Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission)FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

File Number:
0000025981
FRN:
0003482189
Facility ID:
9610
Repack Channel:
36 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
12/28/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CBS BROADCASTING INC.

Doing Business As: CBS BROADCASTING INC.

Daniel G. Ryson

1725 DeSales St. NW

Suite 501

WASHINGTON, DC 20036

United States

+1 (202) 457-4074 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. Ryson

Associate Director Spectrum Management

CBS

Daniel 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 Facility has dual broadband antennas and combiners. One transmitter and combiner will be pretuned to the post-transition channel and enabled at the appropriate time. The other transmitter and combiner will then be retuned.

Transmitters

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

Auxiliary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Alternate Main
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Diamond
Year 2008
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 25 kw
Other Transmitter Type  

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Description of Use Alternate Main
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXT-80
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 68.5 kw
Other Transmitter Type  
Justification for New Transmitter Harris cannot retune existing transmitter. New FCC allocation requires greater TPO than original to maintain proper coverage on new channel.

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
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service Yes
Description Install Electrical Power Distribution Including Panel Boards, Cable Tray, Cables, Recepacles, Transformers, and Grounding System.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Install Transmitter, Racks

Installation of Transmitter Cabinets and Racks.

Cooling Pumps, Etc.

Install cooling pumps, piping, hoses, heat exchangers.

Miscellaneous

General Conditions, Contract Submittals, Documentation, Mobilization, Misc. Installation Materials, Hardware, and Field Testing.

Terminate and Test

Other transmitter costs, delivery, handling, etc. See Attachment 6, Schedule D, Item 8.

Electrical Accessories

75 kVA 480v/208V Transformer, Parallel Surge Suppressor

Closeout Documents

Closeout documentation (warranties, certifications, as-built drawings, etc.) See Attachment 6, Schedule B, Item 3.

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Used When Main Site Isn't Available
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Diamond
Year 2002
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 10.5 kw
Other Transmitter Type  

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Description of Use When Main Site Is Unavailable
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXT-80
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 68.5 kw
Other Transmitter Type  
Justification for New Transmitter Please see attached statement.

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service No
Description  
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 1500.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Installation

West Orange, NJ Transmitter Installation.

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  
Ownership Owned
Owner  
Site  
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 2009
Type Inductive Output Tube
IOT Power Type Two
Description  
Power capacity 42 kw
Solid State Cooling  
Solid State Power Capacity  
Other Transmitter Type  

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Description of Use  
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXT-80
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 68.5 kw
Other Transmitter Type  
Justification for New Transmitter Gates/Harris has stipulated that it cannot and will not attempt to retune any IOT transmitters

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service Yes
Description Install Electrical Power Distribution Including Panel Boards, Cable Tray, Cables, Recepacles, Transformers, and Grounding System.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Switchless Combiner

Magic Tee Switchless Combiner

Install Transmitter, Racks

Installation of Transmitter Cabinets and Racks.

Closeout Documents

Closeout documentation (warranties, certifications, as-built drawings, etc.) See Attachment 6, Schedule B, Item 3.

Cooling Pumps, Etc.

Install cooling pumps, piping, hoses, heat exchangers.

Terminate and Test

Other transmitter costs, delivery, handling, etc. See Attachment 6, Schedule D, Item 8.

Miscellaneous

General Conditions, Contract Submittals, Documentation, Mobilization, Misc. Installation Materials, Hardware, and Field Testing.

Antennas

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

Auxiliary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Retune Existing
Antenna Use Auxiliary (Backup)
Description of Use When Main Site Isn't Available
Ownership Leased
Owner American Tower Corporation
Site N/A
Is this antenna currently shared with any other stations? Yes
Is this antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top-mount single
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 5
Number of Panels 34
Design power capacity in use 7.0 %
Lower Limit 506.00 MHz
Upper Limit 725.00 MHz
Other Antenna Type N/A
ERP: 2041.00 kW
Manufacturer Dielectric
Model TUD C5SP-10/34U-2-B
Year 2006

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

Facility ID Call Sign
47535 WNBC
22206 WNYW
73333 WNJU
74197 WWOR-TV

Auxiliary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? No

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type Additional Module
Number of channels supported 1
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
36

Auxiliary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Auxiliary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Lease New
Antenna Use Auxiliary (Backup)
Description of Use When Primary Unavailable
Ownership Leased
Owner Durst Broadcasting
Site N/A
Is this antenna currently shared with any other stations? Yes
Is this 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 Side-mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 4
Number of Panels 96
Design power capacity in use 75.0 %
Lower Limit 470.00 MHz
Upper Limit 656.00 MHz
Other Antenna Type N/A
ERP: 241.00 kW
Manufacturer RFS
Model PEP96L
Year 2015

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

Facility ID Call Sign
74197 WWOR-TV
22206 WNYW
47535 WNBC
73333 WNJU

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use When Primary Unavailable
Change Type Lease New
Is this a request for upgraded equipment? No
Ownership Leased
Owner Durst Broadcasting
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 Side-mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 4
Number of Panels/Bays 96
Lower Limit 470.00 MHz
Upper Limit 656.00 MHz
Design power capacity in use 75.0 %
Other Antenna Type N/A
ERP: 241.00 kW
Manufacturer
Model PEP-96L
Year 2015
Justification for New Antenna Replaces Existing Auxiliary

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type Additional Module
Number of channels supported 1
Frequencies of channels supported RF channel
Frequency N/A
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? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Enter a list of RF channel numbers.

RF Channel Number
36

Auxiliary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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 Leased
Owner Empire State Building
Site N/A
Is the existing antenna shared with another station or stations? Yes
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 Side-mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Other Type
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 Composite Antenna
ERP: 284.00 kW
Manufacturer Dielectric
Model ESBTUF80
Year 2008

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

Facility ID Call Sign
74197 WWOR-TV
47535 WNBC

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? No
Ownership Leased
Owner Durst Broadcasting
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 stacked
Antenna position in stack Middle
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 5
Number of Panels/Bays 40
Lower Limit 470.00 MHz
Upper Limit 656.00 MHz
Design power capacity in use 46.0 %
Other Antenna Type N/A
ERP: 455.00 kW
Manufacturer
Model PEP40E
Year 2015
Justification for New Antenna Please see Statement.

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 Additional Module
Number of channels supported 1
Frequencies of channels supported RF channel
Frequency N/A
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? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Enter a list of RF channel numbers.

RF Channel Number
36

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Myat
Type Rigid
Diameter 8 3/16 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 165 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Gas Barriers

See Attachment 37. Gas barriers required to pressurize primary transmission line.

Auxiliary Transmission Line

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Add Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use When Main Site Unavailable
Ownership Owned
Owner N/A
Site N/A
Is this transmission currently shared with any other stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Segment Length 19 ½ '
Other Segment Length
Number of parallel runs 1
Length 65 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use When Main Site Unavailable
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 65 feet per run
Justification for New Transmission Line Incorrect segment lengths for channel 36.

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 8 3/16 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 2
Length 165 feet per run
Justification for New Transmission Line Additional line to feed new main and auxiliary, pre-transition combiner modules.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Gas Barriers

See Attachment 37. Gas barriers required to pressurize interim transmission line.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Located on Building
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
ASR Number 1263701
Coordinates (NAD83) Latitude (NAD83) 40° 42' 46.8" N-
Longitude (NAD83) 074° 00' 47.3" W-
Overall Structure Height 1791.97 feet
Support Structure Height 1334.63 feet
Ground Elevation Above Mean Sea Level (AMSL) 14.11 feet
Structure Type BTWR - Building with Tower
Tower Owner Port Authority of New York and New Jersey
Date Constructed 05/10/2013

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
73333 WNJU DTV
73356 WPXN-TV DTV
47535 WNBC 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: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Install Transmission Line

Install transmission line between transmitters and combiner modules

Auxiliary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use When Primary Unavailable
Ownership Leased
Is this tower consider Complex? No
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 1060205
Coordinates (NAD83) Latitude (NAD83) 40° 48' 07.6" N-
Longitude (NAD83) 074° 14' 45.5" W-
Overall Structure Height 339.89 feet
Support Structure Height 299.87 feet
Ground Elevation Above Mean Sea Level (AMSL) 622.04 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Tower, LLC
Date Constructed 01/01/1974

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
73333 WNJU DTV
22206 WNYW DTV
74197 WWOR-TV DTV

Auxiliary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Auxiliary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Auxiliary Tower

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Other Tower Expenses Not Listed

Information not provided.

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 Company lacks sufficient internal resources.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority 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 Yes
Prepare or Review FCC Form 399 for Reimbursement No
Address transition timing and coordination issues w/ other stations and wireless providers Yes
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

Electrical Mechanical Structural Engineers

Designs for transmitter and load cooling, switch design, suspending lines, switches, etc.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? No
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

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 $6,892,175.01 $4,624,810.20 N/A $3,915,861.59 N/A
Total for all systems $8,349,623.42 $5,649,650.61 N/A $4,295,532.32 N/A
Primary Transmitter ULXT-80 $2,384,998.15 $2,129,418.48 $2,083,999.76
Miscellaneous $85,250.00 $85,250.00 Please see attached Statement 3. $80,393.78 CBS seeks no reimbursement for some Prime Contractor costs and only 50% reimbursement for mobilization costs since some construction at 1WTC would be required even if there was no incentive auction repack.
Terminate and Test $12,250.00 $12,250.00 Other transmitter costs, delivery, handling, etc. Cost split 50/50 with Auxiliary (Alternate Main) Transmitter. See Attachment 6, Schedule D, Item 8 and Statement 3. $9,262.50 N/A
Cooling Pumps, Etc. $89,000.00 $89,000.00 Please see attached statement. $68,800.00 N/A
Closeout Documents $4,750.00 $4,750.00 Closeout documentation (warranties, certifications, as-built drawings, etc.). Cost Split 50/50 with Auxiliary (Alternate Main) Transmitter. See Attachment 6, Schedule B, Item 3 and Statement 3. $4,750.00 N/A
Install Transmitter, Racks $52,500.00 $52,500.00 Please see attached statement. $38,625.00 N/A
Switchless Combiner $125,248.15 $125,248.15 Magic Tee Switchless Combiner. Replaces existing pre-transition combiner. See Statement (Attachment 61) and quotation (Attachment 57). $125,248.15 N/A
Other Electrical Service: Install Electrical Power Distribution Including Panel Boards, Cable Tray, Cables, Recepacles, Transformers, and Grounding System. $70,000.00 $70,000.00 Please see attached Statement 3. $66,500.00 N/A
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW $1,946,000.00 $1,690,420.33 Please see Statement and Attachment 2. $1,690,420.33 N/A
Auxiliary Transmitter ULXT-80 $2,276,101.86 $1,888,530.55 $1,831,861.83
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW $1,946,000.00 $1,558,428.69 Please see Quotes provided as Attachments 32, 33, and 35 plus Invoices for freight (see Attachment 45) and Sales Tax (Attachment 46) for some items shipped to a staging location in nearby, taxable New Jersey. $1,558,428.69 N/A
Electrical Accessories $16,351.86 $16,351.86 Please see quotations provided as Attachments 48 & 49. Site Digital Network Wiring Hardware. $16,351.86 N/A
Install Transmitter, Racks $52,500.00 $52,500.00 Please see attached statement. $38,625.00 N/A
Miscellaneous $85,250.00 $85,250.00 Please see attached Statement 3. $80,393.78 CBS seeks no reimbursement for some Prime Contractor costs and only 50% reimbursement for mobilization costs since some construction at 1WTC would be required even if there was no incentive auction repack.
Other Electrical Service: Install Electrical Power Distribution Including Panel Boards, Cable Tray, Cables, Recepacles, Transformers, and Grounding System. $70,000.00 $70,000.00 Please see attached Statement 3. $39,500.00 N/A
Cooling Pumps, Etc. $89,000.00 $89,000.00 Please see attached statement. $84,550.00 N/A
Terminate and Test $12,250.00 $12,250.00 Other transmitter costs, delivery, handling, etc. Cost split 50/50 with Primary Transmitter. See Attachment 6, Schedule D, Item 8 and Statement 3. $9,262.50 N/A
Closeout Documents $4,750.00 $4,750.00 Closeout documentation (warranties, certifications, as-built drawings, etc.). Cost Split 50/50 with Primary Transmitter. See Attachment 6, Schedule B, Item 3 and Statement 3. $4,750.00 N/A
Auxiliary Transmitter ULXT-80 $2,231,075.00 $606,861.17 $0.00
Transmitter Installation $223,875.00 $223,875.00 Please see attached statement. N/A N/A
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW $1,946,000.00 $322,986.17 Please see attached statement. N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,050.00 $13,700.00 N/A N/A N/A
Switchgear - industrial 800 amp $37,150.00 $36,300.00 N/A N/A N/A
Other -- Building Addition Size: 1500.0 $10,000.00 $10,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Miscellaneous

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$4,231.28

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$6,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 22A.
Amount:
$16,875.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$15,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 21A.
Amount:
$18,000.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$18,787.50
Terminate and Test

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$487.50

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$2,250.00

Component Description:
Prime Contractor costs divided as described in Attachment 44, Table 8.
Amount:
$1,125.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$5,400.00
Cooling Pumps, Etc.

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$4,450.00

Component Description:
Prime Contractor costs divided as described in Attachment 21A.
Amount:
$4,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$15,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$5,850.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$45,000.00

Component Description:
Prime Contractor costs divided as described in Attachment 22A.
Amount:
$9,000.00
Closeout Documents

Component Description:
Prime Contractor costs divided as described in Attachment 52A, Table 11.
Amount:
$4,750.00
Install Transmitter, Racks

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$2,625.00

Component Description:
Prime Contractor costs divided as described in Attachment 22A.
Amount:
$22,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$11,250.00

Component Description:
Prime Contractor costs divided as described in Attachment 21A.
Amount:
$4,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$6,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$2,250.00
Switchless Combiner

Component Description:
Magic Tee Switchless Combiner Down Payment. See Attachment 59.
Amount:
$83,498.77

Component Description:
Magic Tee Switchless Combiner Down Payment. See Attachment 58.
Amount:
$41,749.38
Other Electrical Service: Install Electrical Power Distribution Including Panel Boards, Cable Tray, Cables, Recepacles, Transformers, and Grounding System.

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$3,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$27,000.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$11,250.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$2,250.00

Component Description:
Electrical Contractor costs divided as described in Attachment 22A.
Amount:
$9,000.00

Component Description:
Electrical Contractor costs divided as described in Attachment 21A.
Amount:
$13,500.00
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW

Component Description:
1/3 Downpayment for Primary Transmitter.
Amount:
$563,473.44

Component Description:
Final Payment for WCBS-TV Primary Transmitter.
Amount:
$1,126,946.89
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW

Component Description:
Backup Transmitter Installation Materials and Additional Time for Installation and Proof. See Quote provided as Attachment 33.
Amount:
$216,314.75

Component Description:
This Invoice duplicates fees shown in GatesAir Invoice GO10004638-G. Please disregard.
Amount:
N/A

Component Description:
Backup Transmitter - Does not include transformer or installation. See quote provided as Attachment 32.
Amount:
$1,307,017.95

Component Description:
Waveguide Kit Required for Interim transmitter to interface with switches and antenna system. See Attachment 35A.
Amount:
$35,095.99
Electrical Accessories

Component Description:
Fiber Optic Cable used for controlling transmitter equipment and site.
Amount:
$7,872.31

Component Description:
Network Hardware used for controlling transmitter equipment and site.
Amount:
$8,479.55
Install Transmitter, Racks

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$2,250.00

Component Description:
Prime Contractor costs divided as described in Attachment 22A.
Amount:
$22,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 21A.
Amount:
$4,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$6,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$2,625.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$11,250.00
Miscellaneous

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$4,231.28

Component Description:
Prime Contractor costs divided as described in Attachment 21A.
Amount:
$18,000.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$6,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 22A.
Amount:
$16,875.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$15,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$18,787.50
Other Electrical Service: Install Electrical Power Distribution Including Panel Boards, Cable Tray, Cables, Recepacles, Transformers, and Grounding System.

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$3,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$2,250.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$27,000.00

Component Description:
Prime Contractor costs divided as described in Attachment 21A.
Amount:
$13,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$11,250.00

Component Description:
Prime Contractor costs divided as described in Attachment 22A.
Amount:
$9,000.00
Cooling Pumps, Etc.

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$4,450.00

Component Description:
Prime Contractor costs divided as described in Attachment 23A.
Amount:
$15,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 21A.
Amount:
$4,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$5,850.00

Component Description:
Prime Contractor costs divided as described in Attachment 22A.
Amount:
$9,000.00

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$45,000.00
Terminate and Test

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$487.50

Component Description:
Prime Contractor costs divided as described in Attachment 24B.
Amount:
$2,250.00

Component Description:
Prime Contractor costs divided as described in Attachment 44, Table 8.
Amount:
$1,125.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$5,400.00
Closeout Documents

Component Description:
Prime Contractor costs divided as described in Attachment 52A, Table 11.
Amount:
$4,750.00
Transmitter Installation Information not provided.
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW Information not provided.
Service entrance 3 phase/800 amp/208 volt Information not provided.
Switchgear - industrial 800 amp Information not provided.
Other -- Building Addition Size: 1500.0 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 $253,100.00 $263,898.00 N/A $0.00 N/A
Total for all systems $8,349,623.42 $5,649,650.61 N/A $4,295,532.32 N/A
Primary Antenna PEP40E $86,550.00 $91,874.00 $0.00
Adding a module to existing combiner (without antenna) $80,000.00 $85,474.00 Modify and Retune Combiner. See Quote in Attachment 62 divided by two. The other half is shown under the 1WTC auxiliary antenna section. N/A N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A N/A N/A
UHF - High Power Top Mount Five Station broadband panel antenna elliptically or circularly polarized $0.00 $0.00 Using Existing Antenna. N/A N/A
Auxiliary Antenna TUD C5SP-10/34U-2-B $80,000.00 $80,000.00 $0.00
Adding a module to existing combiner (without antenna) $80,000.00 $80,000.00 N/A N/A N/A
UHF - High Power Top Mount Five Station broadband panel antenna horizontally polarized $0.00 $0.00 Using Existing Antenna. N/A N/A
Auxiliary Antenna PEP-96L $86,550.00 $92,024.00 $0.00
UHF - High Power, Side Mount, broadband panel, 96 bay,, 241 kW input, elliptically or circularly polarized $0.00 $0.00 Using Existing Antenna N/A N/A
Adding a module to existing combiner (without antenna) $80,000.00 $85,474.00 Modify and Retune Combiner. See Quote in Attachment 62 divided by two. The other half is shown under the 1WTC main antenna section. N/A N/A
Sweep test of existing antenna $6,550.00 $6,550.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $155,158.41 $211,325.41 N/A $196,397.95 N/A
Total for all systems $8,349,623.42 $5,649,650.61 N/A $4,295,532.32 N/A
Interim Transmission Line $135,196.71 $191,688.71 $189,241.25
Rigid Transmission Line - copper, 8 3/16" broadband $128,040.00 $184,532.00 Replace Widelity Cost with Estimated and Actual Costs. See Attachment 26 plus shipping from Attachments 38, 39, and 64. Transmission line includes many custom length cut sections, elbows, etc. due to being used within a building. $182,084.54 N/A
Gas Barriers $7,156.71 $7,156.71 Required to pressurize interim transmission line. See Quote and Invoice (Attachment 37B) which includes shipping. This cost is divided 50/50 between primary and interim transmission line cost categories. $7,156.71 N/A
Primary Transmission Line $7,156.70 $7,156.70 $7,156.70
Gas Barriers $7,156.70 $7,156.70 Required to pressurize interim transmission line. See Quote and Invoice (Attachment 37B) which includes shipping. This cost is divided 50/50 between primary and interim transmission line cost categories. $7,156.70 N/A
Auxiliary Transmission Line $12,805.00 $12,480.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $12,805.00 $12,480.00 N/A N/A N/A

Components

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

Component Description:
Transmission Line Partial Shipment. See Quote Attachment 26.
Amount:
$31,014.00

Component Description:
Transmission Line Partial Shipment. See Quote Attachment 26.
Amount:
$64,969.00

Component Description:
Transmission Line Partial Shipment. See Estimate Attachment 26.
Amount:
$77,315.00

Component Description:
See Attachment 26 line items 9, 10, 13. Includes Freight.
Amount:
$6,860.54

Component Description:
See Exhibit 26 Line 8.
Amount:
$1,926.00
Gas Barriers

Component Description:
Pressurize interim transmission line. Cost split 50/50 with primary transmission line. See Quote and Invoice in Attachment 37B.
Amount:
$7,156.71
Gas Barriers

Component Description:
Required to pressurize primary transmission line. See Quote and Invoice in Attachment 37B. Cost is split 50/50 with interim transmission line.
Amount:
$7,156.70
Rigid Transmission Line - copper, 6 1/8" 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 $598,400.00 $107,000.00 N/A $101,650.00 N/A
Total for all systems $8,349,623.42 $5,649,650.61 N/A $4,295,532.32 N/A
Primary Tower BTWR $516,500.00 $107,000.00 $101,650.00
Install Transmission Line $107,000.00 $107,000.00 See Attachment 6, Schedule D, Item 4. $101,650.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $409,500.00 $0.00 Using Existing Antenna. N/A N/A
Auxiliary Tower LTOWER $81,900.00 $0.00 $0.00
Short Tower (less than 500') $81,900.00 $0.00 Using Existing Antenna. N/A N/A

Components

Actual Information Description File Name
Install Transmission Line

Component Description:
Prime Contractor costs divided as described in Statement 3.
Amount:
$4,500.00

Component Description:
Prime Contractor costs divided as described in Attachment 50, Table 9.
Amount:
$4,375.00

Component Description:
Prime Contractor costs divided as described in Attachment 51, Table 10.
Amount:
$18,525.00

Component Description:
Prime Contractor costs divided as described in Statement 3.
Amount:
$31,500.00

Component Description:
Prime Contractor costs divided as described in Statement 3.
Amount:
$6,750.00

Component Description:
Prime Contractor costs divided as described in Attachment 44, Table 8.
Amount:
$18,000.00

Component Description:
Prime Contractor costs divided as described in Attachment 43C, Table 7.
Amount:
$18,000.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Short Tower (less than 500') Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $125,557.00 $123,542.00 N/A $47,417.00 N/A
Total for all systems $8,349,623.42 $5,649,650.61 N/A $4,295,532.32 N/A
Outside Professional Services $125,557.00 $123,542.00 $47,417.00
Electrical Mechanical Structural Engineers $44,542.00 $44,542.00 Please see Attachment 22, 28, and 28A. $44,542.00 N/A
RF Exposure Measurements $20,500.00 $20,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,095.00 $4,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,535.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,535.00 $1,500.00 N/A N/A N/A
Project management of the transition $38,500.00 $37,500.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,560.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A $1,100.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $3,000.00 N/A $1,775.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,050.00 $2,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Electrical Mechanical Structural Engineers

Component Description:
Engineering Work Due to Transmitter Site Design Refinements.
Amount:
$44,542.00
RF Exposure Measurements Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Project management of the transition Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Redo Channel Interference Study using New OET TVStudy software.
Amount:
$550.00

Component Description:
Preliminary Channel Interference Study - April 2017
Amount:
$550.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare Engineering Section of FCC Application.
Amount:
$1,775.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $238,683.00 $232,675.00 N/A $34,205.78 N/A
Total for all systems $8,349,623.42 $5,649,650.61 N/A $4,295,532.32 N/A
Other Expenses $238,683.00 $232,675.00 $34,205.78
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $35,000.00 $35,000.00 N/A $28,955.78 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $186,100.00 $186,100.00 Please see attached statement. N/A N/A
Local Zoning $1,000.00 $1,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $333.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,250.00 $5,250.00 See quote provided as Attachment 53 $5,250.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Transmitter Waveguide Kit Freight.
Amount:
$474.48

Component Description:
Magic Tee Switchless Combiner Freight.
Amount:
$1,250.00

Component Description:
Transmitter Freight
Amount:
$4,600.00

Component Description:
Delivery - Distilled Water
Amount:
$970.00

Component Description:
Transmission Line Delivery
Amount:
$21,661.30

Component Description:
Delivery Distilled Water
Amount:
$970.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Local Zoning Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
See Quote provided as Attachment 53.
Amount:
$5,250.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $8,349,623.42 $5,649,650.61 $4,295,532.32

Construction Status

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Question Response
Is construction complete? 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


12/28/2018

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that 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).

  4. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  5. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

  6. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  7. 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


12/28/2018

Attachments

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