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:
6900
Service:
DTV
Call Sign:
WUPA
Channel:
36 (UHF)
File Number:
0000027041
FRN:
0003474871
Date Submitted:
10/17/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ATLANTA TELEVISION STATION WUPA INC.

Doing Business As: ATLANTA TELEVISION STATION WUPA INC.

Daniel G. Ryson

1725 DeSales St. NW

Suite 501

Washington, DC 20036

United States

+1 (202) 457-4505 dryson@cbs.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

Daniel G. Nass , Ryson .

CBS

Daniel G. Ryson

1725 DeSales St. NW

Suite 501

Washington, DC 20036

United States

+1 (202) 457-4074 dryson@cbs.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan ATS will install new broadband ant at interim site. Facility will move to interim site. Current main site ant and tx line will be removed. ATS will install new broadband ant at main site. Facility will move from interim site to main site.

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 Retune Existing
Use Auxiliary (Backup)
Ownership Owned
Owner 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 Rhode and Schwarz
Model NV8303
Year 2001
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.5 kW

Auxiliary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 1.5 kW
Other Power N/A
New Exciter Is a new exciter needed? No

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? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Sigma
Year 2001
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 63 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-100
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 62.9 kW
Justification for New Transmitter Cannot re-tune current IOT transmitter.Replacement IOT transmitter will exceed cost of replacement solid state.

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) Yes
Power 500 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 300.0 feet
Other Electrical Service Yes
Description Electrical work. Includes labor and materials not already listed.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model ULXTE-72
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 35.4 kW
Justification for New Transmitter Facility must move to interim site for an expended period of time. Revised gains and losses at interim site required an increase in transmitter size to ULXTE-72 (35.4 kW @ Ch. 43) to replicate licensed WUPA coverage. See May 2018 Statement.

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 4 inches
Length 400.0 feet
Other Electrical Service Yes
Description Electrical work including labor and materials not listed elsewhere. See Exhibit 7
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Control

Remote Control and Monitoring of Interim Transmitter and site.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Lease New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-32GTH-R
Year 2002

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 Lease New
Is this a request for upgraded equipment? Yes
Ownership Leased
Owner American Tower
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 4
Number of Panels/Bays 99
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model 14 bay, 4 around,, 56 ele total
Year 2018
Justification for New Antenna Channel Change

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? Yes
Type New
Number of channels supported 4
Frequencies of channels supported Upper and lower frequency
Frequency 470.0 MHz - 608.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
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? 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

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Other Antenna Cost Not Listed

Name Description

Dielectric Combiner Installation

installation of combiner

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Lease New
Ownership Leased
Owner American Tower
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 5
Number of Panels/Bays 12
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 100.0 kW
Manufacturer
Model PEPL48D-C170-2-6
Year 2018
Justification for New Antenna Needed for transition logistics

Interim 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 5
Frequencies of channels supported Upper and lower frequency
Frequency 470.0 MHz - 608.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 8 3/16 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Installation

Installation of interim site combiner.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Lease 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? Yes
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 Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1275 feet per run

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

Facility ID Call Sign
23960 WSB-TV
48813 WUVG-DT
64033 WPCH-TV
72120 WGCL-TV

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 Lease New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 2
Length 1275 feet per run
Justification for New Transmission Line Line to be re-furbished and connectors replaced.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Gas Blocks

gas blocks

Interconnect tx line main

50' of 7-3/16" for connect to combiner.

TX line reducers

(2) 7-3/16" to 6-1/8" reducers

Interconnect tx line aux

150' of 6-1/8" line for connect to combiner.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Lease New
Type Rigid
Diameter 8 3/16 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 1225 feet per run
Justification for New Transmission Line For interim site antenna

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Auxiliary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use Interim Tower
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? Unknown
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1206253
Coordinates (NAD83) Latitude (NAD83) 33° 44' 40.9" N-
Longitude (NAD83) 084° 21' 35.7" W-
Overall Structure Height 1080.04 feet
Support Structure Height 956.03 feet
Ground Elevation Above Mean Sea Level (AMSL) 969.15 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 05/14/2002

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
48813 WUVG-DT DTV
168094 WYGA-CD DTV
64033 WPCH-TV DTV
68058 WHSG-TV DTV
55108 WIRE-CD DTV
23959 WRAS FM

Auxiliary 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: Minor Reinforcements needed

Auxiliary 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

Auxiliary Tower

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Other Tower Expenses Not Listed

Name Description

Interim Tower Rent

Flat Rate Rental for Interim Use of the ATC Chester Avenue tower. Required while Primary Tower without disruption of the WUPA on-air signal. See Attachment 7A Section 1-B-1.

Interim Tower Mapping

Structural tower mapping to ensure the proper structural information is relayed to engineering for the rigorous structural assessment for the proposed repack equipment.

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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1223132
Coordinates (NAD83) Latitude (NAD83) 33° 48' 26.4" N-
Longitude (NAD83) 084° 20' 21.5" W-
Overall Structure Height 1182.07 feet
Support Structure Height 1056.09 feet
Ground Elevation Above Mean Sea Level (AMSL) 867.12 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Tower, LLC
Date Constructed 03/27/2002

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
48813 WUVG-DT DTV
73161 WKHX-FM FM
73345 WWWQ FM
72120 WGCL-TV DTV
54585 WRFG FM
39735 WSTT AM
23960 WSB-TV DTV
29735 WUBL FM
11275 WWPW FM
13805 WZGC FM
68058 WHSG-TV DTV
11675 WCLK FM
22819 WATL DTV
64033 WPCH-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 Construction Management

(80) hours on Modification project management and RF installation project management for a total of twenty (30) days. See Attachment 6A Section 3-D-1.

Site Security

Site security for installation and storage of Transmission line and materials for 9 days X 12 hours. These materials are a high risk of theft due to the material makeup such as copper, brass and aluminum.

Primary Tower Mapping

Structural tower mapping to ensure the proper structural information is relayed to engineering for the rigorous structural assessment for the proposed repack equipment. See Attachment 6A.

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 250
Explanation Station does not have adequate staff to handle this internally.
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 No
Quantity N/A
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 No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare and file Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare request for Special Temporary Authority No
Quantity N/A
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 No
Prepare or Review FCC Form 399 for Reimbursement No
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

RF System Tests

RF system testing of the primary and interim combiners to ensure all frequencies are tuned for optimal performance. See Attachments 6 and 7 section 1-B-1.

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

ATC Proj Mgmt

Tower construction project management by ATC. Site coordinations.

Interim site tx internal tx line

Install / modify feed line to combiner and test.

Main tx internal tx line

Install / modify feed line to combiner and test.

Site Coordination Meetings

Site coordination meetings with all broadcasters, contractors and vendors involved with the site project. See Attachments 6 and 7 section 1-B-1.

Address Transition Timing

Coordination and transition planning with all parties onsite and management of the timelines and schedules occurring during the repack. See Attachments 6 and 7 section 1-A-1.

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 $3,663,585.64 $3,421,034.86 N/A $1,406,109.38 N/A
Total for all systems $8,250,567.64 $4,654,979.86 N/A $1,722,113.80 N/A
Interim Transmitter ULXTE-72 $1,608,855.00 $1,475,634.22 $758,547.26
Transmitter Control $4,755.00 $4,755.00 Remote Control and Monitoring of Interim Transmitter and Site. Includes shipping. For quote, see Attachment 13. $0.00 Includes Shipping and 8% State Sales Tax. See quote provided as Attachment 13.
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,343,679.22 Includes Transmitter, Mask Filter, RF Accessories, Electrical, Installation & Proof, Tax, and Shipping. See May 2018 Statement, Attachment 5B, which supersedes Attachments 5 and 5A. $758,547.26 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
4" Rigid Conduit and Wiring (Cost per foot) $40,400.00 $38,400.00 N/A N/A N/A
Other Electrical Service: Electrical work including labor and materials not listed elsewhere. See Exhibit 7 $52,500.00 $52,500.00 See Exhibit 7. (Note: Original 399 Filing reversed Primary and Interim Costs. This was corrected in a April, 2018 revision.) $0.00 N/A
Primary Transmitter ULXTE-100 $1,946,500.64 $1,942,600.64 $647,562.12
Transformer 3 phase/480v - 500 KVA $48,400.00 $46,000.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 62.9 kW $1,820,300.64 $1,820,300.64 Present transmitter cannot be re-tuned per manufacturer. Solid state transmitter cost is less than replacement IOT transmitter. Includes Shipping, Tax, and Installation. See Attachment 2A. $647,562.12 N/A
4" Rigid Conduit and Wiring (Cost per foot) $30,300.00 $28,800.00 N/A N/A N/A
Other Electrical Service: Electrical work. Includes labor and materials not already listed. $47,500.00 $47,500.00 Electrical service required for new transmitter and transmitter cooling equipment. (Note: Original 399 Filing reversed Primary and Interim Costs. This was corrected in a April, 2018 revision.) N/A N/A
Auxiliary Transmitter NV8303 $108,230.00 $2,800.00 $0.00
UHF and VHF - minor banding issues $105,200.00 $0.00 N/A N/A N/A
1.5 kW mask filter $3,030.00 $2,800.00 N/A N/A N/A

Components

Actual Information Description File Name
Transmitter Control

Component Description:
Excludes $1,200 Annual Support Contract at Primary Site which is not a Repack Related Expense. Adds Shipping not shown on original estimate, Attachment 13.
Amount:
$4,755.00
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
Interim Transmitter Down Payment. Please see May 2018 Statement and Attachment 5B.
Amount:
$379,273.63

Component Description:
Interim transmitter progress payment. See May 2018 Statement and Attachment 5B.
Amount:
$379,273.63
Switchgear - industrial 800 amp Information not provided.
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other Electrical Service: Electrical work including labor and materials not listed elsewhere. See Exhibit 7 Information not provided.
Transformer 3 phase/480v - 500 KVA Information not provided.
UHF - Liquid Cooled Solid State Transmitter 62.9 kW

Component Description:
Primary Transmitter Down Payment. See Attachment 8D for an explanation of the "more than 1/3" down payment amount specified in GatesAir's terms. This invoice excludes tax and shipping.
Amount:
$647,562.12
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other Electrical Service: Electrical work. Includes labor and materials not already listed. Information not provided.
UHF and VHF - minor banding issues Information not provided.
1.5 kW mask filter 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 $1,413,655.00 $423,608.00 N/A $105,902.00 N/A
Total for all systems $8,250,567.64 $4,654,979.86 N/A $1,722,113.80 N/A
Interim Antenna PEPL48D-C170-2-6 $196,675.00 $115,395.00 $28,848.75
Combiner Installation $5,000.00 $5,000.00 See EXHIBIT $1,250.00 N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $3,600.00 N/A $900.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $22,500.00 N/A $5,625.00 N/A
UHF - High Power Top Mount Five Station broadband panel antenna elliptically or circularly polarized $81,795.00 $81,795.00 To accommodate move. See Attachment 7 $20,448.75 N/A
Sweep test of existing antenna $6,730.00 $2,500.00 N/A $625.00 N/A
Primary Antenna 14 bay, 4 around,, 56 ele total $1,216,980.00 $308,213.00 $77,053.25
UHF - High Power Top Mount (200-1000 kW), Four Station broadband panel antenna, elliptically or circularly polarized $1,090,000.00 $202,113.00 See Attachment 6, Page 1. This is WUPA's pro rata share. $50,528.25 N/A
Sweep test of existing antenna $6,730.00 $5,000.00 N/A $1,250.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $66,000.00 N/A $16,500.00 N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $18,000.00 N/A $4,500.00 N/A
Dielectric Combiner Installation $17,100.00 $17,100.00 Cost includes removal of existing combiner. $4,275.00 N/A

Components

Actual Information Description File Name
Combiner Installation

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Combiner Installation, Attachment 7A section 3-C-2.
Amount:
$1,250.00
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Antenna Elbow Complex, Attachment 7A section 3-C-2.
Amount:
$900.00
New combiner, cost per channel (without antenna)

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Combiner, Attachment 7A section 3-C-1.
Amount:
$5,625.00
UHF - High Power Top Mount Five Station broadband panel antenna elliptically or circularly polarized

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Antenna, Attachment 7A section 3-B.
Amount:
$20,448.75
Sweep test of existing antenna

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Antenna Line Sweep Test, Attachment 7A section 3-C-2.
Amount:
$625.00
UHF - High Power Top Mount (200-1000 kW), Four Station broadband panel antenna, elliptically or circularly polarized

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Antenna, Attachment 6A section 3-B.
Amount:
$50,528.25
Sweep test of existing antenna

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Antenna Line RF Sweep Test, Attachment 6A section 3-C-2.
Amount:
$1,250.00
New combiner, cost per channel (without antenna)

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Combiner, Attachment 6A section 3-C-1.
Amount:
$16,500.00
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Antenna Elbow Complex, Attachment 6A section 3-C-2.
Amount:
$4,500.00
Dielectric Combiner Installation

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Combiner Installation, Attachment 6A section 3-C-2.
Amount:
$4,275.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,432,725.00 $177,055.00 N/A $29,488.75 N/A
Total for all systems $8,250,567.64 $4,654,979.86 N/A $1,722,113.80 N/A
Interim Transmission Line $488,775.00 $46,121.00 $11,530.25
Rigid Transmission Line - copper, 8 3/16" broadband $488,775.00 $46,121.00 N/A $11,530.25 N/A
Primary Transmission Line $943,950.00 $130,934.00 $17,958.50
Interconnect tx line aux $28,800.00 $28,800.00 Aux transmitter interconnect to combiner. 150ft of 6-1/8" rigid copper line. N/A N/A
TX line reducers $4,500.00 $4,500.00 Required for line adapter from 7-3/16" to 6-1/8" combiner aux interconnect. N/A N/A
Interconnect tx line main $13,800.00 $13,800.00 50ft of 7-3/16" line for main tx connect to combiner. Published price. N/A N/A
Rigid Transmission Line - copper, 8 3/16" $884,850.00 $71,834.00 Primary Site Transmission Line (pro rata share). See Attachment 6 section 3-A. $17,958.50 N/A
Gas Blocks $12,000.00 $12,000.00 Required for aux interconnect to combiner N/A N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 8 3/16" broadband

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Transmission Line, Attachment 7A section 3-A.
Amount:
$11,530.25
Interconnect tx line aux Information not provided.
TX line reducers Information not provided.
Interconnect tx line main Information not provided.
Rigid Transmission Line - copper, 8 3/16"

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Transmission Line, Attachment 6A section 3-A.
Amount:
$17,958.50
Gas Blocks 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 $1,541,147.00 $452,947.00 N/A $153,729.50 N/A
Total for all systems $8,250,567.64 $4,654,979.86 N/A $1,722,113.80 N/A
Primary Tower GTOWER $882,067.00 $328,367.00 $80,020.75
Site Security $1,800.00 $1,800.00 Site security for installation and storage of Transmission line and materials for 9 days X 12 hours. These materials are a high risk of theft due to the material makeup such as copper, brass and aluminum. See Attachment 6A Section 1-B-1. $450.00 N/A
Tower Construction Management $10,000.00 $10,000.00 (80) hours on Modification project management and RF installation project management for a total of twenty (30) days. See Attachment 6A section 3-D-1. $2,500.00 N/A
Primary Tower Mapping $8,267.00 $8,267.00 Structural tower mapping to ensure the proper structural information is relayed to engineering for the rigorous structural assessment for the proposed repack equipment. See Attachment 6A section 3-A-1. $2,066.75 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $136,000.00 N/A $34,000.00 N/A
Major tower reinforcement/modifications $421,000.00 $157,500.00 N/A $39,375.00 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $14,800.00 N/A $1,629.00 N/A
Auxiliary Tower GTOWER $659,080.00 $124,580.00 $73,708.75
Interim Tower Rent $57,600.00 $57,600.00 Flat rate for rental of interim tower while work is being done at the primary tower required to permit stations to continue broadcasting during modification in a safe and timely manner. See Attachment 6A, section 1-B-1. $57,600.00 N/A
Interim Tower Mapping $2,480.00 $2,480.00 Structural tower mapping to ensure the proper structural information is relayed to engineering for the rigorous structural assessment for the proposed repack equipment. See Attachment 7 section 3-A-1. $620.00 N/A
Minor tower reinforcement/modifications $158,000.00 $15,000.00 N/A $3,750.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $45,000.00 N/A $11,250.00 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $4,500.00 N/A $488.75 N/A

Components

Actual Information Description File Name
Site Security

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Site Security, Attachment 6A section 1-B-1.
Amount:
$450.00
Tower Construction Management

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Construction Management, Attachment 6A section 3-D-1.
Amount:
$2,500.00
Primary Tower Mapping

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Mapping, Attachment 6A section 3-A-1.
Amount:
$2,066.75
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Rigging, Attachment 6A section 3-C-1.
Amount:
$34,000.00
Major tower reinforcement/modifications

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Reinforcement, Attachment 6A section 3-C-2.
Amount:
$39,375.00
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Structural Analysis, Attachment 6A section 3-A-1.
Amount:
$1,629.00
Interim Tower Rent

Component Description:
Interim Tower Rental - Flat Rate. See Attachment 6A, section 1-B-1.
Amount:
$57,600.00
Interim Tower Mapping

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Tower Mapping, Attachment 7A section 3-A-1.
Amount:
$620.00
Minor tower reinforcement/modifications

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Tower Reinforcement, Attachment 7A section 3-A-2.
Amount:
$3,750.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Tower Complex Rigging, Attachment 7A section 3-C-1.
Amount:
$11,250.00
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Tower Structural Analysis, Attachment 7A section 3-A-1.
Amount:
$488.75

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 $82,645.00 $70,825.00 N/A $12,194.17 N/A
Total for all systems $8,250,567.64 $4,654,979.86 N/A $1,722,113.80 N/A
Outside Professional Services $82,645.00 $70,825.00 $12,194.17
RF System Tests $10,000.00 $10,000.00 Testing of the primary and interim combiners to ensure all frequencies are tuned for optimal patterns. See Attachments 6A and 7A section 1-B-1. $2,500.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
RF Exposure Measurements $21,050.00 $8,000.00 N/A $1,250.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $10,825.00 Engineering studies for new channel assignment and antenna development. See Attachments 6 and 7 section 1-A-1 ($5,000 each) and Attachment 16 ($825). $3,325.00 N/A
Project management of the transition $39,500.00 $37,500.00 N/A $3,494.17 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,625.00 N/A

Components

Actual Information Description File Name
RF System Tests

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Combiner Tests, Attachment 6A section 1-B-1.
Amount:
$1,250.00

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Combiner Tests, Attachment 7A section 1-B-1.
Amount:
$1,250.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Exposure Measurements

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Antenna RF Exposure Measurements, Attachment 6A section 1-A-4.
Amount:
$1,250.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A). This amount is 25% of primary antenna development, Attachment 6A section 1-A-2.
Amount:
$1,250.00

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Antenna Development, Attachment 7A section 1-A-2.
Amount:
$1,250.00

Component Description:
Conduct preliminary review of repacked channel with prospective shared antenna. See Attachment 16.
Amount:
$825.00
Project management of the transition

Component Description:
Project Management and Repack Implementation. Please see Attachment 15.
Amount:
$3,156.67

Component Description:
Project Management and Repack Implementation. Review American Tower site plans.
Amount:
$337.50
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Develop final ERP and operating parameters for Construction Permit application. See Attachment 16.
Amount:
$1,625.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $116,810.00 $109,510.00 N/A $14,690.00 N/A
Total for all systems $8,250,567.64 $4,654,979.86 N/A $1,722,113.80 N/A
Other Expenses $116,810.00 $109,510.00 $14,690.00
MVPD Notification of Channel Change $1,500.00 $1,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
Site Coordination Meetings $3,500.00 $3,500.00 Site coordination meetings with all broadcasters, contractors and vendors involved with the site project. See Attachments 6 and 7 section 1-B-1. $875.00 N/A
Main tx internal tx line $7,000.00 $7,000.00 Install line from transmitter to combiner and test. N/A N/A
Interim site tx internal tx line $4,000.00 $4,000.00 Install line from transmitter to combiner and test. N/A N/A
ATC Proj Mgmt $28,960.00 $28,960.00 American Tower project management and oversight for primary and interim tower. See Attachments 6 and 7 sections 3-D-1 and 1-A-1. $4,740.00 N/A
Equipment Delivery and Handling Charges $15,000.00 $15,000.00 N/A $2,083.25 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $20,000.00 $20,000.00 Remove and dispose of transmitter and associated non-reused equipment. $666.75 N/A
Address Transition Timing $5,000.00 $5,000.00 Coordination and transition planning with all parties onsite and management of the timelines and schedules occurring during the repack. See Attachments 6 and 7 section 1-A-1. $1,250.00 N/A
Non-zoning permits $20,300.00 $20,300.00 Prepare drawings for permits and permit filing costs for Main and Interim tower work. See Attachments 6 and 7, sections 3-D-1 and 1-A-3. $5,075.00 N/A
DTV Medical Facility Notification $11,550.00 $4,250.00 N/A N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Site Coordination Meetings

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Site Coordination Meetings, Attachment 6A section 1-B-1.
Amount:
$625.00

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Site Coordination Meetings, Attachment 7A section 1-B-1.
Amount:
$250.00
Main tx internal tx line Information not provided.
Interim site tx internal tx line Information not provided.
ATC Proj Mgmt

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Tower Project Management, Attachment 7A section 1-A-1.
Amount:
$2,370.00

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Project Management, Attachment 7A section 1-A-1.
Amount:
$2,370.00
Equipment Delivery and Handling Charges

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Equipment Delivery and Handling, Attachment 6A section 1-A-4.
Amount:
$2,083.25
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Site Disposal Costs, Attachment 6A section 1-A-4.
Amount:
$666.75
Address Transition Timing

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Tower Address Transition Timing, Attachment 6A section 1-A-1.
Amount:
$625.00

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Address Transition Timing, Attachment 7A section 1-A-1.
Amount:
$625.00
Non-zoning permits

Component Description:
Invoice is 25% Down Payment for $187,690.00 ATC primary site quote. (See Attachment 6A.) This amount is 25% of Primary Building and Tower drawings and building permit fees. See Attachment 6A sections 3-D-1 and 1-A-3.
Amount:
$2,537.50

Component Description:
Invoice is 25% Down Payment for $64,770.25 ATC interim site quote. (See Attachment 7A). This amount is 25% of Interim Building and Tower drawings and building permit fees. See Attachment 7A sections 3-D-1 and 1-A-3.
Amount:
$2,537.50
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $8,250,567.64 $4,654,979.86 $1,722,113.80

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.

Andrew J Siegel

Assistant Secretary


10/17/2018

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.

Andrew J Siegel

Assistant Secretary


10/17/2018

Attachments

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