.93 $353,231.23 $221,217.81

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.

CHRIS L MAVROS

D.E., Christian Television Network


06/17/2022

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.

CHRIS L MAVROS

D.E., Christian Television Network


06/17/2022

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.

CHRIS L MAVROS

D.E., Christian Television Network


06/17/2022

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