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

FCC Form 399: Reimbursement Request

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

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

Facility ID:
25067
Service:
DTV
Call Sign:
WPTD
Channel:
35 (UHF)
File Number:
0000028659
FRN:
0006842835
Date Submitted:
03/20/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GREATER DAYTON PUBLIC TELEVISION, INC.

Doing Business As: GREATER DAYTON PUBLIC TELEVISION, INC.

DAVID M. FOGARTY

110 SOUTH JEFFERSON STREET

DAYTON, OH 45402

United States

+1 (937) 220-1611 DFOGARTY@THINKTV.ORG Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model ZD6140P2
Year 2002
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 140 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-50 UHF
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 31.7 kW
Justification for New Transmitter The existing transmitter is not retunable to the new broadcasting spectrum. Comparable equipment is not available.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 520.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change 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 Elliptical
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: 163.0 kW
Manufacturer
Model TFU-14GTH/VP-R04
Year 2009

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 249.0 kW
Manufacturer
Model TFU-18GTH/VP-R04
Year 2019
Justification for New Antenna Old antenna will not work on new broadcast spectrum.

Primary Antenna

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Other Antenna Costs

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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Interim UHF CH-35

Lower Power Side Mount Single Station Dielectric Model

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change 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 Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1200 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1200 feet per run
Justification for New Transmission Line Old line not compatible with new antenna.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership 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) No
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
ASR Number 1011760
Coordinates (NAD83) Latitude (NAD83) 39° 43' 16.0" N-
Longitude (NAD83) 084° 15' 00.0" W-
Overall Structure Height 1131.88 feet
Support Structure Height 1096.44 feet
Ground Elevation Above Mean Sea Level (AMSL) 879.25 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner GREATER DAYTON PUBLIC TELEVISION INC
Date Constructed 10/21/1985


Other Types of Users

Users
Public Safety

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Interim Antenna

Remove and install new Interim Antenna

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 100
Explanation We do not have staff personnel available for the tasks that Project Management would cover, nor is the staff trained to provide those services.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 1
Justification Necessary to provide site survey.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Personnel costs

100 hours x $100/hour

Other Expenses

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

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,149,362.62 $1,140,612.62 N/A $1,010,161.05 N/A
Total for all systems $2,535,089.37 $2,471,861.37 N/A $1,658,353.80 N/A
Primary Transmitter ULXTE-50 UHF $1,149,362.62 $1,140,612.62 $1,010,161.05
UHF - Liquid Cooled Solid State Transmitter 31.7 kW $972,592.62 $972,592.62 To agree with attached invoice US0326959 Gates Air with attached Quote A-76415, Q-79927 and Q-84562 along with explanation letter. $964,861.05 A change order was issued for a piece omitted from the original quote. Change order Q-79927
4" Rigid Conduit and Wiring (Cost per foot) $52,520.00 $49,920.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $29,894.00 N/A
10 Ton system $60,500.00 $57,500.00 N/A $15,406.00 N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 31.7 kW

Component Description:
To agree with invoice US0326959 Q-76415, Q-79927 and Q-84562 with actual and not estimated shipping. Spares not requested.
Amount:
$387,112.36

Component Description:
Second payment towards transmitter price.
Amount:
$304,078.26

Component Description:
30% down payment
Amount:
$273,670.43

Component Description:
Includes change order Q-79927 which is attached
Amount:
$322,920.35

Component Description:
To remove corrected cost component
Amount:
($322,920.35)
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
Switchgear - industrial 800 amp

Component Description:
As per attached quote.
Amount:
$17,936.00

Component Description:
As per quote #2906
Amount:
$11,958.00
10 Ton system

Component Description:
Equipment removed in anticipation of new unit.
Amount:
$715.00

Component Description:
Agrees with quote for 7.5 ton system
Amount:
$14,691.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $476,230.00 $461,492.00 N/A $330,915.00 N/A
Total for all systems $2,535,089.37 $2,471,861.37 N/A $1,658,353.80 N/A
Primary Antenna TFU-18GTH/VP-R04 $476,230.00 $461,492.00 $330,915.00
Interim UHF CH-35 $180,000.00 $180,000.00 N/A $122,722.00 N/A
Sweep test of existing antenna $6,730.00 $6,492.00 Sweep of antenna line as indicated on transition plan. $3,992.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $275,000.00 N/A $204,201.00 N/A

Components

Actual Information Description File Name
Interim UHF CH-35

Component Description:
Final 10% invoice
Amount:
$12,272.20

Component Description:
Second 50% due
Amount:
$61,361.00

Component Description:
First 40% of purchase of interim antenna system.
Amount:
$49,088.80
Sweep test of existing antenna

Component Description:
Invoice amount
Amount:
$3,992.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Final 10% invoice
Amount:
$20,420.10

Component Description:
Second 50% due
Amount:
$102,100.50

Component Description:
First 40% of main antenna system purchase
Amount:
$81,680.40

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $242,400.00 $230,400.00 N/A $24,155.10 N/A
Total for all systems $2,535,089.37 $2,471,861.37 N/A $1,658,353.80 N/A
Primary Transmission Line $242,400.00 $230,400.00 $24,155.10
Rigid Transmission Line - copper, 6 1/8" $242,400.00 $230,400.00 N/A $24,155.10 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Dehydrator
Amount:
$24,155.10

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $456,100.00 $437,000.00 N/A $245,155.00 N/A
Total for all systems $2,535,089.37 $2,471,861.37 N/A $1,658,353.80 N/A
Primary Tower TOWER $456,100.00 $437,000.00 $245,155.00
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $177,756.00 N/A
Interim Antenna $75,000.00 $75,000.00 N/A $64,899.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $2,500.00 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
Final 10% invoice
Amount:
$17,775.60

Component Description:
Second 50% due
Amount:
$88,878.00

Component Description:
First 40% of turnkey installation of main antenna system.
Amount:
$71,102.40
Interim Antenna

Component Description:
Final 10% invoice
Amount:
$6,489.90

Component Description:
Second 50% due
Amount:
$32,449.50

Component Description:
First 40% of turnkey installation of interim antenna.
Amount:
$25,959.60
Minor tower reinforcement/modifications Information not provided.
Structural engineering tower load study for well documented tower

Component Description:
50% of total contract
Amount:
$2,500.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $167,970.00 $159,880.00 N/A $25,740.90 N/A
Total for all systems $2,535,089.37 $2,471,861.37 N/A $1,658,353.80 N/A
Outside Professional Services $167,970.00 $159,880.00 $25,740.90
Personnel costs $10,000.00 $10,000.00 N/A N/A N/A
Additional Field Engineering Service, 1 Days $2,000.00 $2,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,630.00 To agree with invoices received $2,630.00 N/A
Project management of the transition $15,800.00 $15,000.00 N/A 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 $16,370.40 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $1,528.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $423.50 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $953.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $675.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $600.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $2,561.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Personnel costs Information not provided.
Additional Field Engineering Service, 1 Days Information not provided.
Prepare and or review reimbursement form

Component Description:
Progress report
Amount:
$276.00

Component Description:
Form 399
Amount:
$1,295.00

Component Description:
Quarterly
Amount:
$101.00

Component Description:
Form 1876
Amount:
$448.00

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Form 1876
Amount:
$207.00

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Quarterly
Amount:
$50.50
Project management of the transition Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Invoice amount
Amount:
$16,370.40
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Work on STA
Amount:
$1,069.00

Component Description:
Work on STA
Amount:
$459.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Status report
Amount:
$423.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Construction permit
Amount:
$446.00

Component Description:
CP
Amount:
$273.00

Component Description:
Construction permit
Amount:
$234.00
Prepare request for Special Temporary Authorization

Component Description:
Work on STA
Amount:
$675.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
CP application
Amount:
$600.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Dependencies study
Amount:
$140.00

Component Description:
Channel study
Amount:
$150.00

Component Description:
Linked station set
Amount:
$195.00

Component Description:
Transition timing
Amount:
$151.50

Component Description:
Channel study
Amount:
$136.00

Component Description:
Antenna development
Amount:
$725.00

Component Description:
Antenna proposal letter attached
Amount:
$650.00

Component Description:
Channel study
Amount:
$263.50

Component Description:
Study of new channel
Amount:
$150.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $43,026.75 $42,476.75 N/A $22,226.75 N/A
Total for all systems $2,535,089.37 $2,471,861.37 N/A $1,658,353.80 N/A
Other Expenses $43,026.75 $42,476.75 $22,226.75
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 N/A $0.00 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,750.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $6,000.00 $6,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $17,226.75 $17,226.75 To agree with actual and not estimated costs $17,226.75 N/A
Equipment Storage $6,000.00 $6,000.00 N/A N/A N/A
MVPD Notification of Channel Change $1,250.00 $1,250.00 Actual invoice received was in excess of predetermined cost. $1,250.00 N/A

Components

Actual Information Description File Name
Develop and air announcement of upcoming channel change Information not provided.
DTV Medical Facility Notification

Component Description:
Invoice received
Amount:
$3,750.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Actual freight as indicated on invoice number US0326959
Amount:
$16,185.84

Component Description:
Shipping of dehydrator
Amount:
$1,040.91
Equipment Storage Information not provided.
MVPD Notification of Channel Change

Component Description:
Notifications complete
Amount:
$1,250.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,535,089.37 $2,471,861.37 $1,658,353.80

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

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

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

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

Lee Weinel

CFO


03/20/2020

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

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

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

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

  3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

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

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

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

  9. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

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

Lee Weinel

CFO


03/20/2020

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

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

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

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

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

  6. 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.

Lee Weinel

CFO


03/20/2020

Attachments

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