TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
VICTORY TELEVISION NETWORK, INC.	Jim Grant P.O. BOX 26207 LITTLE ROCK, AR 72221 United States	+1 (501) 223-2525	jim.grant@vtntv.com	Corporation

Applicant

Address

Phone

Applicant Type

VICTORY TELEVISION NETWORK, INC.

Jim Grant

P.O. BOX 26207

LITTLE ROCK, AR 72221

United States

+1 (501) 223-2525

jim.grant@vtntv.com

Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
The Preparer is same as the reimbursement contact.

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	No
Briefly describe transition plan	Please see attached Transition Plan Narrative.

Transmitters

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

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	CST II
	Year	1997
	Type	Inductive Output Tube
	IOT Power Type	Two
	Power Capacity	60 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	THU9-48Evo
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	37 kW
	Justification for New Transmitter	Existing transmitter manufacturer, ABS, is no longer in business.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	Yes
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	Yes
	Size	4 inches
	Length	300.0 feet
	Other Electrical Service	Yes
	Description	Electrical installation for transmitter and other items related to overall KVTJ-DT electrical project.
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Heating and Cooling
	Size	20 tons
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	Yes
	Size	816.0 square feet
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Transport Stream Processing and Evaluation	KVTJ-DT has always required a transport stream multiplexer & encoder located at the transmit site. We will need another multiplexer & associated equipment to transition between transmitters.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	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	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	780.0 kW
	Manufacturer
	Model	TFU-31JTH-R 04
	Year	1998

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	No
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	420.0 kW
	Manufacturer
	Model	TFU-22JTH-R-O4
	Year	2018
	Justification for New Antenna	Antenna is slotted coaxial and cut to a single channel. As such, it is not retunable.

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	No
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	Single Channel
	Feed Line Size	6 1/8 inches inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	780.0 kW
	Manufacturer
	Model	TFU-24WB-1-R S230
	Year	2018
	Justification for New Antenna	Interim antenna to operate lower on the tower for the pre-auction channel to avoid prolonged off-period during the transition in order to meet the construction deadline.

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	No
	Broadband or Single Channel?	N/A
	Feed Line Size	N/A
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	Yes
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Interim Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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	Dielectric
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1090 feet per run

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Type	Flexible Air
	Diameter	5 inches
	Segment Length	N/A
	Other Segment Length
	Number of parallel runs	1
	Length	950 feet per run
	Justification for New Transmission Line	Interim transmission line to operate lower on the tower for the pre-auction channel to avoid prolonged off-period during the transition in order to meet the construction deadline.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	Is tower documented for structural analysis?	Yes
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1048797
Coordinates (NAD83)	Latitude (NAD83)	35° 36' 16.0" N-
	Longitude (NAD83)	090° 31' 18.0" W-
	Overall Structure Height	999.99 feet
	Support Structure Height	999.99 feet
	Ground Elevation Above Mean Sea Level (AMSL)	215.88 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Victory Television Network, Inc.
	Date Constructed	04/20/1998

Primary Tower

Tower Modification Costs

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

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Interim Installation	Install interim antenna and transmission line.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	350
	Explanation	Please see the attached Transition Plan Narrative.
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	No
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Outside Engineering Consultant	KVTJ-DT's transition complexity requires a local, outside engineer with subject-matter experience for occasional consulting.

Other Expenses

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

Other Expenses Not Listed

Name	Description
Arkansas Use Tax	We must pay Arkansas use tax on taxable purchases. Our out-of-state vendors are not required to collect or remit the taxes on our behalf. We must calculate and pay use tax ourselves. We have estimated our tax obligation based on our repack budget.
Security Cameras	A set of security cameras in lieu of on-site security, paid personnel to oversee the tower crew, and/or additional storage costs.
Project-related Insurance	Insurance costs directly related to the KVTJ-DT repack project.

Cost Information

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,812,679.00	$1,714,913.00	N/A	$1,163,158.07	N/A
Total for all systems	$4,325,719.65	$4,131,253.85	N/A	$3,097,282.48	N/A
Primary Transmitter THU9-48Evo	$1,812,679.00	$1,714,913.00		$1,163,158.07
20 Ton system	$115,500.00	$102,440.00	Original HVAC system estimate has been revised lower based on the vendor quote received. Cost remains below Widelity Catalog cost range, June 2018 revision. Added a supplemental ducting invoice.	$102,440.00	N/A
Transport Stream Processing and Evaluation	$48,299.00	$48,299.00	KVTJ-DT has always required a transport stream multiplexer & encoder located at the transmit site. We will need a new multiplexer & associated equipment to transition between transmitters (see attached narrative.)	$0.00	N/A
Other -- Building Addition Size: 816.0	$67,980.00	$67,980.00	Addition of the new HVAC on west side of the KVTJ-DT building requires an extension of the building's ice shield and fence line to account for this new equipment. A 1,000 ft tower produces large ice spears that would destroy the HVAC units. See narrative.	$67,980.00	N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	$1,473,000.00	$1,400,000.00	N/A	$921,624.07	N/A
Service entrance 3 phase/800 amp/208 volt	$14,400.00	$13,468.00	Service entrance disconnect upgrade and related labor necessary to integrate KVTJ-DT's service entrance equipment to support the increased electrical capacity needed to complete the repack transition. see narrative.	$13,468.00	N/A
Switchgear - industrial 800 amp	$38,200.00	$28,846.00	Switchgear for KVTJ-DT electrical capacity expansion project. see narrative.	$28,846.00	N/A
4" Rigid Conduit and Wiring (Cost per foot)	$30,300.00	$28,880.00	4" rigid conduit and wiring to support the increase in electrical capacity required to complete the transmitter transition. 300ft needed. see narrative.	$28,800.00	N/A
Other Electrical Service: Electrical installation for transmitter and other items related to overall KVTJ-DT electrical project.	$25,000.00	$25,000.00	hourly labor costs associated with all aspect of KVTJ-DT transmitter electrical installation including capacity expansion project.	N/A	N/A

Components

Actual Information Description	File Name
20 Ton system	Component Description: Ducting work necessary following KVTJ's transition from our pre-repack transmitter to our post-repack transmitter. Adheres to a time and material billing standard. Amount: $2,400.00 Component Description: 20 Ton HVAC System (Heating & Cooling) cost component inclusive of all electrical, ducting, masonry materials, and labor. Amount: $96,240.00 Component Description: Ground and site preparation costs related to installation of the 20-ton HVAC system. Gravel and dirt fill was needed to be placed in the area of the HVAC build out to receive deliveries and perform work with heavy machinery. Amount: $3,800.00
Transport Stream Processing and Evaluation	Component Description: KVTJ-DT Triveni Digital Invoice, Quote, and narrative for transport stream related equipment. Amount: $28,300.00 Component Description: Harmonic Multiplexer for KVTJ-DT for transitioning between existing and new transmitters (see attached narrative.) Amount: $19,999.00
Other -- Building Addition Size: 816.0	Component Description: KVTJ-DT Transmitter building expansion of ice shield and fence line to accommodate repack required HVAC system. Amount: $67,980.00
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	Component Description: Initial payment for primary transmitter & related equipment. The two shipping line items on this invoice are not included in this total. This invoice represents a 30% down payment necessary to start work on this component. Amount: $276,487.23 Component Description: Final payment for KVTJ-DT main transmitter. $92162.40 amount is invoice total minus shipping and tax which are placed on separate cost components within the 399. Amount: $92,162.40 Component Description: 2nd payment for primary transmitter & related equipment. The two shipping line items on this invoice are not included in this total. This invoice represents a 60% down payment necessary to start work on this component. Amount: $552,974.44
Service entrance 3 phase/800 amp/208 volt	Component Description: KVTJ-DT service entrance 3 phase equipment and installation. Amount: $13,468.00
Switchgear - industrial 800 amp	Component Description: KVTJ-DT switchgear and installation. Amount: $28,846.00
4" Rigid Conduit and Wiring (Cost per foot)	Component Description: KVTJ-DT 4" rigid conduit and wiring (cost represented in feet on invoice) Amount: $28,800.00
Other Electrical Service: Electrical installation for transmitter and other items related to overall KVTJ-DT electrical project.	Information not provided.

Cost Information

Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$500,520.00	$485,675.20	N/A	$376,286.70	N/A
Total for all systems	$4,325,719.65	$4,131,253.85	N/A	$3,097,282.48	N/A
Interim Antenna TFU-24WB-1-R S230	$191,990.00	$186,400.00		$177,923.52
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$0.00	The interim scatter study cost will now be bundled into the interim antenna cost component.	N/A	N/A
UHF - High Power, Side Mount, basic slot antenna, 780 kW input, directional,, horizontally polarized	$180,000.00	$180,000.00	Catalog estimated cost for UHF-Lower Power Side Mount: One station - 200-500kW, horizontally polarized	$171,523.52	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
Primary Antenna TFU-22JTH-R-O4	$308,530.00	$299,275.20		$198,363.18
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$275,000.00	N/A	$174,087.98	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$17,875.20	Elbow complex required to be integrated at KVTJ-DT was more expensive than the FCC cost estimates contemplated.	$17,875.20	N/A

Components

Actual Information Description	File Name
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 780 kW input, directional,, horizontally polarized	Component Description: Final payment for KVTJ-DT interim antenna. This is the sum of items costing $15,727.04 and $1,425.32 on invoice # 6946. Amount: $17,152.36 Component Description: Initial payment for interim antenna/mount, & the interim scatter study. Scatter study is bundled into cost of interim antenna hardware. This invoice represents a 45% down payment necessary to start work on this component. Amount: $77,185.58 Component Description: 2nd payment for interim antenna/mount, & the interim scatter study. Scatter study is bundled into cost of interim antenna hardware. This invoice represents a 45% down payment necessary to start work on this component. Amount: $77,185.58
Sweep test of existing antenna	Component Description: Final payment for field engineer interim line/antenna sweep study with report. This invoice represents the final payment on this component. Amount: $640.00 Component Description: Initial payment for field engineer interim line/antenna sweep study with report. This invoice represents a 45% down payment necessary to start work on this component. Amount: $2,880.00 Component Description: Initial payment for field engineer interim line/antenna sweep study with report. This invoice represents a 45% down payment necessary to start work on this component. Amount: $2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: Final Payment for KVTJ-DT primary antenna. This is the sum of items costing $15,182.62, $1,912.96, $237.16, & $76.04. Amount: $17,408.78 Component Description: Initial payment for primary antenna/mount. This is an elliptical antenna, but we are not requesting reimbursement ($30912) for the optional aspect. See attached letter. Invoice represents a 45% down payment necessary to start work on this component. Amount: $78,339.60 Component Description: 2nd payment for primary antenna/mount. This is an elliptical antenna, but we are not requesting reimbursement ($30912) for the optional aspect. See attached letter. Invoice represents a 45% down payment necessary to start work on this component. Amount: $78,339.60
Sweep test of existing antenna	Component Description: Final payment for sweep testing of the primary KVTJ-DT antenna and line. Amount: $640.00 Component Description: Initial payment for field engineer primary line/antenna sweep study with report. This invoice represents a 45% down payment necessary to start work on this component. Amount: $2,880.00 Component Description: 2nd payment for field engineer primary line/antenna sweep study with report. This invoice represents a 45% down payment necessary to start work on this component. Amount: $2,880.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: First and only payment for KVTJ-DT Elbow Complex. Amount: $17,875.20

Cost Information

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	$99,750.00	$95,000.00	N/A	$71,613.67	N/A
Total for all systems	$4,325,719.65	$4,131,253.85	N/A	$3,097,282.48	N/A
Interim Transmission Line	$99,750.00	$95,000.00		$71,613.67
Flexible Air Transmission Line - dielectric, 5"	$99,750.00	$95,000.00	N/A	$71,613.67	N/A
Primary Transmission Line	$0.00	$0.00		$0.00

Components

Actual Information Description	File Name
Flexible Air Transmission Line - dielectric, 5"	Component Description: Pressurization manifold that was necessary to interconnect all the feedline hoses to share the dehydrator and integrate the interim transmission line. Amount: $586.00 Component Description: 2nd payment for interim line & related line equipment. This invoice represents a 45% down payment necessary to start work on this component. Amount: $30,484.83 Component Description: Final payment for interim line and parts. This is the sum of items costing $5,046.40, $178.10, $4.19, $178.10, $19.60, $121.95, $127.56, $133.18, $6.12, $0.87, $19.16, $16.59, $1.54, $492.51, $15.76, and $412.78. Amount: $6,774.41 Component Description: Initial payment for interim line & related line equipment. This invoice represents a 45% down payment necessary to start work on this component. Amount: $30,484.83 Component Description: Equipment and small parts related to flushing the transmission line and then integrating it into our existing pressurization system. The main dehydration pump was included with the line but not all the necessary pieces to fully integrate it were included. Amount: $3,283.60

Actual Information Description

File Name

Flexible Air Transmission Line - dielectric, 5"

Component Description:: Pressurization manifold that was necessary to interconnect all the feedline hoses to share the dehydrator and integrate the interim transmission line.
Amount:: $586.00

Component Description:: 2nd payment for interim line & related line equipment. This invoice represents a 45% down payment necessary to start work on this component.
Amount:: $30,484.83

Component Description:: Final payment for interim line and parts. This is the sum of items costing $5,046.40, $178.10, $4.19, $178.10, $19.60, $121.95, $127.56, $133.18, $6.12, $0.87, $19.16, $16.59, $1.54, $492.51, $15.76, and $412.78.
Amount:: $6,774.41

Component Description:: Initial payment for interim line & related line equipment. This invoice represents a 45% down payment necessary to start work on this component.
Amount:: $30,484.83

Component Description:: Equipment and small parts related to flushing the transmission line and then integrating it into our existing pressurization system. The main dehydration pump was included with the line but not all the necessary pieces to fully integrate it were included.
Amount:: $3,283.60

Cost Information

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,488,800.00	$1,425,000.00	N/A	$1,154,020.25	N/A
Total for all systems	$4,325,719.65	$4,131,253.85	N/A	$3,097,282.48	N/A
Primary Tower TOWER	$1,488,800.00	$1,425,000.00		$1,154,020.25
Serious tower reinforcement/modifications	$1,052,000.00	$1,000,000.00	Please see the attached Transition Plan Narrative and Structural Analysis.	$895,508.25	N/A
Interim Installation	$200,000.00	$200,000.00	N/A	$96,348.00	N/A
Tall Tower (greater than 500')	$210,500.00	$200,000.00	Main antenna installation.	$154,364.00	N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$25,000.00	N/A	$7,800.00	N/A

Components

Actual Information Description	File Name
Serious tower reinforcement/modifications	Component Description: Tower modification required by tower crew to safely operate on the KVTJ-DT tower to perform the necessary reinforcements. Amount: $7,056.25 Component Description: Initial payment for serious tower modifications necessary to accommodate the increased tower load resulting from new primary antenna & new interim antenna/line. This invoice represents a 50% downpayment necessary to start work on this component. Amount: $443,576.00 Component Description: 2nd payment for serious tower modifications necessary to accommodate the increased tower load resulting from new primary antenna & new interim antenna/line. This invoice represents a 40% downpayment necessary to start work on this component. Amount: $354,860.80 Component Description: Final payment for for serious tower modifications necessary to accommodate the increased tower load resulting from new primary antenna & new interim antenna/line. Amount: $88,715.20 Component Description: Fencing repairs necessitated by the recently completed tower work to reinforce it and install new antennas for repack at KVTJ-DT. Amount: $1,300.00
Interim Installation	Component Description: 2nd payment for tower equipment & rigging of side-mounted interim antenna and interim transmission line. This invoice represents a 40% downpayment necessary to start work on this component. Amount: $38,539.20 Component Description: Final payment for tower equipment & rigging of side-mounted interim antenna and interim transmission line. Amount: $9,634.80 Component Description: Initial payment for tower equipment & rigging of side-mounted interim antenna and interim transmission line. This invoice represents a 50% downpayment necessary to start work on this component. Amount: $48,174.00
Tall Tower (greater than 500')	Component Description: Final payment for tower equipment & rigging of new top-mounted primary antenna & removal of existing top-mounted primary antenna. Amount: $15,436.40 Component Description: Initial payment for tower equipment & rigging of new top-mounted primary antenna & removal of existing top-mounted primary antenna. This invoice represents a 50% downpayment necessary to start work on this component. Amount: $77,182.00 Component Description: 2nd payment for tower equipment & rigging of new top-mounted primary antenna & removal of existing top-mounted primary antenna. This invoice represents a 40% downpayment necessary to start work on this component. Amount: $61,745.60
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: KVTJ-DT tower survey requested by Paul J Ford structural analysis firm & Marsand Inc consulting engineers. FAA required 1A survey was needed before the required structural analysis of the existing KVTJ-DT tower could be completed. Amount: $1,400.00 Component Description: Mapping studies necessary to prepare the KVTJ-DT tower to support loading required to complete the repack. Tower was analyzed with proposed loads and then a recommendation was made for changes to support that load. Amount: $6,400.00

Cost Information

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$92,390.00	$87,550.00	N/A	$27,038.55	N/A
Total for all systems	$4,325,719.65	$4,131,253.85	N/A	$3,097,282.48	N/A
Outside Professional Services	$92,390.00	$87,550.00		$27,038.55
Outside Engineering Consultant	$4,800.00	$4,800.00	A long-time former employee and current contract engineer for KVTJ-DT we have utilized to aide our repack efforts. Specifically, he has advised and assisted with RF, HVAC, and electrical issues directly related to KVTJ's repack needs.	$4,800.00	N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,000.00	N/A	N/A	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,000.00	N/A	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,500.00	N/A	$392.55	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$408.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$4,988.00	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$1,500.00	N/A	$1,200.00	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
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$2,500.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$4,500.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$2,250.00	N/A
Project management of the transition	$55,300.00	$52,500.00	N/A	$6,000.00	N/A

Components

Actual Information Description	File Name
Outside Engineering Consultant	Component Description: Invoice and quote for consulting labor performed. Invoiced according to "time & materials" method. Updated and REVISED to comply with reimbursement guidelines. Amount: $4,800.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Information not provided.
ASR modification (prepare FCC Form 854)	Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: Fees related to filing a repack related STA for KVTJ-DT. Net 30 terms as indicated on invoice means that the due date is 12/7/2018. Amount: $266.00 Component Description: Legal fees related to STA filing for KVTJ-DT repack. NET30 terms means the due date is 12/7/2018. Amount: $126.55
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Attorney fees related to filing KVTJ-DT's license to cover application and consultation on matters related to completing the repack project. Amount: $408.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: KVTJ-DT Wiley Rein LLP - Outside Professional Services: Attorney e-mail consultation with management prior to preparing Form 2100 Construction Permit Application. Amount: $68.00 Component Description: KVTJ-DT Wiley Rein LLP - Outside Professional Services: Conference calls and e-mails with attorneys to discuss issues related to preparing Form 2100 Construction Permit Application. Amount: $689.00 Component Description: KVTJ-DT Wiley Rein LLP - Outside Professional Services: Email consultation with attorneys to Prepare Form 2100 Construction Permit Application & general issues related to KVTJ-DT repack. Amount: $816.00 Component Description: KVTJ-DT Wiley Rein LLP - Outside Professional Services: Consultation with attorneys to prepare Form 2100 Construction Permit Application and prepare/file minor modification application. Amount: $3,415.00
Prepare request for Special Temporary Authorization	Component Description: REVISED Invoice to prepare STA interim facility request for KVTJ-DT. Pay terms are 50% upfront & 50% final. Another request will be submitted for the final 50%. This invoice contains costs related to other components Amount: $600.00 Component Description: Final payment related to filing STAs for KVTJ-DT. REVISED Amount: $600.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Information not provided.
Prepare and or review reimbursement form	Component Description: REVISED Invoice to prepare & review schedule 399 reimbursement form for KVTJ-DT. Pay terms are 50% upfront & 50% final. $1250 represents the final payment. This invoice contains costs related to other components. Amount: $1,250.00 Component Description: REVISED Invoice to prepare & review schedule 399 reimbursement form for KVTJ-DT. Pay terms are 50% upfront & 50% final. Another request will be submitted for the final 50%. This invoice contains costs related to other components Amount: $1,250.00
Perform engineering study for new channel assignment and antenna development	Component Description: REVISED inv. to perform eng study-new channel assignment & antenna development. Pay terms are 50% upfront & 50% final. $2250 represents initial payment. Another request will be submitted for the final 50%. Inv contains costs related to other components Amount: $2,250.00 Component Description: REVISED Invoice to perform eng study-new channel assignment & antenna development. Pay terms are 50% upfront & 50% final. $2250 represents the final payment. Inv contains costs related to other components. Amount: $2,250.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: REVISED Invoice to prepare the engineering section of FCC Form 2100 & the CP application for KVTJ-DT. Pay terms are 50% upfront & 50% final. $1125.00 represents the final payment. This invoice contains costs related to other components. Amount: $1,125.00 Component Description: REVISED Invoice to prepare the engineering section of FCC Form 2100 & the CP application for KVTJ-DT. Pay terms are 50% upfront & 50% final. $1125.00 represents the initial payment. This invoice contains costs related to other components. Amount: $1,125.00
Project management of the transition	Component Description: Invoice for project management of the transition. Our CEs visited the KVTJ-DT site to assess it. Pay terms are 50% upfront & 50% final. This is the invoice for the final 50%. REVISED Amount: $3,000.00 Component Description: REVISED Invoice for project management of the transition. Our CEs visited the KVTJ-DT site to assess it. Pay terms are 50% upfront & 50% final. Another request will be submitted for the final 50%. This invoice contains costs related to other components Amount: $3,000.00

Cost Information

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$331,580.65	$323,115.65	N/A	$305,165.24	N/A
Total for all systems	$4,325,719.65	$4,131,253.85	N/A	$3,097,282.48	N/A
Other Expenses	$331,580.65	$323,115.65		$305,165.24
Arkansas Use Tax	$235,887.75	$235,887.75	We must pay Arkansas use tax on taxable purchases. Our out-of-state vendors are not required to collect or remit the taxes on our behalf. We must calculate and pay use tax ourselves. We have projected our tax obligation based on our repack budget.	$221,871.49	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$34,805.00	$34,805.00	Disposal of antenna, transmitter, RF system	$34,805.00	N/A
Project-related Insurance	$900.00	$900.00	The KVTJ-DT repack project occasionally has costs related to insurance such as transit insurance for large items (antennas, transmitters) and site-based insurance costs related to the ongoing construction project.	$900.00	N/A
Security Cameras	$5,099.90	$5,099.90	In lieu of requesting reimbursement for additional security, in-house labor to supervise a tower crew for 2+ months, and/or storage costs; we are requesting four security cameras that we can use to monitor the site in real-time.	$5,099.90	N/A
MVPD Notification of Channel Change	$1,200.00	$1,200.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$498.00	$498.00	N/A	$498.00	We ultimately needed to mail more letters than we originally estimated.
FCC Filing Fees - Special Temporary Authorization request	$195.00	$190.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	N/A	N/A
Equipment Delivery and Handling Charges	$40,000.00	$40,000.00	Shipping for main and interim antennas and interim transmission line. We now know that actual costs for delivery will be higher than originally estimated.	$38,850.85	N/A
DTV Medical Facility Notification	$11,550.00	$3,140.00	Actual cost for this service has come in significantly under our original estimate and we are revising this estimate downward.	$3,140.00	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,070.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Arkansas Use Tax	Component Description: Sales and use tax true-up for previously approved and reimbursed invoices from MARSAND Inc. Please see attached narrative for more information. Amount: $177,083.13 Component Description: Arkansas sales and use tax for gravel and site preparations at KVTJ-DT Amount: $604.50 Component Description: Sales tax on the KVTJ-DT disposal and network cable plant relocation invoice. Amount: $906.75 Component Description: Sales tax on KVTJ-DT ducting time and materials invoice. Amount: $186.00 Component Description: Arkansas sales tax on the KVTJ-DT transmitter disposal invoice. Amount: $1,305.88 Component Description: Sales tax for air pressure manifold invoice Amount: $49.06 Component Description: Arkansas sales tax on the KVTJ LED security lights Amount: $116.25 Component Description: Sales tax on the pressurization parts and equipment invoice. Amount: $264.98 Component Description: Arkansas sales tax for all components of KVTJ-DT electrical capacity upgrade listed on invoice #51474. Amount: $5,719.42 Component Description: Sales tax for KVTJ-DT transmitter building expansion. Amount: $5,390.90 Component Description: Arkansas sales tax for invoice 6934 related to tower work and modification at KVTJ-DT. Amount: $9,102.91 Component Description: Sales tax for the tower safety modification of the KVTJ-DT tower. Amount: $546.86 Component Description: Arkansas sales tax on invoice 6948 covering multiple cost components related to KVTJ-DT main transmitter. Amount: $7,488.94 Component Description: Sales tax for \|1\| 20 Ton HVAC System (heating & cooling), \|2\| delivery & handling, \|3\| disposal components. Amount: $7,618.64 Component Description: Sales tax for KVTJ-DT viewer rescan notice mailers. Amount: $44.82 Component Description: Sales tax for the KVTJ camera invoice Amount: $323.99 Component Description: Arkansas sales tax for the KVTJ-DT elbow complex. Invoice 6936. Amount: $1,550.02 Component Description: Total Arkansas sales tax payment for invoice #6946 covering taxes owed on multiple cost components. Amount: $3,568.44
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Disposal costs associated with the 20 ton HVAC (heating & cooling) component inclusive of hazardous material disposal. Amount: $940.00 Component Description: The KVTJ-DT networking plant is integrated into the old transmitter cabinets which must be disposed of. We cannot fully dispose of the final two cabinets without relocating and reterminating all this wiring to a new location next to the new transmitter. Amount: $11,700.00 Component Description: 20ft on site dumpster service for KVTJ-DT for management of waste and trash generated throughout the repack project. Amount: $2,700.00 Component Description: Demolition and disposal costs related to removing existing equipment throughout the KVTJ-DT electrical capacity expansion project. Amount: $1,900.00 Component Description: Disposal costs related to the KVTJ-DT transmitter building expansion. We will need to haul away waste generated from the expansion project. Amount: $715.00 Component Description: Disposal and Demolition of the full KVTJ-DT transmitter. It is a very large analog transmitter with outside heat exchangers and significant piping, RF, and electrical in the ceiling. Amount: $16,850.00
Project-related Insurance	Component Description: A one-time short term increase in the KVTJ-DT "floater" insurance coverage to account for the site becoming as a "construction site" due to the significant amount of repack-related work happening at the site. Amount: $500.00 Component Description: Transit insurance for interim and primary antennas and line to cover the shipment in transit from Maine to Arkansas. KVTJ-DT ONLY. Amount: $400.00
Security Cameras	Component Description: LED Security Lights attached to the KVTJ building to illuminate the construction area where equipment and materials were left. Complimentary to the approved security cameras. Inclusive of the electrical work necessary to install. Amount: $1,500.00 Component Description: Security cameras in lieu of other reimbursable costs (storage, outside security staff, or personnel oversight costs) related to the repack. Amount: $3,599.90
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Component Description: Cost to mail channel change rescan notices to our active viewer mailing list within the KVTJ-DT coverage area. NET30 terms means the due date is 12-30-18. Amount: $498.00
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Shipping and handling for the KVTJ-DT pressurization parts. Amount: $135.52 Component Description: 2nd payment for delivery/handling costs on the primary transmitter. The two line items are $1920 & $6776. This invoice represents a 60% down payment necessary to start work on this component. Amount: $8,696.00 Component Description: delivery and handling for air pressure manifold. Amount: $47.00 Component Description: Shipping costs related to the KVTJ-DT transmitter on invoice # 6948. The sum of two line items $320.00 and $1129.33. Amount: $1,449.33 Component Description: Delivery and handling for KVTJ-DT electrical capacity upgrade Amount: $785.00 Component Description: 2nd payment ($3825) for delivery/handling costs on the primary antenna. This invoice represents a 45% down payment necessary to start work on this component. Amount: $3,825.00 Component Description: Shipping costs related to the KVTJ-DT elbow complex on invoice 6936. Amount: $1,500.00 Component Description: 2nd payment ($5130) for delivery/handling costs on interim antenna & interim transmission line. This invoice represents a 45% down payment necessary to start work on this component. Amount: $5,130.00 Component Description: Initial payment for delivery/handling costs on the primary transmitter. The two line items are $960 & $3388 . This invoice represents a 30% down payment necessary to start work on this component. Amount: $4,348.00 Component Description: Delivery and handling charges for construction materials related to the KVTJ-DT transmitter building expansion. Amount: $865.00 Component Description: Delivery & handling costs for the 20-ton HVAC system (heating & cooling) component. Amount: $1,125.00 Component Description: Initial payment for delivery/handling costs on interim antenna, primary antenna, & interim transmission line. The two line items are $3,825 & $5,130. This invoice represents a 45% down payment necessary to start work on this component. Amount: $8,955.00 Component Description: Shipping costs related to invoice 6946 which are the antenna and line components. Sum of the $850 and $1140 lines within the invoice. Amount: $1,990.00
DTV Medical Facility Notification	Component Description: KVTJ-DT Medical Notification quote & invoice from DTV Notification. Amount: $3,140.00
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$4,325,719.65	$4,131,253.85	$3,097,282.48

Reimbursement Status

Question	Response
The facility has ceased operating on its pre-auction channel.	No
Construction of final facilities or all necessary modifications are complete.	No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator.	No

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Jim Grant General Manager 04/19/2019

Section

Question

Response

Submission of Estimated Expenses Statements

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

The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Jim Grant

General Manager

04/19/2019

Certification

Section	Question	Response
Submission of Actual Cost Documentation Statements	WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) . The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Jim Grant General Manager 04/19/2019

Section

Question

Response

Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Jim Grant

General Manager

04/19/2019

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

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components