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:
989
Service:
LPD
Call Sign:
WHVD-LD
Channel:
35 (UHF)
File Number:
0000089363
FRN:
0001843697
Eligibility Status:
Eligible
Date Submitted:
08/02/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WORD OF GOD FELLOWSHIP, INC.

3901 HIGHWAY 121 SOUTH

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

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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

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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 WHVD will transition from channel 34 to channel 35 by changing its antenna and utilizing a mask filter.

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)
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 AT75-2k5
Year 2012
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 2.5 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 EKA TXUD2700ACD
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.7 kW
Justification for New Transmitter New transmitter is required because the previous transmitter could not be retuned.

Primary Transmitter

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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

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Other Transmitter Cost Not Listed

Name Description

Primary Transmitter Mask Filter

Primary Transmitter Mask Filter

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)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
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 SWL16OI/34
Year 2012

Primary Antenna

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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? No
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 Elliptical
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model SWEDL8MLS/35
Year 2019
Justification for New Antenna Existing antenna cannot accommodate channel 35 operations.

Primary 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? 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

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Other Antenna Cost Not Listed

Name Description

Antenna removal and installation

Antenna removal and installation

Transmission Line

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

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)
Ownership Leased
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 1041008
Coordinates (NAD83) Latitude (NAD83) 34° 44' 12.8" N-
Longitude (NAD83) 086° 31' 58.9" W-
Overall Structure Height 1001.96 feet
Support Structure Height 899.92 feet
Ground Elevation Above Mean Sea Level (AMSL) 1552.15 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 12/01/1977

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
67953 WNAL-LD LPT
28119 WZDX DTV
60414 WCEH-FM FM
67020 W34EY-D DTV
3086 WTZT-CD DTV
57292 WAAY-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: 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 254
Explanation WHVD-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. WHVD-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 4
Justification Costs incurred for engineering services needed to saw up the old antenna for removal and to run corrections on the transmitter 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
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

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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 $124,499.00 $89,162.76 N/A $89,162.76 N/A
Total for all systems $387,187.30 $199,360.21 N/A $141,370.51 N/A
Primary Transmitter EKA TXUD2700ACD $124,499.00 $89,162.76 $89,162.76
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $106,300.00 $79,438.00 Please see Elettronika America estimate 6562 $79,438.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $1,525.76 Please see WHVD-LD Primary Transmitter - Site Survey/Installation Budget Revision Justification Letter $1,525.76 N/A
Primary Transmitter Mask Filter $8,199.00 $8,199.00 Please see Elettronika America estimate 6562 $8,199.00 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
EKA TXUD2700AC_D UHF Digital TV Transmitter
Amount:
$79,438.00
Transmitter Building Site Survey/Installation

Component Description:
Travel Expenses
Amount:
$1,525.76
Primary Transmitter Mask Filter

Component Description:
WHVD-LD-110-Primary Transmitter - Mask Filter
Amount:
$8,199.00

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 $33,527.74 $22,797.74 N/A $21,297.74 N/A
Total for all systems $387,187.30 $199,360.21 N/A $141,370.51 N/A
Primary Antenna SWEDL8MLS/35 $33,527.74 $22,797.74 $21,297.74
Sweep test of transmission line and antenna $5,730.00 $400.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $400.00 N/A
Elbow complex, single channel, 1 5/8” input (if needed) $6,900.00 $1,500.00 N/A N/A N/A
Antenna removal and installation $0.00 $0.00 Moved to Tower Rigging category N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical $20,897.74 $20,897.74 ***System Notice: Estimate adjusted and locked because line has been superseded.***Please see WHVD-LD SWR QUOTE #21938.pdf $20,897.74 N/A

Components

Actual Information Description File Name
Sweep test of transmission line and antenna

Component Description:
Sweep Test of Antenna Line
Amount:
$400.00

Component Description:
Swept Transmission line and antenna
Amount:
$400.00
Elbow complex, single channel, 1 5/8” input (if needed) Information not provided.
Antenna removal and installation Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical

Component Description:
WHVD-LD - CH35 - Huntsville, AL
Amount:
$20,897.74

Cost Information

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Transmission Line

Information not provided.

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 $157,750.00 $25,000.00 N/A $0.00 N/A
Total for all systems $387,187.30 $199,360.21 N/A $141,370.51 N/A
Primary Tower GTOWER $157,750.00 $25,000.00 $0.00
Tower Rigging Tall Tower (greater than 500') $157,750.00 $25,000.00 Previously approved antenna removal and installation budget moved to appropriate category N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $58,660.56 $49,659.71 N/A $29,724.71 N/A
Total for all systems $387,187.30 $199,360.21 N/A $141,370.51 N/A
Outside Professional Services $58,660.56 $49,659.71 $29,724.71
Additional Field Engineering Service, 4 Days $3,981.06 $3,981.06 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $3,981.06 N/A
RF Exposure Measurements $12,100.00 $5,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,200.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $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/ Review 399 reimbursement form $1,710.00 $1,500.00 N/A N/A N/A
Project management of the transition $26,797.00 $25,743.65 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $25,743.65 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
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 4 Days

Component Description:
Additional Field Engineering
Amount:
$3,981.06

Component Description:
WHVD-LD-580-RF Eng - Additional Field Engineering
Amount:
$3,981.06
RF Exposure Measurements Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
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 Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Perform engineering study for displacement application Information not provided.
Form 399 assistance or other Program Management costs Information not provided.
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition

Component Description:
Project Manager
Amount:
$1,295.70

Component Description:
Project Management
Amount:
$713.00

Component Description:
Project Management
Amount:
$887.30

Component Description:
Project Management
Amount:
$82.50

Component Description:
Project Management
Amount:
$1,526.75

Component Description:
Project Management
Amount:
$759.40

Component Description:
Project Management
Amount:
$591.65

Component Description:
Project Management
Amount:
$325.50

Component Description:
Project Management
Amount:
$166.70

Component Description:
Project Management
Amount:
$846.80

Component Description:
Project Management
Amount:
$415.40

Component Description:
Project Management
Amount:
$715.10

Component Description:
Project Management
Amount:
$685.05

Component Description:
Project Management
Amount:
$581.65

Component Description:
Project Management
Amount:
$705.90

Component Description:
Project Management
Amount:
$1,153.70

Component Description:
Project Management
Amount:
$279.55

Component Description:
Project management
Amount:
$4,279.30

Component Description:
Project Management
Amount:
$3,948.35

Component Description:
Project Management
Amount:
$599.25

Component Description:
Project Management
Amount:
$252.40

Component Description:
Project Management
Amount:
$593.50

Component Description:
Project Management
Amount:
$568.85

Component Description:
Project Management
Amount:
$763.05

Component Description:
Project Management
Amount:
$1,615.05

Component Description:
Project Management
Amount:
$1,117.90

Component Description:
Project Management
Amount:
$274.35
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $12,750.00 $12,740.00 N/A $1,185.30 N/A
Total for all systems $387,187.30 $199,360.21 N/A $141,370.51 N/A
Other Expenses $12,750.00 $12,740.00 $1,185.30
Equipment Storage $1,000.00 $1,000.00 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
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A 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
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 N/A $1,185.30 N/A

Components

Actual Information Description File Name
Equipment Storage Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Freight
Amount:
$1,185.30

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $387,187.30 $199,360.21 $141,370.51

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. Yes
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Arnold Torres

Business Administrator


08/02/2022

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.

Arnold Torres

Business Administrator


08/02/2022

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.

Arnold Torres

Business Administrator


08/02/2022

Attachments

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