TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
KSAX-TV, INC. Doing Business As: KSAX-TV, INC.	Ryan Vandewiele 3415 UNIVERSITY AVE., WEST ST. PAUL, MN 55114 United States	+1 (651) 642-4334	RVandewiele@hbi.com	Corporation

Applicant

Address

Phone

Applicant Type

KSAX-TV, INC.

Doing Business As: KSAX-TV, INC.

Ryan Vandewiele

3415 UNIVERSITY AVE., WEST

ST. PAUL, MN 55114

United States

+1 (651) 642-4334

RVandewiele@hbi.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
Charles R. Naftalin LEGAL COUNSEL HOLLAND & KNIGHT LLP	Charles Naftalin Holland & Knight, 800 17th Street, NW Suite 1100 Washington, DC 20006 United States	+1 (202) 955-3000	charles.naftalin@hklaw.com

Applicant

Address

Phone

Charles R. Naftalin

LEGAL COUNSEL

HOLLAND & KNIGHT LLP

Charles Naftalin

Holland & Knight, 800 17th Street, NW

Suite 1100

Washington, DC 20006

United States

+1 (202) 955-3000

charles.naftalin@hklaw.com

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	The station will replace its owned antenna on its existing tower with a new antenna on a top-mounted omni-directional pylon on a supporting pole. The station also expects to require an interim antenna to avoid notable service disruptions. See Exhibit 1.

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	DHD-15P1
	Year	2002
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	15 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?	No
	Manufacturer
	Model	THU9evo-4
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	6.5 kW
	Justification for New Transmitter	Current primary solid state transmitter has been classified by manufacturer as unable to be re-tuned to new UHF channel. Price includes new exciters and mask filter.

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	Electrical service related to a transformer of a size not specified above.
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

Information not provided.

Interim Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Interim
	Description of Use	N/A
	Change Type	Purchase
	Manufacturer
	Model	Maxiva UAXTE-12R44
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	7.2 kW
	Justification for New Transmitter	Because the catalog doesn't list a 7-8 kW air-cooled solid state transmitter, a GatesAir quote has been provided. See Exhibit 1.

Interim 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
Inside RF System	Is an additional interior RF system required to support this interim transmitter?	Yes

Interim Transmitter

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	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:	80.0 kW
	Manufacturer
	Model	TFU-25J
	Year	1985

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	Top
	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:	55.3 kW
	Manufacturer
	Model	ATW22H3-ETO-24L
	Year	2017
	Justification for New Antenna	Existing antenna is unable to be re-tuned to new repacked channel. See Exhibit 1.

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?
	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	4 1/16 inches inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?
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?	No
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	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:	80.0 kW
	Manufacturer
	Model	ALP32L3-HSO-42
	Year	2017
	Justification for New Antenna	Interim antenna is necessary to avoid loss of broadcast service during transition to new (repacked) channel. See Exhibit 1.

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?	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

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	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing transmission line shared with another station or stations?	No
	Is Transmission Line in operating condition?	Yes
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Waveguide
	Diameter	N/A
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	11.95 feet
	Number of parallel runs	1
	Length	1250 feet per run

Primary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Type	Rigid
	Diameter	4 1/16 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1200 feet per run
	Justification for New Transmission Line	Current transmission line could not be used due to frequency change. See Exhibit 1.

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	Rigid
	Diameter	6 1/8 inches
	Segment Length	20'
	Other Segment Length
	Number of parallel runs	1
	Length	1100 feet per run
	Justification for New Transmission Line	Additional transmission line needed for interim facility to facilitate smooth transition to new channel. See Exhibit 1.

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?	No
	Is tower compliant with Rev G?	Unknown
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1025694
Coordinates (NAD83)	Latitude (NAD83)	45° 41' 59.0" N-
	Longitude (NAD83)	095° 10' 36.0" W-
	Overall Structure Height	1191.91 feet
	Support Structure Height	1139.75 feet
	Ground Elevation Above Mean Sea Level (AMSL)	1356.94 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	KSAX-TV, INC.
	Date Constructed	09/01/1987

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:	Minor Reinforcements needed

Primary Tower

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	N/A
Helicopter Services Required	Are helicopter services required?	Yes

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	No
	Number of Hours	N/A
	Explanation	N/A
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	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	Yes
	RF exposure measurements	Yes
	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
Coverage Verification, Interim Antenna	Coverage verification (field study) for interim antenna operations. See Exhibit 1.
Internal Staff Work	See Exhibit 1.
RF exposure measurements, interim antenna	RF exposure measurements for interim antenna operations. See Exhibit 1.
Outside Legal Analysis and Advice	Analysis and guidance provided by outside legal counsel with respect to repacking deadlines and other FCC requirements. See Exhibit 2 (Jan 2018).

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	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
Transmitter control	Remote control needed to comply with FCC requirements for main studio control of transmitters.

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	$682,982.39	$675,482.39	N/A	$278,504.95	N/A
Total for all systems	$2,326,105.88	$2,243,609.16	N/A	$1,193,440.94	N/A
Interim Transmitter Maxiva UAXTE-12R44	$396,812.39	$389,312.39		$0.00
UHF - Air Cooled Solid State Transmitter 7.2 kW	$249,312.39	$249,312.39	See Exhibit 1 (and including estimated state sales tax).	$0.00	N/A
UHF inside RF system including switching	$147,500.00	$140,000.00	N/A	N/A	N/A
Primary Transmitter THU9evo-4	$286,170.00	$286,170.00		$278,504.95
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	$273,500.00	$273,500.00	N/A	$265,834.95	N/A
Other Electrical Service: Electrical service related to a transformer of a size not specified above.	$12,670.00	$12,670.00	N/A	$12,670.00	N/A

Components

Actual Information Description	File Name
UHF - Air Cooled Solid State Transmitter 7.2 kW	Information not provided.
UHF inside RF system including switching	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	Component Description: Work performed on primary transmitter. Amount: $24,285.19 Component Description: Materials for transmission line components that will connect the new channel 24 transmitter to the new channel 24 antenna. Amount: $2,158.88 Component Description: Materials are for transmission line components that will connect the new channel 24 transmitter to the new channel 24 antenna. Amount: $5,532.11 Component Description: Work performed on primary transmitter. Amount: $145,711.10 Component Description: Work performed on the primary transmitter. Amount: $72,855.55 Component Description: One cable attenuator for connnecting non-linear sample to transmitter; one cable for monitoring forward RF power; and one cable for monitoring reflected power. Amount: $480.63 Component Description: One of multiple invoices under PO #106640 for the KSAX new primary channel 24 transmitter. Amount: $14,811.49
Other Electrical Service: Electrical service related to a transformer of a size not specified above.	Component Description: Work performed on the station's primary transmitter. Amount: $2,670.00 Component Description: Work performed on the station's primary transmitter. Amount: $10,000.00

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	$430,340.00	$349,649.88	N/A	$250,464.48	N/A
Total for all systems	$2,326,105.88	$2,243,609.16	N/A	$1,193,440.94	N/A
Interim Antenna ALP32L3-HSO-42	$124,540.00	$95,926.70		$70,792.93
Sweep test of existing antenna	$6,730.00	$10,204.38	Please see attached letter dated April 29, 2019.	$10,204.38	Please see letter attached to Electronics Research, Inc., - Inv 52367 dated November 30, 2018.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$2,500.00	N/A	N/A	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$14,977.00	N/A	N/A	N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	$89,400.00	$68,245.32	N/A	$60,588.55	N/A
Primary Antenna ATW22H3-ETO-24L	$305,800.00	$253,723.18		$179,671.55
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	$9,570.00	$5,000.00	N/A	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$3,750.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$242,323.18	N/A	$175,921.55	N/A

Components

Actual Information Description	File Name
Sweep test of existing antenna	Component Description: Portion of work regarding the system sweep of the interim antenna. Amount: $3,125.00 Component Description: Portion of invoice regarding system sweep of the interim antenna. Amount: $3,125.00 Component Description: Portion of invoice regarding sweep test of the interim antenna. Amount: $3,954.38
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)	Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	Component Description: Portion of invoice for work performed on interim antenna. Amount: $37,601.05 Component Description: Portion of invoice for work performed on interim antenna. Amount: $22,987.50 Component Description: Work performed on interim antenna installation. Amount: $1,406.77
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	Information not provided.
Sweep test of existing antenna	Component Description: Portion of invoice for work performed on sweet test of primary antenna. Amount: $3,750.00 Component Description: Portion of invoice regarding sweep test of the primary antenna. Amount: $1,875.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: Remove existing primary 42 top mount antenna and install new Ch. 24 top mount antenna and transmission line. Amount: $45,000.00 Component Description: Portion of invoice for work performed on primary antenna. Please see attached cover letter. Amount: $103,686.40 Component Description: Portion of invoice for work performed on the primary antenna. Amount: $49,836.00 Component Description: Please see attached cover letter. Amount: $14,235.15 Component Description: Work performed on the station's primary antenna. Amount: $8,301.69 Component Description: Installation of 50' ERI top mounted TV antenna. Amount: $13,000.00

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	$392,600.00	$296,723.40	N/A	$251,521.37	N/A
Total for all systems	$2,326,105.88	$2,243,609.16	N/A	$1,193,440.94	N/A
Interim Transmission Line	$222,200.00	$177,998.00		$175,056.10
Rigid Transmission Line - copper, 6 1/8"	$222,200.00	$177,998.00	N/A	$175,056.10	N/A
Primary Transmission Line	$170,400.00	$118,725.40		$76,465.27
Rigid Transmission Line - copper, 4 1/16"	$170,400.00	$118,725.40	Please see attached quote for the updated cost information, which remains far less than the default cost for this line item.	$76,465.27	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 6 1/8"	Component Description: Portion of invoice for work performed on interim transmission line. Amount: $87,528.05 Component Description: Portion of invoice for work performed on interim transmission line. Amount: $87,528.05
Rigid Transmission Line - copper, 4 1/16"	Component Description: Hardware and tools needed for installing transmission line on KSAX transmitter. Amount: $45.76 Component Description: Equipment for the station's primary transmission line. Amount: $2,181.74 Component Description: Portion of invoice for work performed on primary transmission line. Amount: $71,235.24 Component Description: Cost of additional parts for the station's primary transmission line. Amount: $3,002.53 Component Description: Portion of invoice for work performed on primary transmission line. Amount: $35,617.62

Actual Information Description

File Name

Rigid Transmission Line - copper, 6 1/8"

Component Description:: Portion of invoice for work performed on interim transmission line.
Amount:: $87,528.05

Component Description:: Portion of invoice for work performed on interim transmission line.
Amount:: $87,528.05

Rigid Transmission Line - copper, 4 1/16"

Component Description:: Hardware and tools needed for installing transmission line on KSAX transmitter.
Amount:: $45.76

Component Description:: Equipment for the station's primary transmission line.
Amount:: $2,181.74

Component Description:: Portion of invoice for work performed on primary transmission line.
Amount:: $71,235.24

Component Description:: Cost of additional parts for the station's primary transmission line.
Amount:: $3,002.53

Component Description:: Portion of invoice for work performed on primary transmission line.
Amount:: $35,617.62

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	$481,800.00	$462,000.00	N/A	$224,963.55	N/A
Total for all systems	$2,326,105.88	$2,243,609.16	N/A	$1,193,440.94	N/A
Primary Tower TOWER	$481,800.00	$462,000.00		$224,963.55
Tall Tower (greater than 500')	$210,500.00	$200,000.00	N/A	N/A	N/A
Tower Helicopter Lift	$87,000.00	$87,000.00	N/A	$74,000.00	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	$7,000.00	N/A
Minor tower reinforcement/modifications	$158,000.00	$150,000.00	N/A	$143,963.55	N/A

Components

Actual Information Description	File Name
Tall Tower (greater than 500')	Information not provided.
Tower Helicopter Lift	Component Description: Helicopter rental for placement of 50' antenna. The helicopter lift was determined to be necessary to meet the FCC repacking deadline. See attached letter and quotes. Amount: $74,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: Tower mapping Amount: $7,000.00
Minor tower reinforcement/modifications	Component Description: Design structural modifications as required by structural analysis results and prepare modification working drawings and technical specification notes. Amount: $7,000.00 Component Description: Work performed regarding the installation of the interim antenna, including labor, subsistence, job materials and tax. Amount: $62,052.72 Component Description: Modification materials per Malouf Engineering (includes tax). Amount: $6,790.83 Component Description: Perform structural analysis and engineering report. Amount: $6,000.00 Component Description: Perform top section, plate structural analysis and structural reanalysis of site for new scenario. Amount: $5,500.00 Component Description: Items for tower modification to allow structure to support the primary and interim antennas. Amount: $33,620.00 Component Description: Costs to remove side mounted interim TV antenna, 6" rigid coax line, hangers, and all associated hardware from KSAX tower. Amount: $23,000.00

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	$270,071.50	$391,786.50	N/A	$159,098.62	N/A
Total for all systems	$2,326,105.88	$2,243,609.16	N/A	$1,193,440.94	N/A
Outside Professional Services	$270,071.50	$391,786.50		$159,098.62
Prepare and or review reimbursement form	$2,630.00	$122,771.75	See Exhibit 2 (January 2018) and quote attached to invoices.	$120,245.75	See Exhibit 2. Costs included significant revisions to reimbursement form due to changes in repacked facility design and responding to FCC requests (and changing contact information).
Outside Legal Analysis and Advice	$16,067.50	$16,067.50	These costs were incurred in obtaining advice from outside counsel regarding the FCC requirements other than the Form 2100 or reimbursement, including periodic progress reports, repacking deadlines and other FCC requirements. See Exhibit 2.	$15,725.50	See Exhibit 2.
Internal Staff Work	$20,674.00	$20,674.00	See Exhibit 1.	$4,724.62	Although subtotal is not greater than approved estimates, additional explanation is provided in Exhibit 2 and 2a. Exhibit 2a links travel expenses with the correct Internal Labor Invoice (355841).
Coverage Verification, Interim Antenna	$80,000.00	$80,000.00	See Exhibit 1.	N/A	N/A
RF Exposure Measurements	$21,050.00	$20,000.00	N/A	N/A	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$80,000.00	N/A	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$8,500.00	See quote attached to invoices.	$5,628.50	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$3,600.00	Please see quote attached to invoices.	$2,601.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$7,173.25	See Exhibit 2. Unexpected additional costs resulted from necessary changes in repacked facility and post-filing follow-up with the FCC to address issues in online database.	$7,173.25	See Exhibit 2. Necessary changes included revisions to initial repacked facility as well as follow-up regarding appearance of application in FCC system, among other matters.
Prepare request for Special Temporary Authorization	$2,050.00	$1,500.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$750.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$500.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$1,750.00	N/A
RF exposure measurements, interim antenna	$20,000.00	$20,000.00	See Exhibit 1.	N/A	N/A

Components

Actual Information Description	File Name
Prepare and or review reimbursement form	Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $378.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $1,198.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $3,434.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $8,234.50 Component Description: Portion of invoice relevant to preparation for reimbursement form. Amount: $159.00 Component Description: Portion of invoice relevant to review and preparation of reimbursement form. Amount: $5,141.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $7,085.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $4,101.50 Component Description: Portion of invoice relevant to review and preparation of reimbursement form. Amount: $1,716.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $1,903.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $4,657.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $1,990.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $3,115.50 Component Description: Portion of invoice relevant to review and preparation of reimbursement form. Amount: $5,370.00 Component Description: Portion of invoice relevant to review and preparation of reimbursement form. Amount: $6,523.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $7,349.50 Component Description: Portion of form relevant to the review and preparation of reimbursement form. Amount: $3,542.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $562.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $2,358.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $79.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $981.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $2,553.50 Component Description: Portion of invoice relevant to review and preparation of reimbursement form. Amount: $8,196.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $8,960.50 Component Description: Portion of invoice relevant to review and preparation of reimbursement form. Amount: $658.50 Component Description: Portion of invoice relevant to reimbursement form. Amount: $1,991.00 Component Description: Portion of invoice relevant to review and preparation of reimbursement form. Amount: $13,829.00 Component Description: Portion of invoice relevant to preparation of reimbursement request Amount: $7,757.50 Component Description: Portion of invoice relevant to preparation of reimbursement forms Amount: $244.25 Component Description: Portion of invoice relevant to preparation and review of reimbursement forms, including responding to further FCC requests. Amount: $252.50 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $1,230.50 Component Description: Portion of invoice relevant to review and preparation of reimbursement information, including responses to FCC requests. Amount: $4,338.00 Component Description: Portion of invoice relevant to preparation of reimbursement form. Amount: $354.00
Outside Legal Analysis and Advice	Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $715.50 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $3,796.50 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $155.00 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $342.00 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $1,026.00 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $1,539.00 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $835.50 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $79.50 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $265.50 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $1,840.00 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $1,111.50 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $459.50 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $366.00 Component Description: Please disregard. Amount: N/A Component Description: Fee for attorney work regarding FCC repacking requirements, including transition progress reports Amount: $118.00 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $2,067.00 Component Description: Portion of invoice relevant to FCC transition requirement. Amount: $1,009.00
Internal Staff Work	Component Description: Including pay stubs from an entity that is commonly owned with the licensee KSAX-TV, Inc. Amount: $1,098.12 Component Description: Expenses related to repack project. Amount: $343.25 Component Description: Ed Smith travel expenses (July 2018) Amount: $353.82 Component Description: This material document summarizes costs, as reimbursed by licensee parent, for travel expenses for trip to KSAX antenna site. Supporting documentation for all expenses reimbursed is also attached. See also Exhibit 2a per staff request. Amount: $222.91 Component Description: Including pay stubs from an entity that is commonly owned with the licensee of KSAX-TV, Inc. Amount: $1,777.57 Component Description: Including pay stubs from an entity that is commonly owned with the licensee of KSAX-TV, Inc. Amount: $923.95 Component Description: Cannot delete cost component section. Please disregard. Amount: N/A Component Description: Copy and document expenses for blueprint creation and transmission for new KSAX facility. Amount: $5.00
Coverage Verification, Interim Antenna	Information not provided.
RF Exposure Measurements	Information not provided.
Comprehensive coverage verification via field study, if needed	Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: Portion of invoice relevant to STA application. Amount: $1,669.00 Component Description: Portion of invoice relevant to preparation of STA application. Amount: $556.50 Component Description: Portion of invoice relevant to STA application. Amount: $1,506.50 Component Description: Portion of invoice relevant to preparation of STA application. Amount: $1,896.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Portion of invoice relevant to preparation of license to cover application. Amount: $2,601.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Portion of invoice relevant to preparation of construction permit application. Amount: $217.00 Component Description: Portion of invoice relevant to construction permit work. Amount: $1,356.25 Component Description: Portion of invoice (as appropriately allocated and marked on invoice) relevant to construction permit work. Amount: $513.50 Component Description: Portion of invoice (including allocations as marked on invoice) relevant to construction permit work. Amount: $4,639.50 Component Description: Portion of invoice (as appropriately allocated on invoice) relevant to construction permit work. Amount: $447.00
Prepare request for Special Temporary Authorization	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Preparation of technical portion of application for license to cover construction permit for re-pack channel 24. Amount: $750.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Portion allocable to relevant line item. The selected attachment has requested detail. Please ignore other versions of Invoice 240733. Amount: $500.00
Perform engineering study for new channel assignment and antenna development	Component Description: Engineering consultation for KSAX-TV FCC repack channel assignment. Amount: $4,568.24 Component Description: Work performed regarding STA request for interim antenna. Amount: $750.00 Component Description: Portion allocable to relevant line item. The selected attachment also has requested detail. Please ignore other versions of Invoice 240733. Amount: $1,000.00
RF exposure measurements, interim antenna	Information not provided.

Cost Information

Other Expenses

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$68,311.99	$67,966.99	N/A	$28,887.97	N/A
Total for all systems	$2,326,105.88	$2,243,609.16	N/A	$1,193,440.94	N/A
Other Expenses	$68,311.99	$67,966.99		$28,887.97
Transmitter control	$4,580.00	$4,580.00	See Exhibit 1.	N/A	N/A
MVPD Notification of Channel Change	$1,000.00	$1,000.00	See Exhibit 1.	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$3,750.00	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$335.00	N/A	$335.00	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$400.00	Pursuant to FCC rules, the fee for filing STA applications is $200.	$400.00	N/A
Develop and air announcement of upcoming channel change	$4,100.00	$4,100.00	See Exhibit 1.	N/A	N/A
Equipment Storage	$4,205.99	$4,205.99	N/A	$4,530.91	Equipment storage costs were slightly higher than initially budgeted because equipment had to be stored longer than expected due to certain construction delays that were outside the control of the licensee.
Disposal Costs (for equipment and other waste, net of any salvage value)	$7,146.00	$7,146.00	See Exhibit 1.	$900.00	N/A
Equipment Delivery and Handling Charges	$35,200.00	$35,200.00	See Exhibit 1.	$18,972.06	N/A

Components

Actual Information Description	File Name
Transmitter control	Information not provided.
MVPD Notification of Channel Change	Information not provided.
DTV Medical Facility Notification	Component Description: Medical notification mailing. Amount: $3,750.00
FCC Filing Fees - Form 2100 license to cover application	Component Description: License to cover application filing fee. Amount: $335.00
FCC Filing Fees - Special Temporary Authorization request	Component Description: STA application filing fee Amount: $200.00 Component Description: STA application filing fee. Amount: $200.00
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: Equipment storage (December 2018) Amount: $299.26 Component Description: Equipment storage. Amount: $299.26 Component Description: Equipment storage. Amount: $299.26 Component Description: Please see attached cover letter. Amount: $299.26 Component Description: Please see attached cover letter. Amount: $270.75 Component Description: Equipment storage. Amount: $299.26 Component Description: Equipment storage (August 2019) Amount: $299.26 Component Description: Storage equipment (August 2018) Amount: $299.26 Component Description: Equipment storage (July 2019). Amount: $299.26 Component Description: Equipment storage (October 2019) Amount: $299.26 Component Description: Equipment storage. Amount: $299.26 Component Description: Storage equipment (November 2018) Amount: $299.26 Component Description: Storage equipment (September 2018) Amount: $299.26 Component Description: Storage equipment (October 2018) Amount: $299.26 Component Description: Please see attached cover letter. Amount: $369.78
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Tele-handler and dumpster rental (including tax) Amount: $900.00
Equipment Delivery and Handling Charges	Component Description: Freight Amount: $466.14 Component Description: Freight for primary transmission line. Amount: $655.90 Component Description: Shipping cost relating to installation of interim antenna. Amount: $55.00 Component Description: Portion of invoice regarding equipment delivery and handling charges (primary antenna and transmission line). Amount: $8,250.54 Component Description: Portion of invoice regarding equipment delivery and handling charges (interim antenna and transmission line). Amount: $4,208.63 Component Description: Portion of invoice regarding equipment delivery and handling charges (interim antenna and transmission line). Amount: $4,208.63 Component Description: Freight cost for additional parts for the station's primary transmission line. Amount: $128.22 Component Description: Freight for transmitter equipment. Amount: $9.00 Component Description: Freight costs regarding the station's primary antenna. Amount: $1,182.53 Component Description: Telehandler and forklift rental to load and unload equipment. Mr. Malecha owns the land where the KSAX tower is located. Amount: $990.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,326,105.88	$2,243,609.16	$1,193,440.94

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.	Ryan Vandewiele Vice President 04/14/2020

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.

Ryan Vandewiele

Vice President

04/14/2020

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.	Ryan Vandewiele Vice President 04/14/2020

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.

Ryan Vandewiele

Vice President

04/14/2020

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

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Interim Transmitter

New Transmitter Costs

Interim Transmitter

Other Transmitter Costs

Interim Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

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

New 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