TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
NEXSTAR BROADCASTING, INC.	Elizabeth Ryder 545 E. JOHN CARPENTER FREEWAY SUITE 700 IRVING, TX 75062 United States	+1 (972) 373-8800	eryder@nexstar.tv	Corporation

Applicant

Address

Phone

Applicant Type

NEXSTAR BROADCASTING, INC.

Elizabeth Ryder

545 E. JOHN CARPENTER FREEWAY

SUITE 700

IRVING, TX 75062

United States

+1 (972) 373-8800

eryder@nexstar.tv

Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Elizabeth Ryder General Counsel Nexstar Broadcasting, Inc.	Elizabeth Ryder 545 E. John Carpenter Freeway Suite 700 Irving, TX 75062 United States	+1 (972) 373-8800	eryder@nexstar.tv

Applicant

Address

Phone

Elizabeth Ryder

General Counsel

Nexstar Broadcasting, Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800

eryder@nexstar.tv

Broadcaster Information and Transition Plan

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	DTV Utah is a complex site with 8 stations sharing a two main antennas as well as aux antenna, combiner system and building. Replacement antenna panels, combiner and transmitters will be required. DTVU is still working on its transition plans.

Transmitters

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

Primary Transmitter

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	SigmaCD2
	Year	1999
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	20 kW

Primary Transmitter

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	THU9evo-20
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	25 kW
	Justification for New Transmitter	Existing transmitter is obsolete and can not be retuned to new channel. See attached quotes. Upgrading to a SS at one power step up from the required TPO. Single tube IOT is the max reimbursement, but Gates quote is lower.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	300 kVA
	Rigid Conduit and Wiring	Yes
	Size	3 inches
	Length	200.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Cooling Only
	Size	30 tons
	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

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Plan Transmitter Layout and Develop Installation Drawings	Develop Installation Layout. Develop Installation Drawings
Removal of Existing Equipment	Remove Existing Equipment from Farnsworth Peak
Remote Control Wiring	Wire Up Existing Remote Control to New Transmitter

Interim Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Interim
	Description of Use	N/A
	Change Type	Purchase
	Manufacturer
	Model	ULTXE-20
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	12.9 kW
	Justification for New Transmitter	DTV Utah Stations will operate on an interim transmitter one at a time in rotating fashion as their existing transmitter is removed and replaced. This is for the KTVX allocated costs for one interim transmitter for the site.

Interim Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	300 kVA
	Rigid Conduit and Wiring	Yes
	Size	2 inches
	Length	800.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Heating and Cooling
	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?	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?	Yes

Interim Transmitter

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Leased
	Owner	DTV Utah
	Site	N/A
	Is the existing antenna shared with another station or stations?	Yes
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Top
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	8
	Number of Panels	48
	Design power capacity in use	100.0 %
	Lower Limit	602.00 MHz
	Upper Limit	700.00 MHz
	Other Antenna Type	N/A
	ERP:	475.0 kW
	Manufacturer
	Model	773 928
	Year	1999

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

Facility ID	Call Sign
36607	KJZZ-TV
1136	KUCW
35823	KUTV
6359	KSL-TV
6823	KBYU-TV
69396	KUED
69582	KUEN

Primary Antenna

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?	Yes
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	Yes
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Bottom
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	8
	Number of Panels/Bays	48
	Lower Limit	482.00 MHz
	Upper Limit	608.00 MHz
	Design power capacity in use	50.0 %
	Other Antenna Type	N/A
	ERP:	2000.0 kW
	Manufacturer
	Model	759 25063
	Year	2017
	Justification for New Antenna	The current panel antenna is finely tuned to a specific band, but cannot be retuned to the new band.

Primary Antenna

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	8
	Frequencies of channels supported	Upper and lower frequency
	Frequency	488.0 MHz - 608.0 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	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?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Antenna Installation	Costs for antenna install.

Transmission Line

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

Tower Equipment And Rigging Costs

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

Primary Tower

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?	Terrain Constrained
	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?	Yes
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1062408
Coordinates (NAD83)	Latitude (NAD83)	40° 39' 33.0" N-
	Longitude (NAD83)	112° 12' 10.0" W-
	Overall Structure Height	308.40 feet
	Support Structure Height	308.40 feet
	Ground Elevation Above Mean Sea Level (AMSL)	9035.32 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	DTV UTAH, LC
	Date Constructed	10/28/1999

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
1136	KUCW	DTV
69582	KUEN	DTV
35823	KUTV	DTV
69396	KUED	DTV
36607	KJZZ-TV	DTV
6823	KBYU-TV	DTV
6359	KSL-TV	DTV

Primary Tower

Tower Modification Costs

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

Primary Tower

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	Terrain constrained
Helicopter Services Required	Are helicopter services required?	No

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	800
	Explanation	KTVX Allocated Costs: DTV Utah will provide project management on site. Additionally, station will retain RF Engineers to review site construction as needed.
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	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	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	No
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	2
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	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	30
	Justification	On site RF Engineering to inspect and supervise construction on behalf of station

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Allocation Consulting	RF Consultant analysis of channel allocations, Interference issues, and spectrum issues
Building Structural Engineering	Structural Engineer review and analysis of building and 2nd Floor Combiner Weight Issues
Prepare and File FCC Progress Reports	Prepare and File FCC Quarterly Progress Reports
RF Consultant	RF Consultant for antenna and combiner designs
Reimbursement Reviews	Reimbursement Reviews with FCC, E&Y, and Cavell.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	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	No
	Non-zoning permits	Yes
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	Yes
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	Yes
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	Yes
	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

Other Expenses Not Listed

Name	Description
Accounting	DTV Utah Accounting and Allocation of costs to stations
Raod Maintenance	Snowplowing Grating and repairs to existing road to remote mountain top.
DTV Utah Operating Agreement Equity Equalization	Per 1988 Operating Agreement. See Exhibit M attached.
KSTU Mask Filter	Adjacent Channel Mask Filter for KSTU. See Exhibit N attached.
Remove and Disposal of Equipment	Common Equipment Removal and Disposal. Rigging, road access, packing materials
Site Access and Transportation	Snow Cat access; helicopter site access; Road opening (snow plowing) etc.
Temporary Sanitation	Required for work on the mountaintop.

Cost Information

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	$2,104,700.00	$1,109,832.99	N/A	$909,866.82	N/A
Total for all systems	$4,310,061.33	$2,516,299.90	N/A	$1,411,330.70	N/A
Interim Transmitter ULTXE-20	$1,003,800.00	$243,062.99		$192,696.82
50 Ton system	$266,000.00	$113,000.00	Revised to increase amount to 1/6 vs 1/8 as well as design and engineering changes required due to a new heat exchanger design for the transmitters.	$109,236.52	Actual design HVAC designs called for more cooling than originally estimated. Additionally, original application estimates submitted at 1/8 cost. Reimbursement submitted on 1/6.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW	$494,500.00	$94,045.33	Revised to reflect 1/6th of Shared Cost	$83,460.30	Original application cost estimate based on 1/8 total costs. Approval received for 1/6 total costs. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation.
Switchgear - industrial 800 amp	$38,200.00	$5,809.33	Revised to reflect 1/6th of shared cost.	$0.00	N/A
UHF inside RF system including switching	$147,500.00	$23,333.33	Revised to reflect 1/6th of Shared Cost	N/A	N/A
2" Rigid Conduit and Wiring (Cost per foot)	$20,800.00	$2,500.00	1/8 Shared Cost	N/A	N/A
Transformer 3 phase/480v - 300 KVA	$36,800.00	$4,375.00	1/8 Shared Cost	N/A	N/A
Primary Transmitter THU9evo-20	$1,100,900.00	$866,770.00		$717,170.00
Remote Control Wiring	$3,500.00	$3,500.00	Wire up existing remote control to new transmitter.	N/A	N/A
Removal of Existing Equipment	$25,000.00	$25,000.00	Removal of existing KTVX Transmitter cabinets, Beam Supplies (2); Heat Exchangers (2); and other equipment. Rigging, All Terrain Vehicles; forklifts; oil and glycol issues.	N/A	N/A
Plan Transmitter Layout and Develop Installation Drawings	$15,000.00	$15,000.00	KTVX Allocated Costs for Transmitter Installation layout and installation drawings	N/A	N/A
Other -- HVAC Service Type: C Size:30 (Other)	$25,000.00	$25,000.00	KTVX Allocated costs for modification of HVAC systems.	N/A	N/A
3" Rigid Conduit and Wiring (Cost per foot)	$10,400.00	$9,800.00	Catalog	N/A	N/A
Transformer 3 phase/480v - 300 KVA	$36,800.00	$35,000.00	Catalog	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$717,170.00	Cost revised down from 788,930 to 717,170 per Rohde & Schwarz quote 802-049530.1 attached	$717,170.00	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	Catalog	N/A	N/A

Components

Actual Information Description	File Name
50 Ton system	Component Description: HVAC Mechanical Design Work for transmitter HVAC project. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $2,400.00 Component Description: Advance payment to secure the equipment and materials before transmitters are installed. Amount requested specific to KTVX. Amount: $27,022.00 Component Description: Progress payment for HVAC done on KTVX primary transmitter and cooling system per Appril 24, 2018 proposal. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $6,366.28 Component Description: Progress payment for August for HVAC project. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $2,118.15 Component Description: Advance payment to secure the equipment and materials before transmitters are installed. Amount specific to KTVX. Amount: $9,357.00 Component Description: HVAC mechancial & structural work. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $3,652.40 Component Description: Cooling system evaluation. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $153.79 Component Description: Mechanical design for transmitter HVAC project. Amount requested specific to KTVX. Amount: $6,200.00 Component Description: Progress payment for HVAC Work. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $11,163.83 Component Description: Progress payment for HVAC Work. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $12,672.16 Component Description: Progress payment for HVAC Work. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $14,166.66 Component Description: Progress Payment for HVAC Work. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $16,416.66 Component Description: Progress payment - Mechanical design for transmitter HVAC project. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $933.33 Component Description: Mechanical design for transmitter HVAC project. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $266.66
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW	Component Description: Ross 2RU 3G/HD/SD/SDI Audio Monitoring Bridge equipment. No sales tax on shipping charges. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $514.00 Component Description: Transmitter install. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $5,412.88 Component Description: Ross Video HD/SD/SDI equipment. Taxes not charged on shipping. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $459.77 Component Description: Sencore HD/SD/SDI equipment. Taxes not charged on shipping. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $660.43 Component Description: Transmitter - ProgPay 3. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $21,682.94 Component Description: Transmitter ProgPay 1 - 1/3 Down Payment. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $27,365.14 Component Description: Transmitter ProgPay 2 - 1/3 Down Payment. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $27,365.14
Switchgear - industrial 800 amp	Component Description: Installation of electrical panels and transformer for the interim transmitter. Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $496.60 Component Description: Installation of electrical panels and transformer for the interim transmitter. Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $3,149.19
UHF inside RF system including switching	Information not provided.
2" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Transformer 3 phase/480v - 300 KVA	Information not provided.
Remote Control Wiring	Information not provided.
Removal of Existing Equipment	Information not provided.
Plan Transmitter Layout and Develop Installation Drawings	Information not provided.
Other -- HVAC Service Type: C Size:30 (Other)	Information not provided.
3" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Transformer 3 phase/480v - 300 KVA	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: Primary transmitter, installment #3 Amount: $179,292.52 Component Description: Primary transmitter, installment #2 Amount: $358,585.00 Component Description: 25% down payment Transmitter System; Original estimate is for a Gates Air system. Actual product purchased is a Rohde & Schwarz system (quote attached). Amount: $179,292.48
Switchgear - industrial 800 amp	Information not provided.

Cost Information

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	$589,830.00	$695,357.24	N/A	$489,600.74	N/A
Total for all systems	$4,310,061.33	$2,516,299.90	N/A	$1,411,330.70	N/A
Primary Antenna 759 25063	$589,830.00	$695,357.24		$489,600.74
Combiner output splitting/switching for dual feed lines, if applicable	$126,000.00	$0.00	Included in combiner costs. See Exhibit E.	N/A	N/A
UHF - High Power Top Mount Eight Station broadband panel antenna horizontally polarized	$300,000.00	$300,000.00	Revised to increase amount to 1/6 vs 1/8 as well as adding an increase for the addition of nitrogen generators	$230,628.63	Original 399 budget proposed at 1/8 cost. Special approval received for 1/6 of costs causing budget overage.
New combiner, cost per channel (without antenna)	$84,200.00	$317,000.00	Revised to increase amount to 1/6 vs 1/8 as well as adding for additional equipment necessary for unanticipated management of the system. See Exhibit E.	$207,434.54	See in attachment-FCC Incentive Auction Repack Reimbursement Request and Explanation.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	$13,700.00	$16,000.00	Revised to increase amount to 1/6 vs 1/8 shared cost, as well as adding for an increase in the elbow complex design caused by the antenna configuration.	$9,589.88	Initial estimate based on 1/6 reimbursement for Elbow complex - broadband and transmission line material installation related to SOW: S&I Elbow Complex
Sweep test of existing antenna	$6,730.00	$3,157.24	Revised to increase to 1/6th of shared cost	$2,828.08	Original estimate for 1/8 costs with approval to request reimbursement at 1/6. Please see FCC Incentive auction repack reimbursement request and explanation.
Antenna Installation	$59,200.00	$59,200.00	Revised to increase amount to 1/6 vs 1/8 shared cost, as well as adding for inspection of the transmission line to ensure the integrity of the line after the antenna removal. See Exhibit D.	$39,119.61	Please see FCC Incentive Auction Repack Reimbursement Request & Explanation - Original 399 application estimate was based on 1/8 cost. Approval received for 1/6 cost reimbursement.

Components

Actual Information Description	File Name
Combiner output splitting/switching for dual feed lines, if applicable	Information not provided.
UHF - High Power Top Mount Eight Station broadband panel antenna horizontally polarized	Component Description: Antenna Structural 25% Progress Payment. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $7,710.92 Component Description: Antenna 5% Final Payment - Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $9,575.39 Component Description: Antenna 45% - Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $86,178.56 Component Description: Utah State Sales Tax for SouthTek invoice STS87757-1. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. See also explanation of Vendor EIN/TIN. Amount: $284.98 Component Description: Antenna Structural 25% Progress Payment. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $6,400.09 Component Description: Antenna system final billing for line items 2, 3, 6 & 7 per quote. Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $7,710.92 Component Description: Antenna Factory Test - Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $5,142.50 Component Description: Antenna 25 % Down Payment - Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $7,710.92 Component Description: Antenna 25% Progress Payment - Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $47,876.97 Component Description: Nitrogen Generation with sales tax noted. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $4,160.41 Component Description: Antenna Material 25% down payment. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $47,876.97
New combiner, cost per channel (without antenna)	Component Description: Combiner - Prog Pay 3. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $90,717.49 Component Description: Combiner - Prog Pay 2. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $90,717.50 Component Description: Combiner Downpayment #1 due with order. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $5,123.06 Component Description: Combiner Downpayment #2. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $5,123.06 Component Description: 80KW Cooling System. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $3,320.18 Component Description: Combiner - Prog Pay 1 - Down Payment. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $22,679.37 Component Description: Combiner Downpayment #2. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $5,123.06 Component Description: Combiner Downpayment #1 due with order. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. - Information updated Amount: $5,123.06 Component Description: 80KW Cooling System. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $3,320.18 Component Description: Combiner - Prog Pay 3. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $90,717.49 Component Description: Combiner - Prog Pay 1 - Down payment. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $22,679.37 Component Description: Combiner - Prog Pay 2. Please see attached - FCC Incentive Auction Repack Reimbursement Request and Explanation. Amount: $90,717.50
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	Component Description: Final billing for additional transmission line and installation services provided by GTI America. Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $4,794.94 Component Description: Progress Invoice - 50% down payment for transmission line material and installation Amount: $4,794.94
Sweep test of existing antenna	Component Description: Rental of impedance transformer used to test the CH.24 system. Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $329.16 Component Description: Test existing Kathrein UHF Antenna System. Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $2,828.08
Antenna Installation	Component Description: Use tax for GTIA-1021 invoice Amount: $53.45 Component Description: Transmission line final payment. Sales tax accrual attached separately. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $798.45 Component Description: Site survey 25% down payment. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $1,310.83 Component Description: Bullet installation 25% Down Payment. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $1,748.05 Component Description: Installation Services 25% down payment. Please see FCC Incentive Auction Repack Reimbursement Request & Explanation. Amount: $11,754.09 Component Description: Antenna Installation 25% Progress Payment Amount: $23,508.19

Cost Information

Transmission Line

Information not provided.

Cost Information

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	$854,600.00	$135,333.34	N/A	$226.66	N/A
Total for all systems	$4,310,061.33	$2,516,299.90	N/A	$1,411,330.70	N/A
Primary Tower TOWER	$854,600.00	$135,333.34		$226.66
Structural engineering tower load study for well documented tower	$12,600.00	$2,000.00	Revised to increase amount to 1/6 vs 1/8	$226.66	N/A
Major tower reinforcement/modifications	$421,000.00	$66,666.67	Revised to increase amount to 1/6 vs 1/8	N/A	N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$66,666.67	Revised to increase amount to 1/6 vs 1/8	N/A	N/A

Components

Actual Information Description	File Name
Structural engineering tower load study for well documented tower	Component Description: Structural Engineering & Design services - May 2017 Amount: $226.66
Major tower reinforcement/modifications	Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Information not provided.

Cost Information

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	$396,900.00	$212,350.00	N/A	$4,352.81	N/A
Total for all systems	$4,310,061.33	$2,516,299.90	N/A	$1,411,330.70	N/A
Outside Professional Services	$396,900.00	$212,350.00		$4,352.81
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	N/A	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$4,000.00	Catalog	$2,627.81	N/A
Reimbursement Reviews	$10,600.00	$10,600.00	Reimbursement Reviews with FCC, E&Y, Cavell.	N/A	N/A
RF Consultant	$16,000.00	$16,000.00	KTVX Allocation of Costs. RF Consulting Engineer for Antenna and Combiner overall system design. Vendor specs and system range testing.	N/A	N/A
Prepare and File FCC Progress Reports	$18,000.00	$18,000.00	Prepare and file FCC Progress Reports	N/A	N/A
Building Structural Engineering	$20,000.00	$20,000.00	KTVX specific and allocation of costs related to building structural and weight analysis.	N/A	N/A
Allocation Consulting	$15,000.00	$15,000.00	KTVX Allocation of costs. RF Engineering Consultant to review channel allocations, interference, alternative channels, support can not construct filing.	N/A	N/A
Additional Field Engineering Service, 30 Days	$45,000.00	$45,000.00	RF Engineer on site to supervise installation and construction of KTVX Equipment.	N/A	N/A
RF Exposure Measurements	$21,050.00	$2,500.00	1/8 Shared Cost	N/A	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$10,000.00	1/8 Shared Cost	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$7,360.00	$7,000.00	Catalog	N/A	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	Catalog	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	Catalog	N/A	N/A
Project management of the transition	$126,400.00	$37,500.00	Catalog	$1,725.00	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	Catalog	N/A	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	Catalog	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	Catalog	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	Catalog	N/A	N/A
Prepare request for Special Temporary Authorization	$4,100.00	$3,000.00	Catalog	N/A	N/A

Components

Actual Information Description	File Name
Perform engineering study for new channel assignment and antenna development	Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations	Component Description: Legal consulting - lease negotiations Amount: $501.40 Component Description: Legal consulting - lease negotiations Amount: $1,960.50 Component Description: Legal consulting - lease negotiations Amount: $165.91
Reimbursement Reviews	Information not provided.
RF Consultant	Information not provided.
Prepare and File FCC Progress Reports	Information not provided.
Building Structural Engineering	Information not provided.
Allocation Consulting	Information not provided.
Additional Field Engineering Service, 30 Days	Information not provided.
RF Exposure Measurements	Information not provided.
Comprehensive coverage verification via field study, if needed	Information not provided.
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 - Prepare and File FCC Form 2100 (main), Construction Permit Application	Information not provided.
Project management of the transition	Component Description: Project Management for Structural Analysis and Tower Modifications. Services from June 30, 2018 through July 27, 2018. Station specific. Amount: $225.00 Component Description: Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates. Services from March 31, 2018 through April 27, 2018. Amount: $674.00 Component Description: Project Management for Structural Analysis and Tower Modifications. Services from January 1, 2018 through January 26, 2018. Amount: $450.00 Component Description: Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates for preparation of Form 387 progress report. Services from May 26, 2018 through June 29, 2018. Amount: $450.00 Component Description: Project Management for Structural Analysis and Tower Modifications. Services from October 27, 2017 through December 31, 2017. Amount: $600.00
Prepare and or review reimbursement form	Information not provided.
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Information not provided.
Prepare request for Special Temporary Authorization	Information not provided.

Cost Information

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	$364,031.33	$363,426.33	N/A	$7,283.67	N/A
Total for all systems	$4,310,061.33	$2,516,299.90	N/A	$1,411,330.70	N/A
Other Expenses	$364,031.33	$363,426.33		$7,283.67
Remove and Disposal of Equipment	$5,000.00	$5,000.00	Removal and disposal of KTVX Equipment down the mountain.	N/A	N/A
Develop and air announcement of upcoming channel change	$3,500.00	$3,500.00	Production costs to develop and air channel change announcement.	N/A	N/A
Equipment Storage	$5,333.33	$5,333.33	1125 per month for 16 months plus pod storage on mountains. Revised to increase amount to 1/6 vs 1/8.	$0.00	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$27,500.00	$27,500.00	DTV Utah estimate of allocated costs for KTVX - Combiner and other common equipment removal and rigging down mountain.	N/A	N/A
Equipment Delivery and Handling Charges	$25,000.00	$25,000.00	Estimate of KTVX specific and Allocation of Costs for delivery of equipment up mountain.	$2,734.67	N/A
Temporary Sanitation	$3,000.00	$3,000.00	1/8 Shared Cost	N/A	N/A
Site Access and Transportation	$25,000.00	$25,000.00	Cost Allocation to KTVX for site transportation and site access including snow cats, helicopter services, road clearing, snow plowing etc.	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	Catalog	$4,549.00	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,070.00	Catalog	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	Catalog	N/A	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$190.00	Catalog	N/A	N/A
Non-zoning permits	$5,900.00	$5,900.00	KTVX Estimate of Cost Allocation.	N/A	N/A
MVPD Notification of Channel Change	$5,000.00	$5,000.00	N/A	N/A	N/A
Accounting	$5,800.00	$5,800.00	DTV Utah estimate of KTVX allocation of costs for accounting services for project.	N/A	N/A
Raod Maintenance	$10,000.00	$10,000.00	1/8 Shared Cost	N/A	N/A
DTV Utah Operating Agreement Equity Equalization	$223,083.00	$223,083.00	See Exhibit M.	N/A	N/A
KSTU Mask Filter	$6,725.00	$6,725.00	1/8 Shared Cost	N/A	N/A

Components

Actual Information Description	File Name
Remove and Disposal of Equipment	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Split invoice between KTVX & KUCW station specific freight charges for delivery to tower site. Amount: $225.00 Component Description: KTVX specific freight costs for delivery to tower site. Amount: $450.00 Component Description: Equipment transport - May 2018 Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $425.00 Component Description: Howe Rental Forklift Payments 10/17/17 to 11/14/17 and 11/14/17 to 12/12/17 paid by KSL Amount: $955.98 Component Description: Forklift Rental 5/14/2018 to 8/06/2018. Please see FCC Incentive auction repack reimbursement request and explanation. Amount: $1,553.69 Component Description: Split invoice between KTVX & KUCW for station specific equipment delivery to tower site Amount: $225.00
Temporary Sanitation	Information not provided.
Site Access and Transportation	Information not provided.
DTV Medical Facility Notification	Component Description: Medical Facility Notice Amount: $2,164.00 Component Description: Medical Facility Notification Amount: $2,385.00
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
Non-zoning permits	Information not provided.
MVPD Notification of Channel Change	Information not provided.
Accounting	Information not provided.
Raod Maintenance	Information not provided.
DTV Utah Operating Agreement Equity Equalization	Information not provided.
KSTU Mask Filter	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$4,310,061.33	$2,516,299.90	$1,411,330.70

Reimbursement Status

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

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.
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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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). 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Elizabeth Ryder General Counsel 01/30/2019

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.

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.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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).
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Elizabeth Ryder

General Counsel

01/30/2019

Certification

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).
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 certifies that the statements in this form and attached documentation are true, complete, and correct. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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) . 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. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Elizabeth Ryder General Counsel 01/30/2019

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).

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 certifies that the statements in this form and attached documentation are true, complete, and correct.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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) .
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.
The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Elizabeth Ryder

General Counsel

01/30/2019

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Interim Transmitter

New Transmitter Costs

Interim Transmitter

Other Transmitter Costs

Interim Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

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

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification

Attachments