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:
8156
Service:
DTV
Call Sign:
WUJA
Channel:
24 (UHF)
File Number:
0000024878
FRN:
0005412069
Date Submitted:
03/27/2023

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CAGUAS EDUCATIONAL TV, INC.

Doing Business As: CAGUAS EDUCATIONAL TV, INC.

JOSUE SALGADO

PO Box 00982

SABANA ABAJO INDUSTRIAL PARK

CAROLINA, PR 00982

United States

+1 (787) 750-4090 JOSUESAL@YAHOO.COM Private Not-for-Profit Educational Institution

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

Alejandro Luciano , PE .

ALEJANDRO LUCIANO PE

Alejandro Luciano PE

PO Box 194528

SAN JUAN, PR 00919

United States

+1 (787) 717-6984 aluciano@aluciano.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 File for CP as needed, Perform Towers Structural Study, modify tower, file for STA, relocate existing main antenna, install new transmitter, transmission line and antenna, broadcast channel change notifications, notify cable, final antenna sweep and tests

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 A3.0KST8U
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 3.0 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? Yes
Manufacturer
Model UAXTE-12R44
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 7.2 kW
Justification for New Transmitter According to the present transmitter manufacturer, It is not cost effective to re-tune the existing transmitter to the new channel. WUJA IS RESPONSIBLE FOR THE PRICE DIFFERENCE BETWEEN ALREADY VERIFIED 3.0KW TRANSMITTER AND THE PROPOSED 7.2 kW TX.

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 Yes
Size 2 inches
Length 40.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 120.0 square feet
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

Name Description

Internal RF Components

Internal RF components needed to complete the transmitter installation .

Additional Electrical Components

Main Breaker, Transmitter Room wall disconnect, and electric wiring

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model UAXTE-1R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity .6 kW
Justification for New Transmitter Due to room dimensions it is unlikely to install a new ch. 24 transmitter with the existing ch. 48 transmitter in the room. A new small interim transmitter is needed to remain on the air while the existing is removed to create space for the ch.24

Interim 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 Yes
Description AC wiring service from main panel including circuit breaker.
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
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim 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: 50.0 kW
Manufacturer
Model ALP16L6-HSW-48
Year 2008

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? Yes
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 Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
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: 100.0 kW
Manufacturer
Model TLP-24W/VP-R (SP)
Year 2018
Justification for New Antenna According to the existing antenna manufacturer, retuning the existing antenna from channel 48 to channel 24 is not feasible.

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? 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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
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 Type Class Full Power
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: 5.0 kW
Manufacturer
Model 750 10402
Year 2018
Justification for New Antenna WUJA need an Interim Antenna and transmission line to transition to the new channel while construction of a replacement tower is completed.

Interim Antenna

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Other Antenna Costs

Section Question Response
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 an 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

Interim 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)
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
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 200 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 200 feet per run
Justification for New Transmission Line The existing transmission line and antenna will be relocated and used with an interim transmitter to remain on the air while the existing is removed, tower modifications, new ch. 24 antenna, transmission line and transmitter installations are finalized.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Foam
Diameter 1 5/8 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 150 feet per run
Justification for New Transmission Line WUJA need an interim transmission line to transition to the new channel using interim facilities while construction of a new tower is completed.

Interim 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 Construct New
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
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? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 18° 16' 40.83" N-
Longitude (NAD83) 066° 06' 31.6" W-
Overall Structure Height 120.00 feet
Support Structure Height 120.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 501.10 feet
Structure Type UTOWER - Unguyed - Free Standing Tower
Tower Owner CAGUAS EDUCATIONAL TV INC.
Date Constructed 07/24/1985


Primary Tower

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Tower Construction Costs

Section Question Response
Construct New Tower Use Primary (Main)
Description of Use N/A
Is this a request for upgraded equipment? No
Height 140.00 feet
Justification for New Tower See Attached Justifications document for New Tower .

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

Dissmantling of Old Tower

Dismantling of old tower as required by the new tower local construction permit.

Change Order

Change order for tower construction due to materials and labor increases.

Tower Installation Supervision

Tower Installation resident supervisor is required by the local construction permits office,OGPE

Tower Mapping New Tower

Tower Mapping for WUJA New documented tower.

Tower Mapping Old Tower

Tower mapping for WUJA old undocumented tower.

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 1200
Explanation Due to extreme budget constrains TV Station WUJA does not have the necessary technical staff to perform the repack project management services.
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Quarterly Progress Reports.

Quarterly Progress Report Preparation.

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 Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
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
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

Name Description

Local Service Tax

Local Service Tax 4.0 percent

Employees Time

Station Employees Time Dedicated to Repack Functions

Local Sales Tax

Local Goods Tax 11.5 percent

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 $304,342.64 $289,389.62 N/A $256,969.58 N/A
Total for all systems $1,612,090.04 $1,417,106.37 N/A $1,191,381.86 N/A
Interim Transmitter UAXTE-1R37 $34,857.02 $34,857.02 $34,857.02
Other Electrical Service: AC wiring service from main panel including circuit breaker. $0.00 $0.00 Included in Main and Auxiliary transmitters electric installation. N/A N/A
UHF - Air Cooled Solid State Transmitter .6 kW $34,857.02 $34,857.02 See Attached RGB Broadcast Services proposal HMDRQ3065 $34,857.02 N/A
Primary Transmitter UAXTE-12R44 $269,485.62 $254,532.60 $222,112.56
Additional Electrical Components $6,990.00 $6,990.00 See uploaded quotation, from Word Interiors Quote Number WI103020WUJA, for transmitters electric installation. $6,990.00 N/A
Internal RF Components $3,731.07 $3,731.07 Please see uploaded WUJA additional RF Components quote HMDRQ3841 fro RGB Broadcast Services Corp. $3,731.07 N/A
Other -- Building Addition Size: 120.0 $15,000.00 $15,000.00 See uploaded World Interiors Building addition proposal WI083020WUJA. $15,000.00 N/A
5 Ton system $20,250.00 $6,336.98 See Uploaded 5 tons AC unit quote. Quote # 0000948 $6,336.98 N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,040.00 $0.00 Included in Main transmitters electric installation. N/A N/A
UHF - Air Cooled Solid State Transmitter 7.2 kW $220,460.12 $220,460.12 See Attached RGB Broadcast Services proposal HMDRQ3063. THIS IS AN UPGRADE. WUJA IS RESPONSIBLE FOR THE PRICE DIFFERENCE BETWEEN THE ALREADY VERIFIED FUNDS AND THE COST OF THIS TRANSMITTER. $188,040.08 N/A
Other Electrical Service: VOLTAGE REGULATOR, LINE CONDITIONER/SURGE PROTECTION AND UPS ARE NEEDED FOR THE NEW TRANSMITTER INSTALLATION. $2,014.43 $2,014.43 ***System Notice: Estimate adjusted and locked because line has been superseded.***See Uploaded UPS Proposal. RGB Broadcast Services Corp. Quote Number HMDRQ3344 $2,014.43 N/A

Components

Actual Information Description File Name
Other Electrical Service: AC wiring service from main panel including circuit breaker. Information not provided.
UHF - Air Cooled Solid State Transmitter .6 kW

Component Description:
WUJA Interim transmitter, See WUJA Interim Transmitter Invoice Explanation Cover Letter, Invoice and Verified proposal document
Amount:
$34,857.02
Additional Electrical Components

Component Description:
WUJA transmitters electric installation.
Amount:
$6,990.00
Internal RF Components

Component Description:
Reimbursement request for WUJA transmitter Internal RF components to complete the main antenna installation.
Amount:
$3,731.07
Other -- Building Addition Size: 120.0

Component Description:
WUJA Building addition reimbursement request.
Amount:
$15,000.00
5 Ton system

Component Description:
WUJA TX Room 5 tons ac unit. invoice Number 3251-PMFCC
Amount:
$6,336.98
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 7.2 kW

Component Description:
See Attached Document: WUJA Explanation Cover Letter Baseline Proposal and Transmitter Invoice.
Amount:
$188,040.08
Other Electrical Service: VOLTAGE REGULATOR, LINE CONDITIONER/SURGE PROTECTION AND UPS ARE NEEDED FOR THE NEW TRANSMITTER INSTALLATION.

Component Description:
See Explanation Cover Letter Included with Transmitter Invoice Document.
Amount:
$2,014.43

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 $151,504.00 $67,771.00 N/A $62,571.00 N/A
Total for all systems $1,612,090.04 $1,417,106.37 N/A $1,191,381.86 N/A
Interim Antenna 750 10402 $13,264.00 $9,034.00 $9,034.00
Sweep test of existing antenna $6,730.00 $2,500.00 See quote from Alejandro Luciano P.E. for the auxilliary antenna sweep. Quote number WUJA-220815-AS. $2,500.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 5 kW input, directional,, horizontally polarized $6,534.00 $6,534.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***See Attached Kathrein Quote Number 20180358-1 $6,534.00 N/A
Primary Antenna TLP-24W/VP-R (SP) $138,240.00 $58,737.00 $53,537.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,200.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $10,615.00 See attached Dielectric Proposal 800097CMZ line 2 $10,615.00 N/A
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized $103,100.00 $36,522.00 See Attached Dielectric Quote 800097CMZ Line 1 Minus the VPOL Price Contribution To The Net Price. $ 45,301.00 - $8779.00 VPOL Price Contribution = $36,522.00 $36,522.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Alejandro Luciano P.E. reimbursement request for WUJA auxiliary facilities antenna system sweep. Invoice 1293 line 12.
Amount:
$2,500.00
UHF - High Power, Side Mount, basic slot antenna, 5 kW input, directional,, horizontally polarized

Component Description:
WUJA Interim Antenna, Kathrein USA, Invoice Number 181710
Amount:
$6,534.00
Sweep test of existing antenna

Component Description:
Main Antenna Sweep 2nd 50% Reimbursement Request. WUJA Main.
Amount:
$3,200.00

Component Description:
WUJA Main Antenna Repack Sweep 50% Reimbursement request. Dielectric Invoice MAN00723 Line 30
Amount:
$3,200.00

Component Description:
WUJA Main Antenna 2nd 50% reimbursement request, Invoice 1696407 line 21 REPACK SWEEP.
Amount:
$3,200.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
WUJA Main Antenna 2nd 50% Reimbursement Request. Invoice 1696407 Line 3 Custom Antenna Brackets.
Amount:
$5,307.50

Component Description:
Main Antenna 2nd 50% Custom Brackets Reimbursement Request. WUJA Main Antenna.
Amount:
$5,307.50

Component Description:
WUJA Main Antenna Mounting Brackets 50% Reimbursement Request. Dielectric Invoice MAN00723 Line 3
Amount:
$5,307.50
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized

Component Description:
50% Reimbursement Request on WUJA Main Antenna. Invoice MAN00723 Item 1
Amount:
$18,261.00

Component Description:
Main Antenna 2nd 50% Reimbursement Request. Invoice Line 1
Amount:
$18,261.00

Component Description:
WUJA Main Antenna 2nd 50% reimbursement request, Invoice 1696407 Line 1 Antenna UHF Side Mount
Amount:
$18,261.00

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 $15,400.00 $15,888.07 N/A $15,888.07 N/A
Total for all systems $1,612,090.04 $1,417,106.37 N/A $1,191,381.86 N/A
Interim Transmission Line $3,600.00 $2,920.01 $2,920.01
Flexible Foam Transmission Line - dielectric, 1 5/8" $3,600.00 $2,920.01 See Attached RGB Broadcast Corporation Proposal HMDRQ3095 $2,920.01 N/A
Primary Transmission Line $11,800.00 $12,968.06 $12,968.06
Flexible Air Transmission Line - dielectric, 3" $11,800.00 $12,968.06 See Attached Dielectric Invoice 800097CMZ Items 4-19. $12,968.06 N/A

Components

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

Component Description:
Interim Transmission Line RGB Broadcast Services Corp. Invoice HMDRQ3095
Amount:
$2,920.01
Flexible Air Transmission Line - dielectric, 3"

Component Description:
Main Transmission Line 2nd 50% Reimbursement Request
Amount:
$6,484.03

Component Description:
WUJA Main Antenna 2nd 50% reimbursement request. Invoice 1696409 line 4, FLEXIBLE TRANSMISSION LINE.
Amount:
$6,484.03

Component Description:
WUJA Main Flexible Transmission Line and Related Components 50% Reimbursement Request. Dielectric Invoice MAN00723 Lines 4 thru 7, 10, 11, 13-20, 27-29 and 31
Amount:
$6,484.03

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 $574,370.00 $524,143.00 N/A $520,905.50 N/A
Total for all systems $1,612,090.04 $1,417,106.37 N/A $1,191,381.86 N/A
Primary Tower UTOWER $0.00 $0.00 $0.00
Primary Tower $574,370.00 $524,143.00 $520,905.50
Short Tower (less than 500') $84,200.00 $33,973.00 See Attached Sabre Tower Proposal 19-0572-TAB-R2. ITEM IV and V, Antenna and Line Installation and Bridge. and CR Tower services quote WUJA-0305 for the antenna and inside building final works. $33,973.00 N/A
Change Order $81,425.00 $81,425.00 See uploaded quote from Sabre Industries for WUJA tower construction cost increase. Quote number 19-0572-TAB-R2 Additional Install Cost. and additional work quote from Dinamic Wireless. Quote Number 20230111101 $81,425.00 N/A
Tower Mapping Old Tower $2,800.00 $2,800.00 See Attached invoice 1192 for WUJA old tower mapping for structural study. Structural study resuilts indicated that tower replacement was needed and the repack administrator verified the funds for a new tower. $2,800.00 N/A
Tower Mapping New Tower $3,500.00 $3,500.00 Estimated tower mapping documents preparation for WUJA new Repack verified tower. $1,462.50 N/A
Dissmantling of Old Tower $47,500.00 $47,500.00 See quote from Dynamic Wireless for the removal on the old WUJA tower. $47,500.00 N/A
New tower $249,945.00 $249,945.00 See Attached Sabre Tower Proposal 19-0572-TAB-R2. Items I, II and III. $249,945.00 N/A
Tower Installation Supervision $105,000.00 $105,000.00 Estimated Tower installation resident supervisor cost. $103,800.00 N/A

Components

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

Component Description:
Reimbursement request for the final antenna and inside building works.
Amount:
$7,020.00

Component Description:
WUJA-TV Tower Request for Reimbursement. Sabre Industries Invoice 422588B Items II and V. Proposal Items IV and V..
Amount:
$26,953.00
Change Order

Component Description:
Reimbursement request for additional tower work neede to complete the tower and antenna installation
Amount:
$7,675.00

Component Description:
WUJA Tower Installation cost change order reimbursement request.
Amount:
$73,750.00

Component Description:
Increased construction costs for WUJA tower.
Amount:
$73,750.00
Tower Mapping Old Tower

Component Description:
Tower Mapping of Old WUJA tower for Structural Study.
Amount:
$2,800.00
Tower Mapping New Tower

Component Description:
WUJA new tower mapping preparation by Alejandro Luciano. Invoice 1281 line 1
Amount:
$1,462.50
Dissmantling of Old Tower

Component Description:
Invoice from Dynamic Wireless Solutions for the removal of the old WUJA tower. Invoice Number 20220833101
Amount:
$47,500.00
New tower

Component Description:
WUJA-TV Tower Request for Reimbursement. Sabre Industries Invoice 422588B Items 1, III, IV. Proposal Items I, II, III.
Amount:
$249,945.00
Tower Installation Supervision

Component Description:
Reimbursement request from Eng. Alfredo Luciano, for the WUJA Tower System Installation resident inspector service. Invoice 2023-0228
Amount:
$9,200.00

Component Description:
Reimbursement request from Eng. Alfredo Luciano, for the WUJA Tower System Installation resident inspector service. Invoice 2023-0131.
Amount:
$8,080.00

Component Description:
Reimbursement request on WUJA Tower System Installation Project Resident Inspector Service Invoice 2022-1230.
Amount:
$6,160.00

Component Description:
Alfredo Luciano reimbursement request for resident inspector for WUJA tower system installation. Invoice No. 2022-1130.
Amount:
$6,160.00

Component Description:
Eng. Alfredo Luciano invoice 2022-0906 for the resident supervision of the installation of the WUJA tower.
Amount:
$5,840.00

Component Description:
Eng. Alfredo Luciano WUJA Tower Installation Resident Inspector Service Invoice 2022-1014 reimbursement request.
Amount:
$7,560.00

Component Description:
WUJA Tower Installation Resident Inspector Service. Invoice Number 2022-1021
Amount:
$8,760.00

Component Description:
Eng. Alfredo Luciano WUJA Tower Installation Resident Inspector Service Invoice 2022-1111 reimbursement request.
Amount:
$10,800.00

Component Description:
Eng. Alfredo Luciano Invoice 2022-0831b for the installation of the WUJA tower.
Amount:
$10,960.00

Component Description:
Eng. Alfredo Luciano WUJA Tower Installation Resident Inspector Service Invoice 2022-1028 reimbursement request.
Amount:
$4,760.00

Component Description:
Eng. Alfredo Luciano WUJA Tower Installation Resident Inspector Service Invoice 2022-1007
Amount:
$6,360.00

Component Description:
WUJA tower Installation resident inspector invoice 2022-0909.
Amount:
$4,120.00

Component Description:
WUJA Tower Installation resident inspector invoice 2022-0930 reimbursement request.
Amount:
$7,160.00

Component Description:
WUJA Tower installation resident inspector invoice 2022-0916.
Amount:
$7,880.00

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 $347,290.00 $309,234.28 N/A $222,993.78 N/A
Total for all systems $1,612,090.04 $1,417,106.37 N/A $1,191,381.86 N/A
Outside Professional Services $347,290.00 $309,234.28 $222,993.78
Quarterly Progress Reports. $6,000.00 $6,000.00 Estimated amount for the preparation of the quarterly repack progress reports $5,025.00 N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $60,929.28 Please see uploaded Comprehensive Coverage verification quote from QCommunications, LLC. Quote# 863C. WUJA Facility ID: 8156 $45,481.28 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A $1,250.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,662.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,493.75 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,580.00 N/A $1,562.50 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,050.00 N/A $2,000.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A 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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 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 N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $1,500.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,100.00 N/A $2,081.25 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $6,825.00 Two different application were prepared to optimize the WUJA facilities $6,825.00 Two application were needed to optimize WUJA facilities.
Project management of the transition $189,600.00 $175,000.00 N/A $153,112.50 N/A

Components

Actual Information Description File Name
Quarterly Progress Reports.

Component Description:
Reimbursement request from Alejandro Luciano P.E. for the WUJA Quarterly Progress reports preparation. Invoice 1315 Line 3.
Amount:
$500.00

Component Description:
Transition Progress Report for TV Station WUJA-TV
Amount:
$2,000.00

Component Description:
Quarterly Progress report by Alejandro Luciano P.E. reimbursement request. Invoice 1284 lines 1,2,3,4,5.
Amount:
$1,125.00

Component Description:
Continued Transition Progress Report for WUJA.
Amount:
$1,400.00
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
WUJA reimbursement request on QCommunications coverage and antenna pattern verification.
Amount:
$45,481.28
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
Alejandro Luciano PE Invoice 1284 line 7, Prepare Frorm 2100 License to cover for WUJA aux facility.
Amount:
$1,250.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Invoice 1193 WUJA Antenna Development for new channel.
Amount:
$1,662.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
WUJA Form 399 preparation.
Amount:
$2,493.75
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Reimbursement request from Alejandro Luciano P.E. for the preparation of the WUJA License to cover application. Invoice 1315 Line 2.
Amount:
$1,562.50
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase

Component Description:
WUJA FAA Form 7460 Research, Preparation and Filling.
Amount:
$2,000.00
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Prepare Special Temporary Authorization Application for WUJA-TV
Amount:
$1,500.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Preparation of WUJA Aux antenna application. Invoice 1285 line 6
Amount:
$2,081.25
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Invoice 1194. TV Station WUJA FCC Engineering Form 2100 preparation for main construction permit.
Amount:
$2,887.50

Component Description:
Alejandro Luciano P.E. reimbursement request for a minor change for WUJA. Invoice 1293 line 13.
Amount:
$3,937.50
Project management of the transition

Component Description:
Reimbursement request from Alejandro Luciano P.E. for the WUJA Repack management services. Invoice 1315 Line 1.
Amount:
$4,250.00

Component Description:
Invoice no. 1305 form Alejandro Luciano P.E. for the WUJA Repack Management Services
Amount:
$12,562.50

Component Description:
Invoice no. 1306 form Alejandro Luciano P.E. for the WUJA Repack Management Services
Amount:
$6,062.50

Component Description:
Alejandro Luciano P.E. invoice for WUJA Repack management services. Invoice number 1286
Amount:
$6,581.25

Component Description:
Invoice 1181 for Project Management of the transition of WUJA.
Amount:
$4,950.00

Component Description:
Alejandro Luciano P.E. reimbursement request for the WUJA repack management. Invoice Number 1303
Amount:
$10,625.00

Component Description:
Alejandro Luciano P.E. Invoice for WUJA Repack Management Services. Invoice number 1296
Amount:
$7,375.00

Component Description:
Alejandro Luciano P.E. repack management invoice for WUJA. Invoice number 1288
Amount:
$21,062.50

Component Description:
Repack Management services Invoice
Amount:
$12,400.00

Component Description:
Reimbursement request for the WUJA Repack management services by Alejandro Luciano P.E. Invoice number 1314.
Amount:
$11,125.00

Component Description:
Repack management services by Alejandro Luciano P.E. Invoice 1281 lines 2,3
Amount:
$1,237.50

Component Description:
Alejandro Luciano P.E. WUJA Repack Management invoice reimbursement request. Invoice number 1280. Rev1
Amount:
$16,312.50

Component Description:
Alejandro Luciano P.E. WUJA Repack Management invoice. Invoice number 1282.
Amount:
$11,368.75

Component Description:
Alejandro Luciano Invoice for WUJA Repack management services. Invoice number 1287.
Amount:
$7,200.00

Component Description:
Alejandro Luciano P.E. WUJA repack management reimbursement request. Invoice 1293 Lines 1-11
Amount:
$20,000.00

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 $219,183.40 $210,680.40 N/A $112,053.93 N/A
Total for all systems $1,612,090.04 $1,417,106.37 N/A $1,191,381.86 N/A
Other Expenses $219,183.40 $210,680.40 $112,053.93
Local Sales Tax $59,790.80 $59,790.80 Estimated State and City Sales on goods, Tax = 11.5%. All equipment purchases for the channel repack are locally taxable at a rate of 11.5% of the actual cost. See Attached Worksheet. $36,803.42 N/A
Employees Time $36,005.20 $36,005.20 Estimated amount for station personnel repack dedicated time. See Attached Worksheet N/A N/A
Local Service Tax $22,241.20 $22,241.20 Estimated State Service Tax 4% of services provided by locals. $1,363.75 N/A
MVPD Notification of Channel Change $316.20 $316.20 See attached WUJA MVPD proposal document. $316.20 N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 Based on previous experience during the analog to digital transition. N/A N/A
Equipment Storage $10,250.00 $10,250.00 Based on previous experience during the analog to digital transition. $6,300.00 N/A
Equipment Delivery and Handling Charges $55,000.00 $55,000.00 Up to today the Equipment Delivery and Handling Charges totalize $41,328.56, at the end of the repack it is expected to totalize close to $55,000.00. Therefore an allocation of $55,000.00 is requested $45,528.56 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $4,500.00 $4,500.00 Based on previous experience during the analog to digital transition. N/A N/A
Local Zoning $19,000.00 $19,000.00 Estimated engineeering fees for WUJA tower application for construction permit. $18,680.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $3,062.00 See Attached WUJA Medical Proposal document. $3,062.00 N/A

Components

Actual Information Description File Name
Local Sales Tax

Component Description:
Sales Tax on Baseline transmitter. See Explanation Cover Letter
Amount:
$22,454.27

Component Description:
Reimbursement request on WUJA Tower import taxes.
Amount:
$9,412.41

Component Description:
Sales Tax on Interim Transmission LIne Invoice RGB Broadcast Services Corp. Invoice HMDRQ3095
Amount:
$410.68

Component Description:
11.5% Merchandises Local Sales Tax.
Amount:
$4,526.06
Employees Time Information not provided.
Local Service Tax

Component Description:
4% Local Sales tax on invoice 1181
Amount:
$198.00

Component Description:
4% Services Local Sales Tax
Amount:
$115.50

Component Description:
4% Sales tax on Invoice 1193
Amount:
$66.50

Component Description:
4% Service Sales tax on Invoice 1192
Amount:
$112.00

Component Description:
Repack Management services 4% local services tax.
Amount:
$496.00

Component Description:
4% Local Service Tax on Invoice 1230
Amount:
$136.00

Component Description:
4% Sales tax on Invoice 1204
Amount:
$140.00

Component Description:
4% Local Sales Tax on invoice 1191
Amount:
$99.75
MVPD Notification of Channel Change

Component Description:
WUJA MVPD Notification DTVNotification invoice INV-001809
Amount:
$316.20
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
WUJA tower and antena storage reimbursement request. Item: Warehouse Handling and Storage Services.
Amount:
$6,300.00
Equipment Delivery and Handling Charges

Component Description:
Reimbursement request for additional freight charges on WUJA Tower shippment.
Amount:
$18,665.00

Component Description:
Transportation charges on WUJA Interim Transmission LIne. RGB Broadcast Services Corp. Invoice HMDRQ3095
Amount:
$651.15

Component Description:
WUJA-TV Tower Request for Reimbursement. Sabre Industries Invoice 422588B Freight. Proposal Items VI-A and VI-B.
Amount:
$12,312.41

Component Description:
Shipping Charges on Baseline Transmitter. See Explanation in Cover Letter.
Amount:
$5,200.00

Component Description:
WUJA tower, and antena delivery to site reimbursement request. Item: Warehouse Handling Out & Delivery to Channel 58 in Aguas Buenas.
Amount:
$4,200.00

Component Description:
Transportation Charges on Invoice HMDRQ3065
Amount:
$4,500.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Local Zoning

Component Description:
Final Works for the WUJA Tower construction local permit application preparation and filing.
Amount:
$5,400.00

Component Description:
Reimbursement request for the preparation of WUJA tower construction local goverment permit application.
Amount:
$13,280.00
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
WUJA Medical Notifications. DTVNotification Invoice Number INV-001812
Amount:
$3,062.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,612,090.04 $1,417,106.37 $1,191,381.86

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.

Alejandro Luciano , P.E. .

Repack Project Manager


03/27/2023

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.

Alejandro Luciano , P.E. .

Repack Project Manager


03/27/2023

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.

Alejandro Luciano , P.E. .

Repack Project Manager


03/27/2023

Attachments

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