TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
WFMJ TELEVISION, INC. Doing Business As: WFMJ TELEVISION, INC.	Jack Grdic 101 WEST BOARDMAN STREET YOUNGSTOWN, OH 44503 United States	+1 (330) 744-8611	JAGRDIC@WFMJ.COM	Corporation

Applicant

Address

Phone

Applicant Type

WFMJ TELEVISION, INC.

Doing Business As: WFMJ TELEVISION, INC.

Jack Grdic

101 WEST BOARDMAN STREET

YOUNGSTOWN, OH 44503

United States

+1 (330) 744-8611

JAGRDIC@WFMJ.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	WFMJ is transitioning from channel 20 to channel 33. The existing Axcera transmitter is not retunable or supported and will be replaced along with the main antenna. An interim antenna will be used during replacement of the main antenna to stay on air.

Transmitters

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

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Backup
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	HP50DDW
	Year	2003
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	25 kW

Auxiliary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Auxiliary (Backup)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	Parallax U15
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	24.3 kW
	Justification for New Transmitter	UBS Axcera will not support retuning existing transmitter. AXCERA Legacy Supported Models 27-Mar-2017-Final.pdf attached.

Auxiliary Transmitter

Other Transmitter Costs

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

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Information not provided.

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	HP50DDW
	Year	2003
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	25 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	Parallax U15
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	24.3 kW
	Justification for New Transmitter	UBS Axcera will not support retuning existing transmitter.AXCERA Legacy Supported Models 27-Mar-2017-Final.pdf attached.

Primary Transmitter

Other Transmitter Costs

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

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Inside RF Components	Inside transmission components to connect transmitter, switches, and filter to the antenna.

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?	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
	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:	460.0 kW
	Manufacturer
	Model	TFU-27ETT-R 4C150 SP DC
	Year	2006

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?	Yes
	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:	740.0 kW
	Manufacturer
	Model	TFU-31ETT/VP-R O6
	Year	2019
	Justification for New Antenna	Current channel 20/21 antenna is not able to be retuned.

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	8 3/16 inches inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Sweep test of new antenna	Testing and tuning of new CH 33 antenna

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	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:	612.0 kW
	Manufacturer
	Model	TFU-16WB C160
	Year	2018
	Justification for New Antenna	Interim antenna while replacing primary antenna to stay on air

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	B
	Feed Line Size	6 1/8 inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an antenna?	Yes
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	Yes
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Interim Antenna

Other Antenna Cost Not Listed

Name	Description
Sweep Test of new antenna	Checkout and proof of new side mount antenna

Transmission Line

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

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	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	Yes
	Is tower documented for structural analysis?	Yes
	Is tower compliant with Rev G?	Yes
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1015316
Coordinates (NAD83)	Latitude (NAD83)	41° 04' 48.6" N-
	Longitude (NAD83)	080° 38' 24.4" W-
	Overall Structure Height	1020.98 feet
	Support Structure Height	957.99 feet
	Ground Elevation Above Mean Sea Level (AMSL)	1033.12 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	WFMJ TELEVISION INC DBA - WFMJ
	Date Constructed	12/03/2013

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
173428	WILB-FM	FM

Other Types of Users

Users
NOAA
YNGSTN POLICE

Primary Tower

Tower Modification Costs

Section	Question	Response
Engineering Study	Please what type of engineering study is required, if any:	Study needed for documented tower
Tower Reinforcements	Please select whether tower reinforcements are needed:	No 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
Rigging Review	In accordance with the ANSI/ASSE A10.48-2016 & TIA 322 standards, any tower project where tower members are replaced or a lift of over 2,000 pounds is made, a rigging plan reviewed by a professional engineer is required.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	80
	Explanation	Engineering services to plan, file applications, and guide WFMJ through the transition and installation assistance due to lack of qualified staff.
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	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
Legal Fees C.P. Extension	Attorney fees for filing Construction Permit Extension
Rechannel Aux Transmitter	Rechannel AUX-INTErIM transmitter to new channel
Engineering for C.P. Extension	Engineering costs involved to extend the main construction permit due to tower crew delays.

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	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	Yes
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	Yes
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	Yes
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Name	Description
Other Legal	Other legal fees for consultation not listed in Outside Professional Services
Equipment Rental	Equipment and machinery rented
Filing Fee AUX construction permit	Filing fee for AUX-INTERIM construction permit
Legal Fees Transition Progress Reports	Includes review of legal requirements, consultation with station personnel and engineering consultants, and review of reports drafted primarily by station personnel.

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	$1,939,550.76	$1,624,775.76	N/A	$1,624,774.52	N/A
Total for all systems	$2,852,317.51	$2,573,090.53	N/A	$2,371,166.21	N/A
Primary Transmitter Parallax U15	$992,550.76	$921,794.76		$921,793.67
Inside RF Components	$16,835.76	$16,835.76	Transmission line components with hangers and flanges to connect transmitter, switches, and filter to antenna. Includes shipping/handling and Ohio-Mahoning county 7.25% tax. See "WFMJ_QT1697381R1 AS ORDERED.pdf"	$16,835.74	N/A
Other Electrical Service: Wiring trays, grounding, fused disconnects, circuit breakers, various conduits, wire and supplies	$28,715.00	$28,715.00	See "WFMJ Electrical Quote 1 REVISED.pdf" and "Valley Electric cover invoice quote FINISH.pdf".	$28,714.68	Budget adjusted due to revised estimates.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$876,244.00	Includes all equipment, shipping, handling, and Mahoning County Ohio sales & use tax SEE "P2947R6 WFMJ MAIN Proposal - signed 8058.pdf" the as ordered proposal	$876,243.25	25 cent difference due to sales tax computation. When budgeting, dollar amounts were rounded up at 50 cents and rounded down at 49 cents.
Auxiliary Transmitter Parallax U15	$947,000.00	$702,981.00		$702,980.85
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$702,981.00	Includes all equipment, shipping, offloading, and Mahoning County Ohio sales tax SEE "P3515 WFMJ AUX Proposal - signed 8059.pdf" the signed and as ordered proposal	$702,980.85	N/A

Components

Actual Information Description	File Name
Inside RF Components	Component Description: 7,25% State of Ohio Mahoning County sales and use tax on inside RF components freight Amount: $122.35 Component Description: Inside RF components to connect transmitter to filter, switches, and antenna. Amount: $14,010.15 Component Description: 7,25% State of Ohio Mahoning County sales and use tax on inside RF components. Amount: $1,015.74 Component Description: Freight charge for inside RF components Amount: $1,687.50
Other Electrical Service: Wiring trays, grounding, fused disconnects, circuit breakers, various conduits, wire and supplies	Component Description: Final electrical invoice Amount: $807.85 Component Description: Labor, materials, and equipment for electrical install of main and interim transmitters revised after review Amount: $27,906.83
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: Final payment on Comark Main TX including RF section, filter, and glycol. Includes Ohio-Mahoning 7.25% sales tax. See "P2947R6 WFMJ MAIN Proposal - signed 8058.pdf" Amount: $350,497.30 Component Description: 60% initial down payment of main transmitter, RF system and extra equipment. Amount: $525,745.95
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: Final payment for Comark AUX tx includes glycol and Ohio-Mahoning 7.25% sales tax. See "P3515 WFMJ AUX Proposal - signed 8059.pdf" Amount: $281,192.34 Component Description: 60% initial down payment of AUX transmitter, and extra equipment. Amount: $421,788.51

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	$496,678.00	$433,885.75	N/A	$420,254.47	N/A
Total for all systems	$2,852,317.51	$2,573,090.53	N/A	$2,371,166.21	N/A
Interim Antenna TFU-16WB C160	$178,334.00	$161,811.00		$160,973.79
Sweep Test of new antenna	$6,864.00	$6,864.00	Estimate is greater than predetermined cause due to the addition of Ohio-Mahoning County sales and use tax of 7.25%	$6,864.00	N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$0.00	N/A	N/A	N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	$13,700.00	$20,317.00	Includes special cut piece, matching transformer, and Mahoning County Ohio sales & use tax. See attached quote Interim Antenna Quote.pdf	$20,317.44	$0.44 higher due to rounding.
Sweep test of existing antenna	$6,730.00	$0.00	N/A	N/A	N/A
UHF - High Power, Side Mount, basic slot antenna, 612 kW input, directional,, elliptically or circularly polarized	$122,630.00	$122,630.00	Includes test transition, shipping, and Mahoning County Ohio sales & use tax. See Interim Antenna Quote.pdf	$122,209.35	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$12,000.00	Includes shipping and Mahoning County Ohio sales and use tax	$11,583.00	N/A
Primary Antenna TFU-31ETT/VP-R O6	$318,344.00	$272,074.75		$259,280.68
Sweep test of new antenna	$6,864.00	$6,864.00	Estimate is higher than predetermined cost due to adding Ohio-Mahoning County sales and use tax at 7.25%. See "700134CMZ-3A - signed WFMJ.pdf"	$6,177.60	N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed)	$15,250.00	$17,395.00	Includes 8" to 6" reducer, special cut piece and Mahoning County Ohio sales & use tax. See "700134CMZ-3A - signed WFMJ.pdf"	$15,655.38	N/A
Sweep test of existing antenna	$6,730.00	$3,338.75	This was actually to sweep test my existing line for compatibility on the repack channel 33, not the antenna. This was paid on invoice WFMJ170327.	$3,338.75	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$244,477.00	Includes shipping, test transition and Mahoning County Ohio sales & use tax with V-Pol upgrade removed. See "700134CMZ-3A - signed WFMJ.pdf".	$234,108.95	N/A

Components

Actual Information Description	File Name
Sweep Test of new antenna	Component Description: Final 10% payment for interim antenna test. Amount: $640.00 Component Description: Sales and use tax on 45% 2nd progress payment sweep test. See "Interim Antenna Quote REVISED with cover.pdf" Amount: $208.80 Component Description: State of Ohio - Mahoning County sales & use tax 7.25% on sweep test. Final. Amount: $46.40 Component Description: Sales & use tax on 45% downpayment of sweep test Amount: $208.80 Component Description: 45% 2nd progress payment for sweep test Amount: $2,880.00 Component Description: 45% down payment for sweep testing Amount: $2,880.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	Component Description: Final 10% payment on elbow complex, transition, and cut piece. Amount: $1,894.40 Component Description: 45% down payment for elbow complex, matching transformer, and special cut piece. Amount: $8,524.80 Component Description: 45% 2nd progress payment for elbow complex, special cut piece, and matching transformer Amount: $8,524.80 Component Description: State of Ohio - Mahoming County sales & Use tax 7.25% on elbow comples, transformer, cut piece and shipping. Final Amount: $137.34 Component Description: Sales & use tax on 45% 2nd progress payment elbow complex, cut piece, and transformer. See "Interim Antenna Quote REVISED with cover.pdf" Amount: $618.05 Component Description: Sales and use tax on 45% downpayment of elbow complex, special cut piece, and transformer Amount: $618.05
Sweep test of existing antenna	Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 612 kW input, directional,, elliptically or circularly polarized	Component Description: State of Ohio - Mahoning County sales & use tax on antenna, test transition and shipping. NOTE: After review 1 cent was added to make up rounding in tax computation. Amount: $1,009.36 Component Description: 45% second progress payment on antenna and test transition Amount: $50,013.00 Component Description: Final 10% of antenna and test transition Amount: $5,760.00 Component Description: 45% down payment for interim antenna and test transition Amount: $50,013.00 Component Description: Balance of shipping charges due Amount: $837.71 Component Description: Sales and use tax on 45% downpayment of antenna and test transition. Amount: $3,625.94 Component Description: Invoice showing credits to full amount of antenna, elbow complex, transformer, and test transition. Also includes shipping not in the original quote. Amount: N/A Component Description: Sales and use tax on 45% 2nd progress payment side mount antenna and test transition. See "Interim Antenna Quote REVISED with cover.pdf" Amount: $3,625.94 Component Description: Final 10% of antenna and test transition PLUS shipping not included in original quote. Amount: $7,324.40
Side mount brackets for high power antennas (if not included in antenna base cost)	Component Description: Final 10% payment on interim antenna side mount brackets. Amount: $1,080.00 Component Description: Sales & use tax on 2nd 45% progress payment of side mount brackets. See "Interim Antenna Quote REVISED with cover.pdf" Amount: $352.35 Component Description: State of Ohio - Mahoning County sales & use tax 7.25% on side mount brackets. Final. Amount: $78.30 Component Description: 45% 2nd progress payment for side mount brackets for 8 inch legs Amount: $4,860.00 Component Description: Sales & use tax on 45% downpayment of side mount brackets Amount: $352.35 Component Description: 45% down payment for custom side mount brackets for 8inch tower legs Amount: $4,860.00
Sweep test of new antenna	Component Description: 7,25% State of Ohio Mahoning County sales and use tax 1st progress payment primary antenna sweep test Amount: $208.80 Component Description: Initial 45% down payment Amount: $2,880.00 Component Description: 45% progress payment main antenna sweep test. Amount: $2,880.00 Component Description: 7,25% State of Ohio Mahoning County sales and use tax 2nd progress payment primary antenna sweep test Amount: $208.80
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed)	Component Description: 7,25% State of Ohio Mahoning County sales and use tax 1st progress payment primary antenna elbow complex, reducer, special cut piece Amount: $529.14 Component Description: 45% progress payment main antenna elbow complex, reducer, and special cut piece. Amount: $7,298.55 Component Description: Initial 45% down payment elbow complex, reducer, cut piece Amount: $7,298.55 Component Description: 7,25% State of Ohio Mahoning County sales and use tax 2nd progress payment primary antenna elbow complex, reducer, special cut piece Amount: $529.14
Sweep test of existing antenna	Component Description: Initial site visit for line sweeps Amount: $3,338.75
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: 45% progress payment main antenna, test transition, and shipping Amount: $102,577.50 Component Description: Partial 10% remaining balance due Amount: $13,128.40 Component Description: State of Ohio Mahoning County sales tax on invoice 525005rev Amount: $951.81 Component Description: Initial 45% down payment antenna, test transition, and shipping LESS $14,073.75 for V-Pol upgrade. Amount: $102,577.50 Component Description: 7.25% Sales and use tax State of Ohio-Mahoning County on 2nd progress payment primary antenna,test transition and freight. Amount: $7,436.87 Component Description: 7,25% State of Ohio Mahoning County sales and use tax 1st progress payment primary antenna, test transition, and freight. Amount: $7,436.87

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$230,075.00	$323,675.00	N/A	$175,843.25	N/A
Total for all systems	$2,852,317.51	$2,573,090.53	N/A	$2,371,166.21	N/A
Primary Tower GTOWER	$230,075.00	$323,675.00		$175,843.25
Rigging Review	$6,975.00	$6,975.00	ANSI/ASSE A10.48-2016 & TIA 322 standards state any tower project where a lift of over 2,000 pounds is made, a rigging plan reviewed by a professional engineer is required for the main antenna only. See Rigging Review.pdf. Includes sales tax	N/A	N/A
Structural engineering tower load study for well documented tower	$12,600.00	$12,000.00	N/A	$11,000.00	N/A
Tall Tower (greater than 500')	$210,500.00	$304,700.00	Includes Primary and Interim antennas, plumb & tension, and Mahoning County Ohio 7.25% sales and use tax, REVISED. New proposal for main antenna installation. See "18837-6 WFMJ Main Antenna Proposal - signed .pdf"	$164,843.25	N/A

Components

Actual Information Description	File Name
Rigging Review	Information not provided.
Structural engineering tower load study for well documented tower	Component Description: Final analysis of WFMJ tower taking into consideration the interim antenna REVISED after review Amount: $3,600.00 Component Description: Baseline structural analysis of WFMJ Tower Amount: $7,400.00
Tall Tower (greater than 500')	Component Description: Main antenna install amount due on proposal acceptance Amount: $65,200.00 Component Description: 7.25% sales and use tax for Ohio Mahoning County on Precision Communications invoice 7712 acceptance of proposal main antenna Amount: $4,727.00 Component Description: 7.25% Ohio-Mahoning sales and use tax on Precision Communications invoice 7272. Amount: $2,138.75 Component Description: Interim antenna install crew on site progress payment Amount: $29,500.00 Component Description: State of Ohio - Mahoning County sales & use tax 7.24% on interim antenna install for 2 invoices to arrive on site and complete the project. FInal. Amount: $4,277.50 Component Description: interim antenna install complete final payment Amount: $29,500.00 Component Description: Proposal acceptance down payment for tower rigging interim antenna. See "Proposal 18331-6 Interim Antenna Installation.pdf" Amount: $29,500.00

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	$120,241.55	$129,066.82	N/A	$99,796.72	N/A
Total for all systems	$2,852,317.51	$2,573,090.53	N/A	$2,371,166.21	N/A
Outside Professional Services	$120,241.55	$129,066.82		$99,796.72
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	$1,580.00	$3,206.25	Aux license to cover for pre-transition and post transition. See"WFMJ-engineering budgetary revision.pdf" and adjusted to match final invoice	$3,206.25	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$2,000.00	N/A	$1,725.00	N/A
Engineering for C.P. Extension	$2,500.00	$2,500.00	N/A	$2,310.00	N/A
Rechannel Aux Transmitter	$6,420.55	$6,420.55	Cost to retune auxiliary transmitter from current channel to post transition channel and connect the transmission line to the new RF system. Verify out of band emissions meet spec. See "WFMJ 190719 CS3187 AUX RETUNE.pdf"	N/A	N/A
Legal Fees C.P. Extension	$690.00	$690.00	Attorney fees to file Construction permit Extension due to no crew available to install main antenna before the phase deadline	$690.00	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,500.00	N/A	$966.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$872.00	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$2,500.00	See "WFMJ-engineering budgetary revision.pdf" item 3	$2,212.50	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$2,000.00	See "WFMJ-engineering budgetary revision.pdf" item 5	N/A	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	$2,105.00	$6,000.00	Side mount antenna is used as pre-transition aux system, interim STA post transition, and licensed aux when construction is complete. See "WFMJ-engineering budgetary revision.pdf"	$4,942.50	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$4,000.00	See "WFMJ-engineering budgetary revision.pdf" item 2	$2,527.50	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$6,532.50	See "Invoice # 897-01-0003 with cover.PDF".
Prepare and or review reimbursement form	$2,630.00	$7,984.02	Legal expenses for Form 399 review were more than anticipated due to initial Request for Information from fund administrator. See "Justification for Estimated Cost overage 399 review.pdf". Additional costs to revise estimates that were 2 years old.	$7,984.02	Legal expenses for Form 399 review were more than anticipated due to initial Request for Information from fund administrator. See "Justification for Estimated Cost overage 399 review.pdf"
Project management of the transition	$12,640.00	$12,000.00	N/A	$3,812.45	N/A
Main/Aux TX Installation	$62,016.00	$62,016.00	*System Notice: Estimate adjusted and locked because line has been superseded.*Transmitter installation to be done by Murlatt and Associates instead of Comark. See quote "REVISED Transmitter Installation Estimate with cover - WFMJ.pdf", "WFMJ additional transmitter installation estimate.pdf" and "WFMJ Quote for RF Completion.pdf".	$62,016.00	N/A

Components

Actual Information Description	File Name
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	Component Description: Engineering costs to prepare license to cover for pre transition Aux antenna Amount: $427.50 Component Description: Engineering costs to file modification to aux license for post transition operation and license to cover. Amount: $2,778.75
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	Component Description: Legal fees to prepare and file AUX-INTERIM construction permit Amount: $690.00 Component Description: Prepare and file AUX-INTERIM license to cover Amount: $276.00 Component Description: Attorney fees to modify aux license pre transition to post transition operating parameters for license to cover Amount: $621.00 Component Description: Legal fees to submit an application for License to Cover for post transition auxiliary facility Amount: $138.00
Engineering for C.P. Extension	Component Description: Engineering costs to prepare CP Extension due to unavailability of a tower crew by phase deadline Amount: $2,310.00
Rechannel Aux Transmitter	Information not provided.
Legal Fees C.P. Extension	Component Description: Attorney fees to file Construction Permit Extension Amount: $690.00
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: Legal fees to prepare and file STA Amount: $414.00 Component Description: Legal fees to prepare and file STA Amount: $552.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Setup, review and file Form 2100 C.P. Follow up and circulation of authorization to client. Amount: $872.00
Prepare request for Special Temporary Authorization	Component Description: Engineering to request STA until main antenna can be replaced Amount: $2,212.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Component Description: Develop pre and post channel aux antenna and construction permit Amount: $4,942.50
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Item 2 - preparation of form 2100 SCH A for C.P. Amount: $2,527.50
Perform engineering study for new channel assignment and antenna development	Component Description: Item 1 Engineering studies for new channel and antenna Amount: $4,852.50 Component Description: Revised to clarify work done was for interim antenna coverage study and not maximization Amount: $1,680.00
Prepare and or review reimbursement form	Component Description: Review and answer initial request for more information from fund administrator. See "Justification for Estimated Cost overage 399 review.pdf". Amount: $5,881.50 Component Description: Discussed cost and method of notifying MPVD's. Amount: $375.00 Component Description: Legal services for reimbursement CORES II setup for Chief Engineer access. Amount: $804.56 Component Description: Additional charges for revised estimate to legal costs Amount: $439.00 Component Description: Completion and review of form 1876. Review catalog of reimbursement expenses for legal fees. Amount: $483.96
Project management of the transition	Component Description: planning and site visit to finalize and submit initial 399 budget Amount: $2,687.45 Component Description: Meetings at NAB and continuing development of budget Amount: $1,125.00
Main/Aux TX Installation	Component Description: Offload and place main and aux transmitters. Amount: $4,600.00 Component Description: Complete installation of inside RF components connecting aux interim transmitter to antenna and switch. Amount: $10,000.00 Component Description: Transmitter installation and proof Amount: $20,386.00 Component Description: Site visit for final measurements and marking equipment positions for TX install. Defined in "Revised Transmitter Installation Estimate with cover - WFMJ.pdf" Amount: $3,423.50 Component Description: Transmitter installation main and aux transmitters Amount: $17,606.50 Component Description: Additional on site transmitter installation services to hang RF components. Components not shipped with transmitter and needed separate install. Amount: $6,000.00

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	$65,772.20	$61,687.20	N/A	$50,497.25	N/A
Total for all systems	$2,852,317.51	$2,573,090.53	N/A	$2,371,166.21	N/A
Other Expenses	$65,772.20	$61,687.20		$50,497.25
Disposal Costs (for equipment and other waste, net of any salvage value)	$18,077.73	$18,077.73	Removal of existing transmitter, 2 IOT, 2 beam supplies, and used glycol. Attached Beam Supply Removal Quote-807628.pdf, 10647 WFMJ Axcera Removal 062727.pdf, Glycol Disposal.pdf. Includes Mahoning County Ohio sales & use tax.	$18,077.73	Original estimate did not include disposal of two high powered antennas.
FCC Filing Fees - Form 2100 license to cover application	$335.00	$1,005.00	Adjusted to meet the updated predetermined costs for 2019 and is quantity (3) for Aux pre transition, Aux post transition, and Main antenna applications.	$670.00	N/A
Legal Fees Transition Progress Reports	$5,000.00	$5,000.00	Includes review of legal requirements, consultation with station personnel and engineering consultants, and review of reports drafted primarily by station personnel. See Legal Fees.pdf	$272.50	N/A
Filing Fee AUX construction permit	$2,220.00	$2,220.00	Aux construction permits for pre-transition channel AND post transition channel.	$2,220.00	N/A
Equipment Rental	$2,758.47	$2,758.47	Forklift, pallet jack, and scissors lift to move equipment and reach the RF system in a building with a 40 foot roof. See quote Equipment Rental Quote.pdf and Invoice WFMJ Leppo RO-225888.pdf. More installation trips needed than anticipated.	$2,758.47	Due to equipment delays and missing or broken pieces, there were more installation trips necessary requiring more scissor lift rentals than anticipated.
Other Legal	$0.00	$0.00	Includes other legal fees for consultation not listed in Outside Professional Services. See Legal Fees.pdf ORIGINAL $5000 NOT ALLOWED BY FUND ADMINISTRATOR.	$0.00	N/A
MVPD Notification of Channel Change	$3,805.00	$3,805.00	Revised costs for legal fees in developing and sending the MVPD notices. Estimate is updated in "8267828 cover invoice quote MVPD.pdf"	$3,805.00	N/A
Develop and air announcement of upcoming channel change	$500.00	$500.00	AIRTIME CHARGES NOT ALLOWED. AMOUNT REDUCED TO PRODUCTION COSTS ONLY.	N/A	N/A
Equipment Delivery and Handling Charges	$16,809.00	$16,809.00	Offloading and placing main and aux transmitters, heat exchangers, pumps, Offloading and storing on site of CH 33 interim antenna and CH 33 filter and RF section. See "Delivery and handling budget adjust.pdf"	$15,703.55	N/A
Local Zoning	$500.00	$500.00	N/A	N/A	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$200.00	Reflects actual filing fee as shown on the application	$200.00	N/A
DTV Medical Facility Notification	$11,550.00	$6,790.00	N/A	$6,790.00	N/A
Equipment Storage	$4,022.00	$4,022.00	3 months of main antenna storage at Dielectric if tower crew is not available at time of antenna shipment. Price is $1,250 per month and 7.25% Ohio-Mahoning County sales tax is included. See "700134CMZ-3A - signed WFMJ.pdf"	N/A	N/A

Components

Actual Information Description	File Name
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Disposal and recycling of 2 high voltage beam power supplies for decommissioned Axcera transmitter. See "Beam Supply Removal Quote-04132018_8086 with cover.pdf" Amount: $2,500.00 Component Description: Disposal of pre-transition main and aux antennas, inside RF filter, magic tee and decommissioned line. Salvage fees deducted. Amount: $11,119.66 Component Description: Disposal of heat transfer fluid (glycol) from decommissioned Axcera transmitter. Amount: $1,133.50 Component Description: Remove and scrap Axcera transmitter and plumbing. See "WFMJ_Disposal_Proposal TCT with cover.pdf" Amount: $4,209.57 Component Description: Salvage fees paid WFMJ for disposal of Axcera cabinets and coolant plumbing. Amount: ($770.94) Component Description: Salvage fees paid WFMJ for disposal of Axcera cabinets Amount: ($295.31) Component Description: 7.25% Ohio-Mahoning sales and use tax on GS Technologies invoice #63219 Amount: $181.25
FCC Filing Fees - Form 2100 license to cover application	Component Description: Filing fee for AUX license to cover pre-transition channel Amount: $335.00 Component Description: Filing fee for post transition License to Cover for an Auxiliary Facility Amount: $335.00
Legal Fees Transition Progress Reports	Component Description: Form 387 review and email. Amount: $272.50
Filing Fee AUX construction permit	Component Description: Filing fee for AUX-INTERIM construction permit Amount: $1,110.00 Component Description: Fee for post transition aux license Amount: $1,110.00
Equipment Rental	Component Description: Scissors jack lift rental for initial transmission line sweep. Test point located 30 feet above the floor. Amount: $353.07 Component Description: Scissors lift rental to move transmission line for auxiliary transmitter retune Amount: $449.16 Component Description: Oxygen acetylene rental for soldering field flanges to complete inside RF installation. Amount: $140.29 Component Description: Scissors lift rental to reach high celiling to finish inside RF connections to combiner, filter, switch, and antenna. Amount: $449.16 Component Description: Scissors lift rental to hang RF components high in ceiling. Amount: $449.16 Component Description: Rental of scissors lift to reach components inhigh ceiling and pallet jack for moving equipment during Comark main and aux transmitter install. See "Equipment Rental Quote.pdf" Amount: $917.63
Other Legal	Information not provided.
MVPD Notification of Channel Change	Component Description: Amount requested for preparing and sending MVPD notices. Amount: $3,805.00
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Offload and place new Comark main and aux/interim transmitters, heat exchangers, and pumps. See also "Delivery and handling budget adjust.pdf" Amount: $12,089.22 Component Description: Labor and equipment to offload interim antenna and RF section. See "WFMJ-Off Load Dielectric-Proposal-2018-5-29 TCT.pdf" Amount: $2,531.10 Component Description: Inside RF handling and delivery due to inclement weather. Amount: $1,083.23
Local Zoning	Information not provided.
FCC Filing Fees - Special Temporary Authorization request	Component Description: Filing fee for STA request Amount: $200.00
DTV Medical Facility Notification	Component Description: Compile, draft, and mail notifications to medical facilities Amount: $6,790.00
Equipment Storage	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,852,317.51	$2,573,090.53	$2,371,166.21

Reimbursement Status

Question	Response
The facility has ceased operating on its pre-auction channel.	Yes
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.	Robert J Flis Chief Engineer 12/19/2019

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.

Robert J Flis

Chief Engineer

12/19/2019

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.	Robert J Flis Chief Engineer 12/19/2019

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.

Robert J Flis

Chief Engineer

12/19/2019

(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

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

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

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

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

Other Types of Users

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components