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:
60554
Service:
LPD
Call Sign:
W41DO-D
Channel:
33 (UHF)
File Number:
0000197766
FRN:
0030533806
Eligibility Status:
Eligible
Date Submitted:
11/23/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Major Market Broadcasting of New York Inc.

Ravi Kapur

2383 Pruneridge Avenue

Suite 4

Santa Clara, CA 95050

United States

+1 (415) 886-7284 ravi@chicago22.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

President

QCommunications, LLC

705 SE MELODY LN

STE B

LEES 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. No
Briefly describe transition plan Transitioning from Channel 41 to Channel 33

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 unknown
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 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 TRN-U-3000FA
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3 kW
Justification for New Transmitter Need a 3kw transmitter because they moved from Bloomberg bldg to the Empire State Building which required for the pattern.

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) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 500 kVA
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 5 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 34.0 square feet

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Decomm

Transmitter and antenna decomm and disposal

Transmitter Shipping

Estimated shipping

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? Yes
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
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels 8
Design power capacity in use 61.0 %
Lower Limit 632.00 MHz
Upper Limit 637.00 MHz
ERP: 15.0 kW
Manufacturer
Model custom
Year 2010

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
51441 WKOB-LD

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 Elliptical
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 4
Lower Limit 602.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 51.0 %
ERP: 15.0 kW
Manufacturer
Model UTVC-01-X
Year 2022
Justification for New Antenna Old antenna cannot be tuned to new channel. 2x2 custom panel array

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? Broadband
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? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes
Power Dividers Does the panel antenna require power dividers? Yes
Number of Power Dividers 2
Cable Harness Does the panel antenna require cable harness? Yes
Number of Cable Harnesses 2

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 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 160 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 2
Length 195 feet per run
Justification for New Transmission Line old line not usable for new channel and location
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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 Move Equipment
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? Located on Building
Is this tower currently shared with any other stations? No
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? No
Coordinates (NAD83) Latitude (NAD83) 40° 45' 08.1" N-
Longitude (NAD83) 073° 58' 02.1" W-
Overall Structure Height 903.00 feet
Support Structure Height 903.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 903.00 feet
Structure Type B - Building
Tower Owner 845 United Nations Limited Partners
Date Constructed 11/15/2009


Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Located on Building
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Roofing Waterproofing

Waterproofing of Empire State Building's roof per ESB requirements

Structural Reinforcement

Structural Reinforcement for the 81st Floor of Empire State Building (2 antenna locations)

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 100
Explanation Internal station personnel
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 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 No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

General Legal

General Legal

Outside Engineering Services

Consulting Engineer Services

Special Inspections - welding

Special Inspections for welding

Engineering - Structural

Structural Engineering design for installations

Landmark Building - DOB Doc prep and filing

Empire State Building Landmark - DOB/DOC prep & filing for landmark building commission

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? 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

Name Description

Debris Containers

Debris containers

Empire State Bldg fees

Includes ESB dock fees, parking, tolls, fuel and security at roof access point

New York City DOB Permit Fees

NYC DOB Permit fees

Special Environmental Permits

Environmental permits: NYC Building Department which includes asbestos and other hazard testing.

Vendor Credit card fees

Vendor fees to process station payment for credit cards

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 $288,550.00 $261,523.05 N/A $66,450.00 N/A
Total for all systems $716,703.33 $699,408.38 N/A $121,971.45 N/A
Primary Transmitter TRN-U-3000FA $288,550.00 $261,523.05 $66,450.00
Transmitter Shipping $4,800.00 $4,800.00 Estimated shipping. Actual costs TBD $0.00 N/A
Transmitter Decomm $66,450.00 $66,450.00 Per actual costs - Advent Industrial $66,450.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $47,273.05 Per Advent Industrial Quote for turnkey project for site prep and transmitter install N/A N/A
Other -- Building Addition Size: 34.0 $0.00 $0.00 N/A N/A N/A
Other -- HVAC Service Type: H Size:5 (Other) $0.00 $0.00 N/A N/A N/A
Transformer 3 phase/480v - 500 KVA $48,400.00 $45,000.00 Per Advent Industrial Turnkey Proposal N/A N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $106,300.00 $98,000.00 Per Anywave quote $0.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $0.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Transmitter Shipping

Component Description:
Shipping costs - Anywave - INV FA2208-1496
Amount:
$4,800.00
Transmitter Decomm

Component Description:
decomm and disposal of old transmitter and antenna
Amount:
$66,450.00
Transmitter Building Site Survey/Installation Information not provided.
Other -- Building Addition Size: 34.0 Information not provided.
Other -- HVAC Service Type: H Size:5 (Other) Information not provided.
Transformer 3 phase/480v - 500 KVA Information not provided.
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Transmitter - Anywave - INV FA2208-1496
Amount:
$98,000.00
Service entrance 3 phase/800 amp/208 volt Information not provided.
Switchgear - industrial 800 amp Information not provided.

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 $41,216.05 $50,616.05 N/A $21,261.05 N/A
Total for all systems $716,703.33 $699,408.38 N/A $121,971.45 N/A
Primary Antenna UTVC-01-X $41,216.05 $50,616.05 $21,261.05
Side Mount antenna brackets $4,625.00 $4,625.00 N/A N/A N/A
Cable harness (each, for panel antenna system, if not included in antenna cost) $2,000.00 $4,000.00 Actual costs TBD N/A N/A
Power Dividers (each, for panel antenna system, if not included in antenna cost) $2,600.00 $10,000.00 actual costs TBD $0.00 N/A
Pattern scatter analysis for side mount (if not included in antenna base cost) $5,000.00 $5,000.00 Actual costs TBD N/A N/A
UHF-Low Power, Side Mount, Broadband Panel, 4 bay, 15.0kW input, Elliptical $21,261.05 $21,261.05 Actual costs TBD $21,261.05 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A

Components

Actual Information Description File Name
Side Mount antenna brackets Information not provided.
Cable harness (each, for panel antenna system, if not included in antenna cost) Information not provided.
Power Dividers (each, for panel antenna system, if not included in antenna cost)

Component Description:
10/12/22 Zeroed out. Captured under another cost component. Power dividers for antenna - Kathrein - INV 4370
Amount:
N/A
Pattern scatter analysis for side mount (if not included in antenna base cost) Information not provided.
UHF-Low Power, Side Mount, Broadband Panel, 4 bay, 15.0kW input, Elliptical

Component Description:
HPOL equiv antenna - Kathrein - INV 4370
Amount:
$21,261.05
Sweep test of transmission line and antenna 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 $19,360.00 $19,692.00 N/A $9,692.00 N/A
Total for all systems $716,703.33 $699,408.38 N/A $121,971.45 N/A
Primary Transmission Line $19,360.00 $19,692.00 $9,692.00
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $10,000.00 $10,000.00 Actual costs TBD N/A N/A
Flexible Foam Transmission Line - dielectric, 1 5/8" $9,360.00 $9,692.00 Action costs Per Kathrein invoice 4370 $9,692.00 N/A

Components

Actual Information Description File Name
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators Information not provided.
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
transmission line - Kathrein INV 4370
Amount:
$9,692.00

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 $200,592.20 $200,592.20 N/A $0.00 N/A
Total for all systems $716,703.33 $699,408.38 N/A $121,971.45 N/A
Primary Tower B $200,592.20 $200,592.20 $0.00
Structural Reinforcement $18,500.00 $18,500.00 Structural reinforcement on 81st floor of Empire State Building - 2 antenna locations N/A N/A
Roofing Waterproofing $25,000.00 $25,000.00 Roof Waterproofing per Empire State Building requirements N/A N/A
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $157,092.20 $157,092.20 Includes line and (2) antenna installations along with associated rigging costs $0.00 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 $109,708.25 $109,708.25 N/A $14,357.25 N/A
Total for all systems $716,703.33 $699,408.38 N/A $121,971.45 N/A
Outside Professional Services $109,708.25 $109,708.25 $14,357.25
Landmark Building - DOB Doc prep and filing $24,700.00 $24,700.00 Costs to prepare landmark building commission documents to adhere to regulations for Empire State Building N/A N/A
Outside Engineering Services $9,450.00 $9,450.00 costs per actual invoices $4,250.00 N/A
General Legal $23,485.75 $23,485.75 Actual costs per invoices $5,641.25 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
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 engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 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
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Form 399 assistance or other Program Management costs $10,000.00 $10,000.00 N/A $4,466.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Project management of the transition $10,550.00 $10,550.00 N/A N/A N/A
Special Inspections - welding $4,500.00 $4,500.00 Advent Industrial quote - special welding inspections N/A N/A
Engineering - Structural $15,000.00 $15,000.00 Structural engineering for Empire State Building N/A N/A

Components

Actual Information Description File Name
Landmark Building - DOB Doc prep and filing Information not provided.
Outside Engineering Services

Component Description:
Engineering - Smith and Fisher - INV 7648
Amount:
$1,750.00

Component Description:
Consulting Engineer - Smith and Fisher - INV 7640
Amount:
$2,500.00

Component Description:
Engineering - Tech Assurance Labs - INV 1490
Amount:
$2,925.00

Component Description:
Smith & Fisher - Engineering - INV 7648
Amount:
$1,750.00

Component Description:
engineering - Ben Pidek - INV 2207-1006
Amount:
$525.00
General Legal

Component Description:
Legal - TLP - INV 2929
Amount:
$3,658.00

Component Description:
Legal - TLP Inv 2848
Amount:
$1,612.00

Component Description:
March 2022 Legal - Baker - INV 51001380
Amount:
$371.25

Component Description:
Legal - TLP - INV 2702
Amount:
$17,844.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare Form 601 Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for displacement application Information not provided.
Form 399 assistance or other Program Management costs

Component Description:
April 2022 PM - QComm - INV 20220513
Amount:
$154.00

Component Description:
August 2022 through closeout - QComm - INV 20220838
Amount:
$3,357.20

Component Description:
July 2022 PM - QComm - INV 20220812
Amount:
$184.80

Component Description:
May 2022 PM - QComm - INV 20220616
Amount:
$770.00
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition Information not provided.
Special Inspections - welding Information not provided.
Engineering - Structural 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 $57,276.83 $57,276.83 N/A $10,211.15 N/A
Total for all systems $716,703.33 $699,408.38 N/A $121,971.45 N/A
Other Expenses $57,276.83 $57,276.83 $10,211.15
Equipment Storage $400.00 $400.00 Actual costs TBD $400.00 N/A
Equipment Delivery and Handling Charges $9,811.15 $9,811.15 Actual costs TBD $9,811.15 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,500.00 $2,500.00 Actual costs TBD N/A N/A
Vendor Credit card fees $1,595.93 $1,595.93 Per actual costs $0.00 N/A
Special Environmental Permits $4,000.00 $4,000.00 Environmental permits and testing per the NYC Building Department regulations N/A N/A
New York City DOB Permit Fees $11,024.75 $11,024.75 New York City Department of Buildings (DOB) permit fees per Advent Industrial turnkey proposal N/A N/A
Empire State Bldg fees $9,000.00 $9,000.00 Empire State building fees including dock fees, parking, tolls, fuel and security guard at Empire State Building roof access point N/A N/A
Debris Containers $17,500.00 $17,500.00 Per Advent Industrial turnkey proposal N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A

Components

Actual Information Description File Name
Equipment Storage

Component Description:
Storage fees for August 2022 - Chapman - INV Q3415
Amount:
$200.00

Component Description:
July 2022 storage - Chapman - INV Q3383
Amount:
$200.00
Equipment Delivery and Handling Charges

Component Description:
move equipment from old facility
Amount:
$361.15

Component Description:
Shipping - Kathrein - INV 4370
Amount:
$9,450.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Vendor Credit card fees

Component Description:
10/27/22 Zeroed out. Kathrein CC fees - INV 4370
Amount:
N/A
Special Environmental Permits Information not provided.
New York City DOB Permit Fees Information not provided.
Empire State Bldg fees Information not provided.
Debris Containers Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $716,703.33 $699,408.38 $121,971.45

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.

Ravi Kapur

President


11/23/2022

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.

Ravi Kapur

President


11/23/2022

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