TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
MARYLAND PUBLIC BROADCASTING COMMISSION Doing Business As: MARYLAND PUBLIC TELEVISION	Larry D. Unger, President & CEO 11767 OWINGS MILLS BOULEVARD OWINGS MILLS, MD 21117 United States	+1 (410) 356-5600	lunger@mpt.org	Government Entity

Applicant

Address

Phone

Applicant Type

MARYLAND PUBLIC BROADCASTING COMMISSION

Doing Business As: MARYLAND PUBLIC TELEVISION

Larry D. Unger, President & CEO

11767 OWINGS MILLS BOULEVARD

OWINGS MILLS, MD 21117

United States

+1 (410) 356-5600

lunger@mpt.org

Government Entity

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
Samuel Hariton Widelity Inc.	Samuel Hariton 4031 University Dr Suite 100 Fairfax, VA 22030 United States	+1 (339) 222-8107	sam.hariton@widelity.com

Applicant

Address

Phone

Samuel Hariton

Widelity Inc.

Samuel Hariton

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107

sam.hariton@widelity.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	Current transmission system consists of a transmitter feeding a transmission line which connects to an antenna on the tower. Work includes connecting new repack channel main/aux transmitters to current broadband line and antenna.

Transmitters

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

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Used in case of failure of the main
	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	TDU2-5K00LV
	Year	2003
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	5.0 kW

Auxiliary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Auxiliary (Backup)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	MPTV-PRLX-U4
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	6.5 kW
	Justification for New Transmitter	Current transmitter is not supported for a channel change. See attached Transmitter Replace justification letter from manufacturer. An increase of power is part a multi-station agreement provided to the FCC to accommodate moving WETA to channel 31.

Auxiliary Transmitter

Other Transmitter Costs

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

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Rigid Coax Line	Rigid interconnection coax lines from transmitter to filter to antenna switch.
Motorized Switch	Switches which transmitter will feed the mask filter. This is not an upgrade as station uses a motorized switch. Current switch can't be utilized and have station remain on-air.
Bag Filter	Bag type water filtration for heat exchanger system. Current pre-repack cooling system has this filtering.
Coolant	The coolant used for the transmitter heat exchanger is not included in the transmitter price
Remote Control Interface	License required to interface transmitter into current remote control system

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	TDU2-5K00LV
	Year	2003
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	5.0 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	MPTV-PRLX-U4
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	6.5 kW
	Justification for New Transmitter	Current transmitter is not supported for a channel change. See attached Transmitter Replace justification letter from manufacturer. An increase of power is part a multi-station agreement provided to the FCC to accommodate moving WETA to channel 31.

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 contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor.
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Remote Control Interface	License required to interface transmitter into current remote control system
Coolant	The coolant used for the transmitter heat exchanger is not included in the transmitter price
12-Pole Mask Filter	Sharp tuned mask filter to further protect adjacent channel Class A WMJF-CD, Ch. 23 and WMPT, Ch 21. Part of a multi-party resolution provided to the FCC to accommodate moving WETA to channel 31 .
Motorized Switch	Electric actuated switch to switch main/auxiliary transmitters into antenna. Current transmitter has this capability but switch cannot be moved as it is in pre-repack service.
Bag Filter	Bag type water filtration for heat exchanger system. Current pre-repack cooling system has this filtering.
Site Design and Survey	Incorporates all aspects of the transmitter room design, including power distribution requirements, equipment placement, RF system layout, plumbing, and remote control.
Rigid Coax Line	Rigid interconnection coax lines from transmitter to filter to antenna switch.

Antennas

Section	Question	Response
Antenna Related Expenses	Do you have antenna related expenses?	No

Transmission Line

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

Tower Equipment And Rigging Costs

Section	Question	Response
Tower Equipment or Rigging Costs Changes	Do you have tower equipment or rigging costs changes?	No

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	200
	Explanation	Applicant has limited internal resources to oversee installing and commissioning this repack project. It will rely on outside services to manage all work required.
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	No
	Quantity	N/A
	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	No
	Quantity	N/A
	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	Yes
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	No
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	Yes
	Number of Days	1
	Justification	Electrical sweep to evaluate suitability of antenna and line on repack channel. 6400 Sweep and tower climber to optimize Ant/line for repack channel. 6400 plus 3000.

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Progress Reporting	Prepare and file 10 required progress reports on FCC Form 2100, Schedule 387 on a quarterly basis with the FCC.

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	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?	No
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	No
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Information not provided.

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	$744,631.10	$686,481.10	N/A	$334,672.10	N/A
Total for all systems	$904,461.10	$839,851.10	N/A	$358,460.80	N/A
Primary Transmitter MPTV-PRLX-U4	$427,726.10	$414,226.10		$207,247.10
Rigid Coax Line	$2,600.00	$2,600.00	Rigid interconnection coax lines from transmitter to filter to antenna switch.	$1,300.00	N/A
Site Design and Survey	$17,673.10	$17,673.10	see Estimated Cost Justification WMPB-110-1st Primary Transmitter - Transmitter Site Survey and Design v0	$17,673.10	N/A
Bag Filter	$6,975.00	$6,975.00	Bag type water filtration for heat exchanger system. Current pre-repack cooling system has this filtering.	$3,487.50	N/A
Motorized Switch	$18,110.00	$18,110.00	Electric actuated switch to switch main/auxiliary transmitters into antenna. Current transmitter has this capability but switch cannot be moved as it is in pre-repack service.	$9,055.00	N/A
12-Pole Mask Filter	$91,463.00	$91,463.00	Sharp tuned mask filter to further protect adjacent channel Class A WMJF-CD, Ch. 23 and WMPT, Ch 21. Part of a multi-party resolution provided to the FCC to accommodate moving WETA to channel 31 .	$45,731.50	N/A
Coolant	$1,000.00	$1,000.00	The coolant used for the transmitter heat exchanger is not included in the transmitter price	$0.00	N/A
Remote Control Interface	$2,205.00	$2,205.00	License required to interface transmitter into current remote control system	$0.00	N/A
Other Electrical Service: Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor.	$14,200.00	$14,200.00	Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor. See attached electrical quote	$0.00	N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	$273,500.00	$260,000.00	Current transmitter is not supported for a channel change. See attached Transmitter Replace justification letter from manufacturer. An increase of power is part a multi-station agreement provided to the FCC to accommodate moving WETA to channel 31.	$130,000.00	N/A
Auxiliary Transmitter MPTV-PRLX-U4	$316,905.00	$272,255.00		$127,425.00
Remote Control Interface	$2,205.00	$2,205.00	License required to interface transmitter into current remote control system	$0.00	N/A
Coolant	$1,000.00	$1,000.00	The coolant used for the transmitter heat exchanger is not included in the transmitter price	$0.00	N/A
Bag Filter	$6,975.00	$6,975.00	N/A	$3,487.50	N/A
Motorized Switch	$16,425.00	$16,425.00	Switches which transmitter will feed the mask filter. This is not an upgrade as station uses a motorized switch. Current switch can't be utilized and have station remain on-air.	$0.00	N/A
Rigid Coax Line	$2,600.00	$2,600.00	Rigid interconnection coax lines from transmitter to filter to antenna switch.	$1,300.00	N/A
Other Electrical Service: Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor.	$14,200.00	$14,200.00	Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor. See attached electrical quote	$0.00	N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	$273,500.00	$228,850.00	Current transmitter is not supported for a channel change. See attached Transmitter Replace justification letter from manufacturer. An increase of power is part a multi-station agreement provided to the FCC to accommodate moving WETA to channel 31.	$122,637.50	N/A

Components

Actual Information Description	File Name
Rigid Coax Line	Component Description: 20' coax sections primary line 2.4 on main 50 % deposit Amount: $1,300.00
Site Design and Survey	Component Description: SYS-DES-SS-PARLX-UL Amount: $15,300.00 Component Description: Sweep of antenna system WMPB Baltimore Amount: $2,373.10
Bag Filter	Component Description: bag filter for Main xmtr. 50 % deposit upon ordering. line 2.3 Amount: $3,487.50
Motorized Switch	Component Description: Motorized switch for main. 50% deposit. line 2.6 Amount: $9,055.00
12-Pole Mask Filter	Component Description: 12 pole design. Item 2.5 on quote 50% deposit Amount: $45,731.50
Coolant	Information not provided.
Remote Control Interface	Information not provided.
Other Electrical Service: Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor.	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	Component Description: 50% deposit for Lines 1,2 and 3 on invoice. 11447. System components with installation and check out & proof Amount: $130,000.00
Remote Control Interface	Information not provided.
Coolant	Information not provided.
Bag Filter	Component Description: line 2.3 on quote for auxiliary unit bag filter 50% deposit Amount: $3,487.50
Motorized Switch	Information not provided.
Rigid Coax Line	Component Description: 20' coax section for auxiliary line 2.4 on quote 50% deposit Amount: $1,300.00
Other Electrical Service: Electrical contractor to connect transmitter into existing electrical panel and wire heat exchanger into transmitter. Includes material and labor.	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	Component Description: Motorized Switch line2.5 on quote. 50% deposit Amount: $8,212.50 Component Description: lines 1-1.17 on quote. for auxiliary unit. 50% deposit Amount: $114,425.00

Cost Information

Antennas

Information not provided.

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

Information not provided.

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	$108,960.00	$107,050.00	N/A	$14,628.70	N/A
Total for all systems	$904,461.10	$839,851.10	N/A	$358,460.80	N/A
Outside Professional Services	$108,960.00	$107,050.00		$14,628.70
Project management of the transition	$31,600.00	$30,000.00	N/A	$10,455.45	N/A
Progress Reporting	$35,000.00	$35,000.00	Prepare and file 10 required progress reports on FCC Form 2100, Schedule 387 on a quarterly basis with the FCC.	$551.75	N/A
Additional Field Engineering Service, 1 Days	$15,800.00	$15,800.00	Electrical sweep to evaluate suitability of antenna and line on repack channel. $6400 Sweep and tower climber to optimize Ant/line for repack channel. $6400 plus $3000.	$3,000.00	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$5,000.00	Fees related to multi-party resolution agreement with Maryland Public TV, WETA and HME Equity Fund II, LLC. Involved several stations moving channels to accommodate WETA moving from ch 14 to 31.	$168.50	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$168.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$285.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$0.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$0.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$0.00	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
Project management of the transition	Component Description: Project Management Amount: $1,765.90 Component Description: Project Management Amount: $1,388.00 Component Description: Project Management Amount: $66.20 Component Description: Project Management Amount: $2,416.60 Component Description: Project Management Amount: $763.05 Component Description: Project Management Amount: $162.90 Component Description: Project Management Amount: $146.10 Component Description: Project Management Amount: $2,280.15 Component Description: Project Management Amount: $1,466.55
Progress Reporting	Component Description: Legal fees associated with the Repacking Project Amount: $104.50 Component Description: Legal fees associated with the repacking project Amount: $104.50 Component Description: Additional items for other locations and other MPT issues. Amount: $89.25 Component Description: Progress Reporting for Repacking Project for WMPB Amount: $142.50 Component Description: Legal fees associated with the repacking project Amount: $79.50 Component Description: Legal Fees associated with Progress Reporting for Repacking Project Amount: $31.50
Additional Field Engineering Service, 1 Days	Component Description: sweep of existing antenna system at WMPB Amount: $3,000.00
Attorney Fees - Negotiation of lease and other matters for shared locations	Component Description: reimbursement for just the owings mill location WMPB. Amount: $126.00 Component Description: Professional Services Amount: $42.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Legal fees associated with the repacking project Amount: $168.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Legal fees for filing form 399/2100 Page 7 of invoice Amount: $285.00
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	Information not provided.
Perform engineering study for new channel assignment and antenna development	Information not provided.
Prepare and or review reimbursement form	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	$50,870.00	$46,320.00	N/A	$9,160.00	N/A
Total for all systems	$904,461.10	$839,851.10	N/A	$358,460.80	N/A
Other Expenses	$50,870.00	$46,320.00		$9,160.00
MVPD Notification of Channel Change	$1,000.00	$1,000.00	Notification will need to be made to MVPD's as required. Applicant to explore using an outside firm to determine which facilities will need to be notified and send the appropriate notification letters.	$0.00	N/A
Equipment Delivery and Handling Charges	$18,320.00	$18,320.00	Transmitter shipping and offloading. See transmitter quote options.	$9,160.00	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$20,000.00	$20,000.00	Applicant will be required to dispose of the current transmission line and transmitter and heavy oil filled high voltage power supplies. These cannot be disposed of in a typical landfill.	$0.00	N/A
DTV Medical Facility Notification	$11,550.00	$7,000.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
MVPD Notification of Channel Change	Information not provided.
Equipment Delivery and Handling Charges	Component Description: line 2.2 on auxiliary offloading 50% deposit Amount: $2,250.00 Component Description: Transmitter system transportation. 50% deposit Amount: $2,330.00 Component Description: line 2.1 auxiliary transmitter system transporation 50 % deposit Amount: $2,330.00 Component Description: Offloading 50% deposit Amount: $2,250.00
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
DTV Medical Facility Notification	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$904,461.10	$839,851.10	$358,460.80

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.	Carl R Wolfe Director, Transmission and Distribution 05/18/2020

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.

Carl R Wolfe

Director, Transmission and Distribution

05/18/2020

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.	Carl R Wolfe Director, Transmission and Distribution 05/18/2020

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.

Carl R Wolfe

Director, Transmission and Distribution

05/18/2020

(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

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Transmission Line

Tower Equipment And Rigging Costs

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

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification

Attachments