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:
68009
Service:
LPD
Call Sign:
WTZP-LD
Channel:
31 (UHF)
File Number:
0000088386
FRN:
0017800376
Eligibility Status:
Eligible
Date Submitted:
10/04/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

EAGLE BROADCASTING GROUP, INC.

Doing Business As: EAGLE BROADCASTING GROUP, INC.

Charles E. Jones

227E. Main St

Jackson, OH 45640

United States

+1 (740) 285-2813 WTZPproject@gmail.com Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Tony Zummallen

Preparer Contact Representative

QCommunications, LLC

Tony Zummallen

705B SE Melody Lane #314

Lee's Summit, MO 64063

United States

+1 (816) 729-1177 tony@Qcomm.tv

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan WTZP will purchase a new antenna, feedline and transmitter to replace temporary equipment now in use due to the displacement deadline. The project includes a tower study and all actions required to meet the current Ohio Building Code tower standards.

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 DTXPRO1200U
Year 1990
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.2 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 UAX-OP-1400
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2 kW
Justification for New Transmitter Re-tuning the existing main transmitter is not an option because Pineapple Technology is no longer in business..

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

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)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? No
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type Refurbished parapanel
ERP: 15.0 kW
Manufacturer
Model RYMSBP24DR
Year 1999

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? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model TLP-8E
Year 2022
Justification for New Antenna The old parapanel is a single-channel antenna and thus is unsuitable for continuing operations on the replacement channel. WTZP-LD has begun interim operations on the new channel at reduced power using a borrowed antenna, ANT Model ATS1x1.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
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? 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

Installation of new antenna and feedline

Installation cost quoted separately from cost to rig tower and remove abandoned TV antenna and 6' feedline to bring tower within current standards.

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 Purchase New
Use Primary (Main)
Ownership Owned
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 Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 450 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 1000 feet per run
Justification for New Transmission Line Existing line had been abandoned on tower by unknown previous user, had been spliced.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Hardware

Hangers, hoist grip, grip hanger kit adapters, flanges, connectors, other associated items for installation

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? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1027116
Coordinates (NAD83) Latitude (NAD83) 38° 45' 42.0" N-
Longitude (NAD83) 083° 03' 41.0" W-
Overall Structure Height 940.61 feet
Support Structure Height 899.27 feet
Ground Elevation Above Mean Sea Level (AMSL) 1103.00 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner The Ohio State University
Date Constructed 06/01/1992

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
66187 WOSP FM

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Tower mapping and report for structural engineer
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Structural Analysis and Mapping

Structural Analysis and Mapping

Top Mount Pole

Plan is to remove abandoned top-mount TV antenna & feedline to help bring tower within building codes. Pole to maintain height per owner.

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 475
Explanation Project Management firm will be hired once funding awarded.
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 No
Prepare Form 601 Yes
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
Negotiation of Lease and other Matter for Shared Locations Yes
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 Yes
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

General Engineering - Repack

Consulting Engineering

Attorney fees- Repack General

Attorney fees for work performed not anticipated prior to repack

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 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
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

Name Description

Tree Clearing

Tree clearing to prepare for Geotechnical Survey and Foundation Mapping

Filing Fees - STA

FCC Filing fees for STA

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 $94,000.00 $45,707.98 N/A $35,707.98 N/A
Total for all systems $906,599.99 $823,413.43 N/A $185,470.58 N/A
Primary Transmitter UAX-OP-1400 $94,000.00 $45,707.98 $35,707.98
Transmitter Building Site Survey/Installation $10,000.00 $10,000.00 Request to cover installation of transmitter and all ground components. N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $35,707.98 Old transmitter cannot be used for the new channel. $35,707.98 N/A

Components

Actual Information Description File Name
Transmitter Building Site Survey/Installation Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Final transmitter invoice - Gates - INV TE10006206-2
Amount:
$25,619.67

Component Description:
1/3 deposit - GatesAir - tx - INV TE10006206-1
Amount:
$10,088.31

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 $71,111.63 $71,111.63 N/A $9,807.88 N/A
Total for all systems $906,599.99 $823,413.43 N/A $185,470.58 N/A
Primary Antenna TLP-8E $71,111.63 $71,111.63 $9,807.88
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Horizontal $5,756.63 $5,756.63 ***System Notice: Estimate adjusted and locked because line has been superseded.***Per Dielectric quote. Old antenna not frequency agile. Temp antenna was intended for emergency use only; will not replicate coverage. Use of 8-bay antenna vs 12/16-bay places it in inside predetermined costs limits but requires more powerful transmitter $5,756.63 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A $3,200.00 N/A
Side Mount antenna brackets $4,625.00 $4,625.00 N/A $851.25 N/A
Installation of new antenna and feedline $55,000.00 $55,000.00 In addition to rigging tower to remove abandoned equipment to reduce weight and help bring tower within current standards. May decrease if antenna installed as proposed at top of tower during installation of pole. $0.00 N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Horizontal

Component Description:
Antenna - Dielectric - INV 1935721
Amount:
$5,756.63
Sweep test of transmission line and antenna

Component Description:
1/2 sweep - Dielectric - INV 1935721
Amount:
$3,200.00
Side Mount antenna brackets

Component Description:
Mount kit - Dielectric - INV 1935721
Amount:
$851.25
Installation of new antenna and feedline Information not provided.

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 $28,000.00 $28,000.00 N/A $6,979.50 N/A
Total for all systems $906,599.99 $823,413.43 N/A $185,470.58 N/A
Primary Transmission Line $28,000.00 $28,000.00 $6,979.50
Flexible Foam Transmission Line - dielectric, 1 5/8" $24,000.00 $24,000.00 Existing line had been previously abandoned on the tower before returned to use for WTZP. It has been damaged and repaired, but shows a greater line loss and lower efficiency than would be predicted for this type of line. $6,979.50 N/A
Hardware $4,000.00 $4,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
flexline - Dielectric - INV 1935721
Amount:
$6,979.50
Hardware 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 $523,848.88 $515,571.84 N/A $36,621.84 N/A
Total for all systems $906,599.99 $823,413.43 N/A $185,470.58 N/A
Primary Tower GTOWER $523,848.88 $515,571.84 $36,621.84
Tower mapping and report for structural engineer $21,000.00 $15,472.96 Cost determined from submitted quote. $15,472.96 N/A
Major tower reinforcement/modifications $300,000.00 $300,000.00 Anticipating tower analysis will indicate major tower reinforcement required to meet current 2017 Ohio Building Code (2015 IBC) and ANSI/TIA 222-G requirements N/A N/A
Tower Rigging Tall Tower (greater than 500') $157,750.00 $155,000.00 Vendor estimate for rigging tower for removal of old antennas and feedlines and preparation for installation of new equipment. Includes installation of new top pole (reusing beacon), $6,050.00 N/A
Structural Analysis and Mapping $15,098.88 $15,098.88 Cost determined from invoices. $15,098.88 Estimated same as actual
Top Mount Pole $30,000.00 $30,000.00 41' top mount pole and top plate costs to maintain tower height. N/A N/A

Components

Actual Information Description File Name
Tower mapping and report for structural engineer

Component Description:
2nd payment of 2 for ERI
Amount:
$8,090.46

Component Description:
1st payment or 2 for ERI
Amount:
$7,382.50
Major tower reinforcement/modifications Information not provided.
Tower Rigging Tall Tower (greater than 500')

Component Description:
25% down - Rigging - INV 822122-1
Amount:
$6,050.00
Structural Analysis and Mapping

Component Description:
Tower reinforcement analysis - ERI - INV WTZP-38496B-1
Amount:
$7,873.88

Component Description:
1st payment of 2
Amount:
$7,225.00
Top Mount Pole 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 $176,745.80 $150,128.30 N/A $92,404.70 N/A
Total for all systems $906,599.99 $823,413.43 N/A $185,470.58 N/A
Outside Professional Services $176,745.80 $150,128.30 $92,404.70
Comprehensive coverage verification via field study, if needed $52,600.00 $26,125.00 N/A $26,125.00 N/A
Attorney fees- Repack General $3,166.50 $3,166.50 N/A $3,166.50 N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Project management of the transition $50,112.50 $50,000.00 Anticipating hiring TBA company to assume final project design, financial management and reimbursement contact role. $7,561.40 N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $3,232.50 N/A N/A N/A
General Engineering - Repack $5,270.00 $5,270.00 Per actual costs $5,240.00 N/A
Form 399 assistance or other Program Management costs $50,311.80 $50,311.80 Cost determined by invoices $50,311.80 Actual costs submitted

Components

Actual Information Description File Name
Comprehensive coverage verification via field study, if needed

Component Description:
WTZP - QComm - pattern verification - INV 20220855
Amount:
$26,125.00
Attorney fees- Repack General

Component Description:
LEGAL FEES-DISPLACEMENT-BROOKS- INV 4018567
Amount:
$3,166.50
Prepare Form 601 Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition

Component Description:
Jan 2022 PM - QComm - INV 220032
Amount:
$1,694.00

Component Description:
Project Management
Amount:
$1,540.00

Component Description:
Feb 2022 PM - QComm - INV 220046
Amount:
$1,078.00

Component Description:
Dec 2021 PM - QComm - INV 2022017
Amount:
$3,249.40
Perform engineering study for displacement application Information not provided.
Prepare engineering section of 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.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
General Engineering - Repack

Component Description:
Consulting Engineer - Lohnes - INV 202201-1616-01
Amount:
$4,520.00

Component Description:
STA application - Lohnes - INV 202207-1616-01
Amount:
$720.00
Form 399 assistance or other Program Management costs

Component Description:
AUGUST PM- QCOMM INV 20220848 WTZP
Amount:
$8,885.80

Component Description:
Paperwork PM
Amount:
$1,771.00

Component Description:
Reimbursement PM - June 2021
Amount:
$446.60

Component Description:
Tech PM Jan 2021 - QComm - INV QC21-758
Amount:
$3,080.00

Component Description:
June 2022 PM - QComm - INV 20220717
Amount:
$2,525.60

Component Description:
Paperwork PM
Amount:
$646.80

Component Description:
March 2022 PM - QComm INV 20220311
Amount:
$2,564.10

Component Description:
Paperwork PM
Amount:
$1,740.20

Component Description:
Technical assistance PM - QComm - Oct - Dec 2020 - INV QC20-644
Amount:
$1,678.60

Component Description:
April 2022 PM - QComm - INV 20220517
Amount:
$2,325.40

Component Description:
Oct 2021 Tech & 399 PM - QComm - INV 230084
Amount:
$1,632.40

Component Description:
May 2022 PM - QComm - INV 20220620
Amount:
$1,540.00

Component Description:
Paperwork PM
Amount:
$1,247.40

Component Description:
Nov 2021 Tech & 399 PM - QComm - INV 230100
Amount:
$924.00

Component Description:
Reimbursement/Tech PM - May 2021
Amount:
$1,355.20

Component Description:
Reimbursement/Tech PM - Sept 2021
Amount:
$2,541.00

Component Description:
Tech & 399 PM - Aug 2021 - QComm - INV 230032
Amount:
$3,988.60

Component Description:
Paperwork PM
Amount:
$308.00

Component Description:
Paperwork PM
Amount:
$3,742.20

Component Description:
Reimbursement/Technical PM - April 2021
Amount:
$4,519.90

Component Description:
July 2022 Tech & 399 PM - QComm - INV 20220819
Amount:
$2,849.00

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 $12,893.68 $12,893.68 N/A $3,948.68 N/A
Total for all systems $906,599.99 $823,413.43 N/A $185,470.58 N/A
Other Expenses $12,893.68 $12,893.68 $3,948.68
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 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
Disposal Costs (for equipment and other waste, net of any salvage value) $3,000.00 $3,000.00 N/A N/A N/A
Tree Clearing $3,678.68 $3,678.68 Tree clearing necessary to perform the Geotechnical Survey and Foundation Mapping work $3,678.68 N/A
Equipment Delivery and Handling Charges $4,500.00 $4,500.00 N/A N/A N/A
Filing Fees - STA $270.00 $270.00 Per actual costs $270.00 N/A

Components

Actual Information Description File Name
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Tree Clearing

Component Description:
Tree clearing to prepare for geotechnical survey and foundation mapping - ERI - INV 57017
Amount:
$3,678.68
Equipment Delivery and Handling Charges Information not provided.
Filing Fees - STA

Component Description:
EIN is station's EIN - STA application # 0000195580
Amount:
N/A

Component Description:
STA filing fees - FCC - LMS0000195580
Amount:
$270.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $906,599.99 $823,413.43 $185,470.58

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
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.

Charles Jones

Owner


10/04/2022

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.

Charles Jones

Owner


10/04/2022

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