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:
83945
Service:
DTV
Call Sign:
KGLA-DT
Channel:
35 (UHF)
File Number:
0000028479
FRN:
0015540131
Date Submitted:
04/30/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MAYAVISION, INC.

Doing Business As: Telemundo New Orleans

Alejandro Schweikert

3540 S I-10 SERVICE ROAD W

SUITE 342

METARIE, LA 70001

United States

+1 (504) 799-4242 ALEJANDRO@KGLA.TV Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Arthur M Hoover , III .

President Technical Consultant

Technical Services Group, Inc.

12015 Cloverland Court

Baton Rouge, LA 70809

United States

+1 (225) 751-9800 amh@tsgcom.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan KGLA-DT plans to purchase a new like-for-like primary transmitter, primary antenna and primary transmission line. A new like-for-like auxiliary transmitter, as well as an interim antenna and interim line will be required during the transition period.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use 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 5.2 kW
Year 2010
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 5.2 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model THU9-4 Evo
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.5 kW
Justification for New Transmitter To facilitate continuous service of KGLA signal during the transition period for KGLA primary transmitter

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 275.0 feet
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

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Other Transmitter Cost Not Listed

Information not provided.

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 CST II
Year 2007
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 26 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? No
Manufacturer
Model THU9-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 31 kW
Justification for New Transmitter The existing transmitter cannot be retuned because the manufacturer is no longer in business and retuning services are 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 300 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 275.0 feet
Other Electrical Service Yes
Description Reconfigure 48 Distribution, Tray, & Exterior Transmitter Raceway
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 15 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

Name Description

UHF inside RF system including switching

Reject Loads, Elbows, and other connections within transmission building

Installation Services

Installation of new primary transmitter

Building Reconfiguration

No additional building space is necessary, however some reconfiguration of the existing building is needed to make room for the equipment (removal and installation of walls).

4-port switch

Coaxial switch, control panel, and cables

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? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 780.0 kW
Manufacturer
Model PSIUSMDT24A0C
Year 2007

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? 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? Yes
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: 681.0 kW
Manufacturer
Model ATW20H3-ETS-35H
Year 2017
Justification for New Antenna A new main antenna is necessary because the existing main antenna is a single frequency antenna, and is not capable of operation on the Channel 35

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?
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?
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

Information not provided.

Interim Antenna

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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? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 1
Lower Limit 590.00 MHz
Upper Limit 650.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 681.0 kW
Manufacturer
Model TFU-24WB C160
Year 2017
Justification for New Antenna An interim antenna is required for KGLA to remain on air during the demolition of the existing main antenna and installation of the channel 35 top mounted New main Antenna.

Interim Antenna

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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

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change 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 8 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1144 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 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1144 feet per run
Justification for New Transmission Line New Transmission line is necessary because the existing transmission line for Ch. 42 is not compatible with the new Ch. 35. The new transmission line will have different segment lengths.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 4 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 1020 feet per run
Justification for New Transmission Line An interim transmission line is required for KGLA to connect to the interim antenna to allow KGLA to remain on air during the demolition of the existing main antenna and installation of the channel 35 top mounted New main Antenna.

Interim 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? Terrain Constrained
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
ASR Number 1028295
Coordinates (NAD83) Latitude (NAD83) 29° 58' 42.0" N-
Longitude (NAD83) 089° 56' 26.0" W-
Overall Structure Height 1048.54 feet
Support Structure Height 991.46 feet
Ground Elevation Above Mean Sea Level (AMSL) 0.00 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner MAYAVISION, INC.
Date Constructed 06/01/1984


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 undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

TSG Tower Crew Costs

Mobilization, demobilization equipment, and mobilization/demobilization separate from Rio Tower & Steel expenses

Structural Analysis

Structural Analysis to be run after Mapping is complete.

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 2562
Explanation KGLA requires the aid of outside project management services in order to fulfill the requirements of the Repack. KGLA does not have sufficient resource capacity and expertise in house to handle all of the reimbursement filing, expense tracking, vendor co
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 Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 50
Justification The KGLA site is completely surrounded by water. The estimated for 50 days of additional engineering services is based on logistical challenges. See attachment for more detailed explanation.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
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 Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? 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

Name Description

Engineering and Administrative

Minor Engineering issues and other Administrative Costs

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 $1,830,094.86 $1,707,844.91 N/A $1,707,844.87 N/A
Total for all systems $4,468,973.94 $4,727,347.41 N/A $4,281,737.16 N/A
Primary Transmitter THU9-20 $1,478,544.86 $1,244,056.99 $1,244,056.96
4-port switch $24,506.73 $24,506.73 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-1.10 $24,506.73 N/A
Building Reconfiguration $19,304.46 $19,304.46 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-1.9 $19,304.46 N/A
Installation Services $130,135.43 $130,135.43 Please see KGLA-DT Technical Services Group, Inc. Estimate 1.1 $130,135.43 N/A
UHF inside RF system including switching $130,137.46 $130,137.46 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-1.7 $130,137.45 N/A
15 Ton system $88,400.00 $13,708.23 KGLA will only seek reimbursement for Ductwork and Reconfiguration. Please see attached KGLA-DT Revised Estimate KGLA-1.6 - HVAC and KGLA FCC RFI#2 CCavell 3-17 annotated with response $13,708.23 N/A
Other Electrical Service: Reconfigure 48 Distribution, Tray, & Exterior Transmitter Raceway $49,760.78 $49,760.78 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-1.5 $49,760.78 N/A
3" Rigid Conduit and Wiring (Cost per foot) $14,300.00 $7,148.10 Expense split between Primary and Auxiliary Transmitters. Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-1.4 for Primary share of this expense $7,148.09 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $34,452.26 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-1.3 $34,452.25 N/A
Switchgear - industrial 800 amp $38,200.00 $34,173.40 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-1.2 $34,173.40 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $800,730.14 Please see KGLA-DT Technical Services Group, Inc. Estimate 1.1 $800,730.14 N/A
Auxiliary Transmitter THU9-4 Evo $351,550.00 $463,787.92 $463,787.91
3" Rigid Conduit and Wiring (Cost per foot) $14,300.00 $7,148.10 Expense split between Auxiliary and Primary Transmitters. Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-2.4 for Auxiliary share of this expense $7,148.09 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $23,257.35 Transformer is 30 KVA and entered at 150 KVA because it is the lowest option allowable in LMS. Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-2.3 $23,257.35 N/A
Switchgear - industrial 800 amp $38,200.00 $23,776.06 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-2.2 $23,776.06 N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $409,606.41 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-2.1 $409,606.41 N/A

Components

Actual Information Description File Name
4-port switch

Component Description:
Category 1.0 Main/Primary Transmitter
Amount:
$24,506.73
Building Reconfiguration

Component Description:
Category 1.0 Main/Primary Transmitter
Amount:
$19,304.46
Installation Services

Component Description:
KGLA-110-1st Primary Transmitter - Installation Services
Amount:
$130,135.43
UHF inside RF system including switching

Component Description:
Category 1.0 Main/Primary Transmitter
Amount:
$130,137.45
15 Ton system

Component Description:
Mechanical HVAC Ductwork reconfiguration
Amount:
$13,708.23
Other Electrical Service: Reconfigure 48 Distribution, Tray, & Exterior Transmitter Raceway

Component Description:
Category 1.0 Main/Primary Transmitter
Amount:
$49,760.78
3" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Category 1.0 Main/Primary Transmitter
Amount:
$7,148.09
Transformer 3 phase/480v - 300 KVA

Component Description:
Category 1.0 Main/Primary Transmitter
Amount:
$34,452.25
Switchgear - industrial 800 amp

Component Description:
Category 1.0 Main/Primary Transmitter
Amount:
$34,173.40
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Main Transmitter Equipment & Installation
Amount:
$800,730.14
3" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Category 2.0 FCC 399 Auxiliary Transmitter
Amount:
$7,148.09
Transformer 3 phase/480v - 150 KVA

Component Description:
Category 2.0 FCC 399 Auxiliary Transmitter
Amount:
$23,257.35
Switchgear - industrial 800 amp

Component Description:
Category 2.0 FCC 399 Auxiliary Transmitter
Amount:
$23,776.06
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
Category 2.0 FCC 399 Auxiliary Transmitter
Amount:
$409,606.41

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 $544,557.69 $487,664.36 N/A $475,328.91 N/A
Total for all systems $4,468,973.94 $4,727,347.41 N/A $4,281,737.16 N/A
Interim Antenna TFU-24WB C160 $248,327.69 $247,109.73 $247,109.72
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $4,983.16 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-3.1 $4,983.16 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,538.88 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-3.2 $22,538.88 N/A
UHF - High Power, Side Mount, basic slot antenna, 1 bay,, 681 kW input, directional,, horizontally polarized $213,187.69 $213,187.69 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-3.4C $213,187.68 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-3.3 $6,400.00 N/A
Primary Antenna ATW20H3-ETS-35H $296,230.00 $240,554.63 $228,219.19
Sweep test of existing antenna $6,730.00 $6,400.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-4.2 $6,400.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $234,154.63 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-4.1 $221,819.19 N/A

Components

Actual Information Description File Name
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
Pattern scatter analysis
Amount:
$4,983.16
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
ERI Model i230ECW-24-35 antenna side custom mounts
Amount:
$22,538.88
UHF - High Power, Side Mount, basic slot antenna, 1 bay,, 681 kW input, directional,, horizontally polarized

Component Description:
3.4C Slot Antenna UHF - High Power, Side Mount
Amount:
$213,187.68
Sweep test of existing antenna

Component Description:
Antenna and Line Sweep
Amount:
$6,400.00
Sweep test of existing antenna

Component Description:
Category 4.0 FCC 399 Primary Antenna
Amount:
$6,400.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
4.1 Antenna UHF - High Power Top Mount
Amount:
$221,819.19

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 $306,568.00 $324,845.94 N/A $324,845.93 N/A
Total for all systems $4,468,973.94 $4,727,347.41 N/A $4,281,737.16 N/A
Interim Transmission Line $75,480.00 $106,242.96 $106,242.95
Flexible Air Transmission Line - dielectric, 4" $75,480.00 $106,242.96 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-5.1B $106,242.95 N/A
Primary Transmission Line $231,088.00 $218,602.98 $218,602.98
Rigid Transmission Line - copper, 6 1/8" $231,088.00 $218,602.98 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-6.1A $218,602.98 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 4"

Component Description:
5.1B Flex Transmission Line - copper
Amount:
$106,242.95
Rigid Transmission Line - copper, 6 1/8"

Component Description:
6.1A Rigid Transmission Line - copper, 6 1/8"
Amount:
$218,602.98

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 $960,047.94 $1,445,071.91 N/A $1,350,134.41 N/A
Total for all systems $4,468,973.94 $4,727,347.41 N/A $4,281,737.16 N/A
Primary Tower GTOWER $960,047.94 $1,445,071.91 $1,350,134.41
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $604,031.25 see Estimated Cost Justification KGLA-410-Existing Primary Tower - Tower Rigging, Complex Tower v1 $604,031.25 N/A
Structural Analysis $26,122.94 $26,122.94 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-7.1 $26,122.94 N/A
Major tower reinforcement/modifications $421,000.00 $722,992.72 Please see attached KGLA-DT Revised Estimate KGLA-7.2A - Tower Reinforcement and Modifications and TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-7.2B $693,680.22 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $26,300.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-7.5 $26,300.00 N/A
TSG Tower Crew Costs $65,625.00 $65,625.00 Please see attached KGLA-DT Revised Estimate KGLA-7.4B - Tower Rigging $0.00 N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Category 7.0 Tower Equipment & Rigging Costs - Primary Tower
Amount:
$65,625.00

Component Description:
Rio Tower SOW Rig/Derig Tower
Amount:
$515,593.75

Component Description:
Site Visit Post Modification Observation Visit Perform a post modification observation site visit and tower climb with two engineers
Amount:
$22,812.50
Structural Analysis

Component Description:
Bo Hoover: Structural analysis review
Amount:
$900.00

Component Description:
Tower Analysis -Additional Scenario Analyze the tower for the proposed KGLA repack antenna replacement, while keeping in place the existing FM antenna and corresponding 3 in coax feedline.
Amount:
$1,875.00

Component Description:
Structural Analysis
Amount:
$23,347.94
Major tower reinforcement/modifications

Component Description:
KGLA-410-Existing Primary Tower - Major Tower Reinforcement/Modifications
Amount:
$16,625.00

Component Description:
Site Visit - Post-Modification Observation Visit Tower
Amount:
$122,347.87

Component Description:
Furnish: Recycled concrete rock
Amount:
$112,391.66

Component Description:
Changes needed for land preparation work at the transmitter site on Bayou Bienvenue.
Amount:
$28,300.00

Component Description:
Category 7.0 FCC 399 Tower Equip & Rigging
Amount:
$414,015.69
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Category 7.0 FCC 399 Tower Equip & Rigging
Amount:
$26,300.00
TSG Tower Crew Costs Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $580,640.88 $518,026.51 N/A $233,648.47 N/A
Total for all systems $4,468,973.94 $4,727,347.41 N/A $4,281,737.16 N/A
Outside Professional Services $580,640.88 $518,026.51 $233,648.47
Additional Field Engineering Service, 50 Days $31,989.88 $31,989.88 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.02 $31,989.88 N/A
RF Exposure Measurements $21,050.00 $16,001.74 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.03 $16,001.74 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $57,500.00 Please see attached KGLA-DT Revised Estimate KGLA-8.04 - Comprehensive Coverage Verification Field Study $0.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $2,250.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.09 $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.10 $0.00 N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.11 $250.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $3,500.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.13 $0.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.14 $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.15 $0.00 N/A
Project management of the transition $404,796.00 $366,449.89 Please see attached KGLA-DT Revised Estimate KGLA-8.01 - Project Management $177,196.85 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.20 $0.00 N/A
Prepare and or review reimbursement form $2,630.00 $11,585.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.19 $7,835.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.18 $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.12 $375.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.16 $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-8.17 $0.00 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 50 Days

Component Description:
Engineering Support During Construction
Amount:
$31,989.88
RF Exposure Measurements

Component Description:
TSG OET-65 RF Exposure Measurements including OET 65 Study for Safe operating zones on tower
Amount:
$16,001.74
Comprehensive coverage verification via field study, if needed

Component Description:
Category 8.0 FCC 399 Outside Professional Services
Amount:
$57,500.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
FHH Law Prepare and File request for Special Temporary Authorization
Amount:
$2,250.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application

Component Description:
Construction Permit App Aux
Amount:
$250.00
Prepare request for Special Temporary Authorization

Component Description:
Prepare request for Special Temporary Authorization
Amount:
$3,500.00

Component Description:
Vendor Credit - Prepare request for Special Temporary Authorization
Amount:
($3,500.00)
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
Vendor Credit - RF Consulting Engineer Fees - Aux Antenna: Prepare engineering section
Amount:
($1,500.00)

Component Description:
RF Consulting Engineer Fees - Aux Antenna: Prepare engineering section
Amount:
$1,500.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare engineering section of FCC Form 2100 (Main), License to Cover
Amount:
$1,500.00

Component Description:
Vendor Credit - Prepare engineering section of FCC Form
Amount:
($1,500.00)
Project management of the transition

Component Description:
FCC 387 Quarterly reports
Amount:
$225.00

Component Description:
Cost Reconciliation
Amount:
$487.50

Component Description:
Project Management
Amount:
$6,071.65

Component Description:
Project Management Services performed by Todd Acomb May 2019
Amount:
$3,750.00

Component Description:
Project Management Services performed by Todd Acomb July 2019
Amount:
$4,200.00

Component Description:
Project Management Services performed by Todd Acomb March 2019
Amount:
$3,187.50

Component Description:
Project Management Services performed by Todd Acomb June 2019
Amount:
$9,562.50

Component Description:
Project Management
Amount:
$2,040.60

Component Description:
Project Management Services performed by Todd Acomb August 2019
Amount:
$10,350.00

Component Description:
Project Management
Amount:
$1,470.00

Component Description:
Project Management
Amount:
$562.80

Component Description:
Project Management Services performed by Todd Acomb February 2019
Amount:
$15,000.00

Component Description:
Project/Construction management of the transition
Amount:
$11,550.00

Component Description:
Project Management Services performed by Todd Acomb November 2019
Amount:
$12,000.00

Component Description:
Project Management Services performed by Todd Acomb April 2019
Amount:
$5,062.50

Component Description:
Project Management
Amount:
$1,371.75

Component Description:
Project Management Services
Amount:
$15,525.00

Component Description:
Project Management
Amount:
$6,447.60

Component Description:
Project Management
Amount:
$585.00

Component Description:
Project Management
Amount:
$6,703.70

Component Description:
Project Management
Amount:
$1,525.00

Component Description:
Project Management Services performed by Todd Acomb January 2019
Amount:
$11,062.50

Component Description:
Please deny this invoice. Part of 203512
Amount:
N/A

Component Description:
Category 8.0 Outside Professional Services
Amount:
$5,962.50

Component Description:
Please deny this invoice. Part of 203512
Amount:
N/A

Component Description:
Project Management
Amount:
$562.80

Component Description:
Project Management
Amount:
$1,232.65

Component Description:
Project Management
Amount:
$3,265.00

Component Description:
Project Management Services performed by Todd Acomb September 2019
Amount:
$22,200.00

Component Description:
Project Management
Amount:
$2,377.50

Component Description:
Project Management
Amount:
$2,317.50

Component Description:
Project Management
Amount:
$408.75

Component Description:
Onsite meeting, professional services, project management, FCC 399 initial prep and review response
Amount:
$10,692.35
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Category 8.0B Outside Professional Services
Amount:
$2,500.00
Prepare and or review reimbursement form

Component Description:
Channel Repack memo; re same
Amount:
$7,835.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Category 8.0B Outside Professional Services
Amount:
$7,000.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Construction Permit App Main
Amount:
$375.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
TSG RF Consulting Engineer Fees- Aux Antenna: Prepare engineering
Amount:
$2,000.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Category 8.0B Outside Professional Services
Amount:
$3,000.00

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 $247,064.57 $243,893.78 N/A $189,934.57 N/A
Total for all systems $4,468,973.94 $4,727,347.41 N/A $4,281,737.16 N/A
Other Expenses $247,064.57 $243,893.78 $189,934.57
Engineering and Administrative $7,637.50 $7,637.50 Please see attached KGLA-DT Revised Estimate KGLA-9.01 - Engineering and Administrative $7,637.50 N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.03 $0.00 N/A
Equipment Storage $57,535.56 $57,535.56 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.04. The KGLA site is completely surrounded by water. The est cost is based on 6 months of off-site storage. $57,535.56 N/A
Equipment Delivery and Handling Charges $58,826.79 $58,826.79 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.05. The KGLA site is surrounded by water. Est. based on allocation of 25 days rental of small barge and other logistics. $58,826.79 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $0.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $315.79 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.11 $0.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $48,934.72 $48,934.72 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.14. The KGLA site is surrounded by water. All disposal will require daily water transportation to land-based disposal sites $48,934.72 N/A
Non-zoning permits $5,000.00 $5,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.06 $5,000.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $189.47 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.12 N/A N/A
DTV Medical Facility Notification $11,550.00 $11,578.95 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.09 $0.00 N/A
AM Pattern Disturbance -- Remedy $21,050.00 $19,375.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.08 N/A N/A
AM Pattern Disturbance -- Impact study $7,890.00 $7,500.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.07 $0.00 N/A
Local Zoning $10,000.00 $10,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.13 $10,000.00 N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 Please see attached TSG Estimate - 2015987 KGLA 399 Category of Cost Proposal Estimate v5 2-12-2020 - All Sections - Section KGLA-9.02 $2,000.00 N/A

Components

Actual Information Description File Name
Engineering and Administrative

Component Description:
Attorney fees
Amount:
$3,700.00

Component Description:
KGLA-610-Engineering and Administrative
Amount:
$3,937.50
Develop and air announcement of upcoming channel change

Component Description:
Develop and air announcement of upcoming channel change
Amount:
$15,000.00
Equipment Storage

Component Description:
Equipment Storage
Amount:
$57,535.56
Equipment Delivery and Handling Charges

Component Description:
Freight and Delivery
Amount:
$58,826.79
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application

Component Description:
Category 9.0B Other Expenses
Amount:
$315.79
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Category 9.0 Other Expenses
Amount:
$48,934.72
Non-zoning permits

Component Description:
Electrical
Amount:
$5,000.00
FCC Filing Fees - Special Temporary Authorization request Information not provided.
DTV Medical Facility Notification

Component Description:
FHH Law DTV Medical Facility Notification
Amount:
$11,578.95
AM Pattern Disturbance -- Remedy Information not provided.
AM Pattern Disturbance -- Impact study Information not provided.
Local Zoning

Component Description:
Category 9.0 Other Expenses
Amount:
$10,000.00
MVPD Notification of Channel Change

Component Description:
MVPD Notification of Channel Change
Amount:
$2,000.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,468,973.94 $4,727,347.41 $4,281,737.16

Reimbursement Status

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

Certification

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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.

Todd Acomb

Project Manager


04/30/2020

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.

Todd Acomb

Project Manager


04/30/2020

Attachments

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