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:
Service:
DRT
Call Sign:
KGO-TV
Channel:
12 (High VHF)
File Number:
0000026889
FRN:
0003471331
Date Submitted:
04/20/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KGO TELEVISION, INC.

Doing Business As: KGO TELEVISION, INC.

77 WEST 66TH STREET, 16TH FLR

ATTN: JOHN W. ZUCKER, ESQ.

NEW YORK, NY 10023

United States

+1 (212) 456-7777 john.w.zucker@abc.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

The Preparer is same as the reimbursement contact.

 

 

 

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 KGO is being moved from channel 7 to channel 12. The plan is to bring up the new aux antenna on channel 7 and operate via the aux during the swap of the main antenna. We will then transition to channel 12 on the new main antenna. See Plan attached.

Transmitters

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Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup
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 Platinum I
Year 2008
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 16.6 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model VAX24TE
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 19.2 kW
Justification for New Transmitter The existing aux transmitter is a channel 7 specific solid state transmitter that can't be re-tuned

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 50 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 1500.0 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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

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Add 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 Platinum I
Year 2008
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 16.6 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 VAX24TE
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 19.2 kW
Justification for New Transmitter Current Transmitter is a channel 7 specific solid state transmitter and cannot be re-tuned

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 50 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 1500.0 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

Paint

Paint

Demo

HVAC Ductwork removal

KGO Site Survey

Gates Air Basic Site Survey

Electrical

General Electrical work

Project Managment

P&O, General Conditions, Onsite Supervision

FireStop

Fire safety Requirement

Seismic

Earthquake Safety Code

Ductwork Scaffold

HVAC Ductwork Removal

Abatement

Asbestos Removal

Hygienist

Worker Safety

Transmitter De-Install

Remove (2) Platinum Transmitters model PTCD40P4

Antennas

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

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Backup antenna
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? Yes
Existing Antenna Manufacturer and Type Class Class A
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
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 Custom
ERP: 72.0 kW
Manufacturer
Model THV-5A7-C170
Year 2008

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Backup Antenna
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 8
Lower Limit 174.00 MHz
Upper Limit 216.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 23.8 kW
Manufacturer
Model Custom
Year 2018
Justification for New Antenna Needed to support new channel assignment.

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported Upper and lower frequency
Frequency 174.0 MHz - 216.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? Yes
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 8 3/16 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

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

RF Testing Of Line

Testing cost of the new line

Removal of existing antenna

Estimated cost to remove current aux antenna

Core Drill Holes

(3)

Fill Holes

(1) Floor and Wall

Install and Test Combiner

Install and Test Aux Combiner

Custom Pipe Mount

Fabrication

New Aux antenna installation

Installation cost for new antenna

Primary Antenna

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Add 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 this antenna currently shared with any other stations? No
Is this antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Class A
Mounting Top Mount
Antenna position in stack Top
Polarization Circular
Type Other
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 Tesla Coil Full CP
ERP: 23.8 kW
Manufacturer
Model TCL-6A7(S)
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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Class A
Mounting Top Mount
Antenna position in stack Top
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: 23.8 kW
Manufacturer
Model THV-6A12/CP-R O4
Year 2017
Justification for New Antenna The current antenna is a channel 7 tuned antenna and will not work for the post transition channel (12).

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? No
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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? 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

Name Description

RF Test Complex

RF Test

Install

New Antenna

Fill Holes

In floor and walls

Switch Gear

Switch Gear associated with channel 12

Demo

Old Antenna

Core Drill Holes

(2)

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup antenna
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 Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 800 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use Backup Antenna feed
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1000 feet per run
Justification for New Transmission Line The Aux antenna needs to move, and new transmission line is required for the new location.

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Aux Line Install

Aux Antenna line installation

Demo Old Aux Line

Remove old Aux Line

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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1100 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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1300 feet per run
Justification for New Transmission Line The current main line will not accommodate the output power levels of the post transition transmitter.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Main Line Install

Installation of new line for main antenna

Demo Old Main Line

Remove Old Main Line

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1001289
Coordinates (NAD83) Latitude (NAD83) 37° 45' 19.0" N-
Longitude (NAD83) 122° 27' 10.0" W-
Overall Structure Height 976.69 feet
Support Structure Height 779.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 833.98 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner SUTRO TOWER INC
Date Constructed 03/27/1998

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
35500 KQED DTV
65526 KRON-TV DTV
59964 KISQ FM
35703 KTVU DTV
58912 KCSM-TV DTV
25452 KPIX-TV DTV
54770 KFOG FM
70032 KSOL FM
71586 KCNS DTV
65484 KOSF FM
6380 KOIT FM
51429 KFSF-DT DTV
43095 KMTP-TV DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for tower with candelabra
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 Candelabra
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Mapping

Tower Mapping

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 500
Explanation Project management for shared tower location
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 1
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 1
NEPA Section 106 environmental review No
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 20
Justification This is a shared location that requires coordination.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Architectural Plans

Sutro Architectural plans, building mapping

Building Permits

Estimated cost for building permits

Field Testing and Engineering

Testing at Sutro

Legal Fees Multi Station Project Ctrl

Project cost

Medical Facilites DTV Notices

Medical Notices

Neighborhood RF Survey

Surrounding neighborhood RF Studies

Permit Public Relations

Public Relations

Project Management

Sutro Tower

RF Exposure Reports

RF Exposure Reports

Sutro Legal Fees

Legal Fees at Sutro

Update Architechtural Plans

Plans with new TL locations

Alternate Site Study

Engineering, antenna, designs, Architectural, budgeting, etc

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 Yes
BLM or NFS Coordination Yes
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
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

Disposal

Remove old HW, fill concrete hole, patch roof, etc

Fork Lift Rental

Fork Lift

KFOG-FM Equipment

Equipment

KFOG-FM Relocation

Relocation

KFOG-FM Testing

Testing

Post Assignmnet Antenna Studies

Application data, vertical sketches for structural engineering

Preliminary TL Parts List

Reconfiguration of combiners

Sales Tax

Local Sale Tax

Special Inspection

Welding & Bolts

VSWR Monitoring

Tower worker antenna lockout, Replaces Symphony

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 $1,895,455.00 $1,956,642.19 N/A $0.00 N/A
Total for all systems $6,173,733.00 $6,253,821.21 N/A $463,565.56 N/A
Primary Transmitter VAX24TE $1,196,955.00 $1,231,102.92 $0.00
Transmitter De-Install $54,098.00 $54,098.00 See: KGO De Installation quote KGO. The estimated cost for disposal is an additional $10,000. N/A N/A
Hygienist $1,600.00 $1,600.00 See WGI Repack Values Spreadsheet N/A N/A
Ductwork Scaffold $5,572.00 $5,572.00 See Wadleigh KGO Repacking Estimate N/A N/A
Seismic $9,300.00 $9,300.00 See Wadleigh KGO Repacking Estimate N/A N/A
FireStop $3,860.00 $3,860.00 See Wadleigh KGO Repacking Estimate N/A N/A
Project Managment $233,636.00 $233,636.00 See Wadleigh KGO Repacking Estimate Estimated cost Includes P&O, General Conditions and Supervision N/A N/A
Demo $12,140.00 $12,140.00 See WGI Repack Values Spreadsheet N/A N/A
Paint $6,780.00 $6,780.00 See Wadleigh KGO Repacking Estimate N/A N/A
Other -- Building Addition Size: 1500.0 $0.00 $0.00 N/A N/A N/A
50 Ton system $172,500.00 $209,961.00 See Wadleigh KGO Repacking Estimate N/A N/A
Abatement $3,967.00 $3,967.00 See Wadleigh KGO Repacking Estimate N/A N/A
KGO Site Survey $7,502.00 $7,502.00 See: KGO Site Survey_Gates N/A N/A
Electrical $160,000.00 $160,000.00 See Wadleigh KGO Repacking Estimate N/A N/A
High VHF - Air Cooled Solid State Transmitter 16.6 . 20.7 kW $526,000.00 $522,686.92 See KGO VAXTE-24 Final Main PDF N/A N/A
Auxiliary Transmitter VAX24TE $698,500.00 $725,539.27 $0.00
High VHF - Air Cooled Solid State Transmitter 16.6 . 20.7 kW $526,000.00 $515,578.27 See KGO VAXTE-24 Final ALT PDF N/A N/A
50 Ton system $172,500.00 $209,961.00 See Wadleigh KGO Repacking Estimate N/A N/A
Other -- Building Addition Size: 1500.0 $0.00 $0.00 N/A N/A N/A

Components

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 $1,055,418.00 $843,451.00 N/A $0.00 N/A
Total for all systems $6,173,733.00 $6,253,821.21 N/A $463,565.56 N/A
Primary Antenna THV-6A12/CP-R O4 $654,943.00 $651,093.00 $0.00
Core Drill Holes $9,950.00 $9,950.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Demo $84,137.00 $84,137.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Switch Gear $40,000.00 $40,000.00 New switch gear associated with moving to channel 12 N/A N/A
Fill Holes $12,335.00 $12,335.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Install $84,137.00 $84,137.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
High VHF - Lower Power, Top Mount, Class A, basic slot antenna, 24 kW input, elliptically or circularly polarized $399,234.00 $399,234.00 Current Channel 7 specific antenna cannot be retuned to channel 12 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
High VHF - Lower Power Top Mount Class A basic slot antenna elliptically or circularly polarized $0.00 $0.00 N/A N/A N/A
RF Test Complex $6,120.00 $6,120.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $8,780.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Auxiliary Antenna Custom $400,475.00 $192,358.00 $0.00
Custom Pipe Mount $20,000.00 $20,000.00 Overall FCC Criteria Cost Analysis PDF. 1/2 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Install and Test Combiner $9,180.00 $9,180.00 Overall FCC Criteria Cost Analysis PDF. 1/2 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Fill Holes $1,236.00 $1,236.00 Overall FCC Criteria Cost Analysis PDF. 1/2 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Core Drill Holes $7,463.00 $7,463.00 Overall FCC Criteria Cost Analysis PDF. 1/2 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Removal of existing antenna $10,133.00 $10,133.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
RF Testing Of Line $3,060.00 $3,060.00 Overall FCC Criteria Cost Analysis PDF. 1/2cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
High VHF - Lower Power, Side Mount, Class A, broadband panel, 8 bay,, 24 kW input, elliptically or circularly polarized $69,775.00 $69,775.00 Overall FCC Criteria Cost Analysis PDF. 1/2cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Sweep test of existing antenna $6,730.00 $3,060.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $0.00 Combiner estimate for channel 7 and 12 N/A N/A
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $19,313.00 Overall FCC Criteria Cost Analysis PDF. 1/2 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $5,390.00 N/A N/A N/A
New Aux antenna installation $43,748.00 $43,748.00 Overall FCC Criteria Cost Analysis PDF. 1/2cost Sutro Tower Repacking Estimate pkg PDF N/A N/A

Components

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 $993,983.00 $1,062,248.00 N/A $111,324.10 N/A
Total for all systems $6,173,733.00 $6,253,821.21 N/A $463,565.56 N/A
Primary Transmission Line $710,534.00 $763,350.00 $91,550.25
Demo Old Main Line $149,311.00 $149,311.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Rigid Transmission Line - copper, 6 1/8" $262,600.00 $315,416.00 The current main line will not accommodate the output power levels of the post transition transmitter. See Sutro Tower Repacking Estimate Pkg PDF $91,550.25 N/A
Main Line Install $298,623.00 $298,623.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Auxiliary Transmission Line $283,449.00 $298,898.00 $19,773.85
Demo Old Aux Line $60,000.00 $60,000.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Rigid Transmission Line - copper, 3 1/8" $104,000.00 $119,449.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF $19,773.85 N/A
Aux Line Install $119,449.00 $119,449.00 Overall FCC Criteria Cost Analysis PDF. 1/2cost Sutro Tower Repacking Estimate pkg PDF N/A N/A

Components

Actual Information Description File Name
Demo Old Main Line Information not provided.
Rigid Transmission Line - copper, 6 1/8"

Component Description:
See Line#8
Amount:
$91,550.25
Main Line Install Information not provided.
Demo Old Aux Line Information not provided.
Rigid Transmission Line - copper, 3 1/8"

Component Description:
See Line#44
Amount:
$19,773.85
Aux Line Install 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 $875,877.00 $1,079,659.00 N/A $174,969.12 N/A
Total for all systems $6,173,733.00 $6,253,821.21 N/A $463,565.56 N/A
Primary Tower TOWER $875,877.00 $1,079,659.00 $174,969.12
Major tower reinforcement/modifications $421,000.00 $601,300.00 Overall FCC Criteria Cost Analysis PDF. 1/3 cost Sutro Tower Repacking Estimate pkg PDF Spreadsheet line item 52 and 53 $67,476.65 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $440,000.00 Overall FCC Criteria Cost Analysis PDF. 1/3 cost Sutro Tower Repacking Estimate pkg PDF. spreadsheet line item 51 and 54 $79,187.23 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $24,482.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $24,570.11 Travel Expense Overage $88.11 See file Invoice #7956 with supporting Docs
Tower Mapping $13,877.00 $13,877.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF. $3,735.13 N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications

Component Description:
see line#60
Amount:
$18,323.33

Component Description:
See Line#60
Amount:
$3,324.16

Component Description:
See Line#60
Amount:
$26,308.33

Component Description:
see line#60
Amount:
$13,534.16

Component Description:
Line #60
Amount:
$5,986.67
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
see line#58
Amount:
$1,124.35

Component Description:
See Line#58
Amount:
$33,020.77

Component Description:
See Line#58
Amount:
$16,439.50

Component Description:
see line#54
Amount:
$8,439.89

Component Description:
see line#58
Amount:
$15,037.22

Component Description:
Line #58
Amount:
$1,337.00

Component Description:
see invoice line #58
Amount:
$3,788.50
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Overage T&E $88.47
Amount:
$24,570.11
Tower Mapping

Component Description:
see line #5
Amount:
$118.82

Component Description:
See Line#5
Amount:
$152.41

Component Description:
see item#5
Amount:
$3,081.56

Component Description:
Line#5
Amount:
$268.67

Component Description:
Line Item#5
Amount:
$113.67

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 $782,791.00 $745,549.02 N/A $156,930.29 N/A
Total for all systems $6,173,733.00 $6,253,821.21 N/A $463,565.56 N/A
Outside Professional Services $782,791.00 $745,549.02 $156,930.29
Alternate Site Study $58,619.00 $58,619.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $58,533.87 N/A
Update Architechtural Plans $4,671.00 $4,671.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Sutro Legal Fees $8,333.00 $8,333.00 06-29-17 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $6,157.39 N/A
RF Exposure Reports $3,500.00 $3,500.00 Local RF exposure reports at Sutro N/A N/A
Project Management $85,500.00 $85,500.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $8,611.71 N/A
Permit Public Relations $19,108.00 $19,108.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $1,741.49 N/A
Neighborhood RF Survey $3,333.00 $3,333.00 Overall FCC Criteria Cost Analysis PDF 1/6 cost N/A N/A
Medical Facilites DTV Notices $7,668.00 $7,668.00 DTVNotification Quote ABC Stations 1/3 cost N/A N/A
Field Testing and Engineering $75,000.00 $75,000.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Building Permits $183,333.00 $183,333.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $18,102.60 N/A
Architectural Plans $51,369.00 $51,369.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $22,813.14 N/A
Additional Field Engineering Service, 20 Days $20,000.00 $20,000.00 06-29-17 Overall FCC Criteria Cost Analysis PDF N/A N/A
RF Exposure Measurements $21,050.00 $3,333.00 06-29-17 Overall FCC Criteria Cost Analysis PDF 1/6 cost N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $75,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $0.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $0.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $0.00 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 $3,381.62 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 Quote N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,887.50 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 06-29-17 Overall FCC Criteria Cost Analysis PDF N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 06-29-17 Overall FCC Criteria Cost Analysis PDF N/A 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 N/A N/A
Prepare and or review reimbursement form $2,630.00 $15,365.02 See:KGO Legal Services Estimate to complete the repacking See: KGO Legal Services Invoice for repacking covering period through June 3 $9,860.87 N/A
Project management of the transition $79,000.00 $75,000.00 Overall FCC Criteria Cost Analysis PDF. Sutro Tower Repacking Estimate pkg PDF N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 06-29-17 Overall FCC Criteria Cost Analysis PDF N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,982.50 N/A
Legal Fees Multi Station Project Ctrl $22,667.00 $22,667.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $17,857.60 N/A

Components

Actual Information Description File Name
Alternate Site Study

Component Description:
Line Item #2
Amount:
$58,533.87
Update Architechtural Plans Information not provided.
Sutro Legal Fees

Component Description:
Cooper White and Cooper Expense under alternate site study
Amount:
$6,157.39
RF Exposure Reports Information not provided.
Project Management

Component Description:
see line#129
Amount:
$738.22

Component Description:
See Line#129
Amount:
$146.87

Component Description:
See Line#129
Amount:
$125.00

Component Description:
see line #129
Amount:
$889.58

Component Description:
see line item #129
Amount:
$5,315.62

Component Description:
Line #129
Amount:
$1,396.42
Permit Public Relations

Component Description:
see line# 57
Amount:
$62.50

Component Description:
See Line#57
Amount:
$516.49

Component Description:
see line#57
Amount:
$712.50

Component Description:
Line Item#57
Amount:
$237.50

Component Description:
Line #57
Amount:
$212.50
Neighborhood RF Survey Information not provided.
Medical Facilites DTV Notices Information not provided.
Field Testing and Engineering Information not provided.
Building Permits

Component Description:
See Line#56
Amount:
$197.83

Component Description:
See Line#56
Amount:
$705.37

Component Description:
see line#56
Amount:
$4,666.93

Component Description:
Line Item #56
Amount:
$10,478.17

Component Description:
Line #56
Amount:
$2,054.30
Architectural Plans

Component Description:
See Line#54
Amount:
$10,067.49

Component Description:
See Line#54
Amount:
$2,285.23

Component Description:
Line #54
Amount:
$10,460.42
Additional Field Engineering Service, 20 Days Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations 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

Component Description:
Legal Expense Resubmitted for Invoice Rejected on March 2nd, 2018
Amount:
$550.76

Component Description:
Legal Expense Resubmitted for Rejected Invoice on March 2nd, 2018
Amount:
$2,830.86
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Item 2 see invoice details
Amount:
$2,887.50
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare and or review reimbursement form

Component Description:
Legal Expense
Amount:
$314.73

Component Description:
Legal Expense
Amount:
$742.44

Component Description:
Legal Expense
Amount:
$1,218.07

Component Description:
Legal related to form 399 Resubmitted for Invoice rejected on March 2nd, 2018
Amount:
$3,695.85

Component Description:
Legal Expense Resubmitted for Invoice rejected on March 2nd 2018
Amount:
$1,825.99

Component Description:
Legal related to form 399 Resubmitted for invoice rejected on March 2nd, 2018
Amount:
$2,063.79
Project management of the transition Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Item 1 see invoice for details
Amount:
$6,982.50
Legal Fees Multi Station Project Ctrl

Component Description:
see line#139
Amount:
$2,001.96

Component Description:
see line#139
Amount:
$2,281.73

Component Description:
See Line#139
Amount:
$100.54

Component Description:
See Line#139
Amount:
$283.49

Component Description:
Line #139
Amount:
$537.94

Component Description:
see line item #139
Amount:
$12,651.94

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 $570,209.00 $566,272.00 N/A $20,342.05 N/A
Total for all systems $6,173,733.00 $6,253,821.21 N/A $463,565.56 N/A
Other Expenses $570,209.00 $566,272.00 $20,342.05
VSWR Monitoring $96,125.00 $96,125.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Special Inspection $5,000.00 $5,000.00 Overall FCC Criteria Cost Analysis PDF. 1/3 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Sales Tax $249,800.00 $249,800.00 Local Sales Tax and Two Transmitters Overall FCC Criteria Cost Analysis PDF. 1/6 cost. Two transmitters are KGO only Sutro Tower Repacking Estimate pkg PDF $9,462.55 N/A
Preliminary TL Parts List $4,250.00 $4,250.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $6,712.84 Peter Eckmann Consultants Invoice 1625
Post Assignmnet Antenna Studies $15,563.00 $15,563.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF $3,890.83 N/A
KFOG-FM Testing $8,333.00 $8,333.00 Overall FCC Criteria Cost Analysis PDF. 1/3 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
KFOG-FM Relocation $42,000.00 $42,000.00 Overall FCC Criteria Cost Analysis PDF. 1/3 cost Sutro Tower Repacking Estimate pkg PDF $0.00 N/A
KFOG-FM Equipment $12,704.00 $12,704.00 Overall FCC Criteria Cost Analysis PDF. 1/3 cost Sutro Tower Repacking Estimate pkg PDF $275.83 N/A
Fork Lift Rental $25,636.00 $25,636.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Disposal $8,333.00 $8,333.00 Overall FCC Criteria Cost Analysis PDF. 1/3 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
MVPD Notification of Channel Change $0.00 $0.00 Do not anticipate seeking reimbursement for this expense at this time. N/A N/A
Develop and air announcement of upcoming channel change $10,000.00 $10,000.00 On Air time to promote channel changes N/A N/A
Equipment Storage $10,000.00 $10,000.00 Transmitter storage for 30 months at 300/month $0.00 N/A
Equipment Delivery and Handling Charges $52,833.00 $52,833.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $16,442.00 $16,442.00 Overall FCC Criteria Cost Analysis PDF. 1/6 cost Sutro Tower Repacking Estimate pkg PDF N/A N/A
BLM or NFS Coordination $0.00 $0.00 N/A N/A N/A
Non-zoning permits $0.00 $0.00 N/A N/A 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
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $7,668.00 See DTVNotification Quote ABC Stations N/A N/A
Local Zoning $0.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
VSWR Monitoring Information not provided.
Special Inspection Information not provided.
Sales Tax

Component Description:
See Line#141
Amount:
$9,462.55
Preliminary TL Parts List

Component Description:
see line#4
Amount:
$2,463.10

Component Description:
See line#4
Amount:
$4,249.74
Post Assignmnet Antenna Studies

Component Description:
Item removed
Amount:
N/A

Component Description:
Line Item#3
Amount:
$3,890.83
KFOG-FM Testing Information not provided.
KFOG-FM Relocation Information not provided.
KFOG-FM Equipment

Component Description:
Line Item #63
Amount:
$275.83
Fork Lift Rental Information not provided.
Disposal Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
BLM or NFS Coordination Information not provided.
Non-zoning permits Information not provided.
FCC Filing Fees - Special Temporary Authorization request 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.
DTV Medical Facility Notification Information not provided.
Local Zoning Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $6,173,733.00 $6,253,821.21 $463,565.56

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.

John W. Zucker

Assistant Secretary


04/20/2018

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.

John W Zucker

Assistant Secretary


04/20/2018

Attachments

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