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:
16950
Service:
DTV
Call Sign:
KNXT
Channel:
22 (UHF)
File Number:
0000026332
FRN:
0030857197
Date Submitted:
07/13/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

DIOCESE OF FRESNO EDUCATION CORP.

Doing Business As: DIOCESE OF FRESNO EDUCATION CORP.

Jaime Gonzalez

1550 N. FRESNO ST.

FRESNO, CA 93703

United States

+1 (559) 488-7440 jaime@dioceseoffresno.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 Removal all existing equipment and replace. Requires an interim facility.

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 Klystron
Year 1986
Type Other Type
Other Transmitter Type Klystron
Power Capacity 34 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 Parallax U8
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 13 kW
Justification for New Transmitter Old Transmitter Manufacturer out of business and can not be re-tuned. see S4074 KNXT DCXP-2 Paragon IOT pricing and equipment. Using Lower Gain Antenna because our neighbor is on a adjacent channel and for better community of license service

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 100.0 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

Name Description

CA Sales Tax

CA sales tax

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model Parallax U10
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 16.2 kW
Justification for New Transmitter Required due to excessive off air time between professional services and product replacements. Using smaller antenna to lower installation and removal cost and tower loading.see attached quote 4074 R4-KNXT-Primary U8 Interim U10 Liquid 1A

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 4 inches
Length 200.0 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
Inside RF System Is an additional interior RF system required to support this interim transmitter? Yes

Interim Transmitter

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Other Transmitter Cost Not Listed

Name Description

CA Sales Tax

CA sales Tax 7.975%

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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Top
Polarization Horizontal
Type Other
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 16 bay array
ERP: 185.0 kW
Manufacturer
Model KAT157159
Year 1985

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? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Top
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 126.0 kW
Manufacturer
Model ATW12H7-HSC2-22L
Year 2017
Justification for New Antenna Cover Population, it is different from original construction and channel frequency. Also our hill top neighbor is now adjacent channel so our pattern needs to more closely match their pattern.

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? No
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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

CA Sales Tax

CA sales tax on ERI Primary Antenna and Transmission Line

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? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Bottom
Polarization Horizontal
Type Other
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 Broadband Array
ERP: 120.0 kW
Manufacturer
Model i230ECW-8-22
Year 2018
Justification for New Antenna Need to establish interim facility to rebuild main. No antenna farms to provide coverage of city of license and maintain service contour.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 3 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

CA Sales Tax

CA sales tax on ERI Interim Antenna and Line

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 Flexible Air
Diameter 5 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 190 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 Flexible Air
Diameter 5 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 225 feet per run
Justification for New Transmission Line Old line is too short for new antenna feed point. see KNXT-Quote # 20170710-89 Rev B.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

dehydrator

air line dehydrator

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 Rigid
Diameter 3 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 225 feet per run
Justification for New Transmission Line To allow rigging removal of existing main facility. see attached quote KNXT Quote no #20180327-547 Rev A.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Dryline Dehydrator

To pressurized the Transmission Line.

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

Auxiliary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use Interim
Ownership Leased
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1012373
Coordinates (NAD83) Latitude (NAD83) 36° 17' 15.7" N-
Longitude (NAD83) 118° 50' 23.3" W-
Overall Structure Height 251.97 feet
Support Structure Height 251.97 feet
Ground Elevation Above Mean Sea Level (AMSL) 5720.07 feet
Structure Type LTOWER - Lattice Tower
Tower Owner Sinclair Television of Fresno, LLC
Date Constructed 01/01/1971


Auxiliary 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: Minor Reinforcements needed

Auxiliary 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

Auxiliary Tower

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Other Tower Expenses Not Listed

Information not provided.

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? Yes
One or more FM, AM or TV radio broadcaster(s) No
Others Types of Users Yes
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? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 36° 17' 13.8" N-
Longitude (NAD83) 118° 50' 20.3" W-
Overall Structure Height 199.00 feet
Support Structure Height 199.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 5885.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Diocese of Fresno Educational Corporation
Date Constructed 07/05/1986


Other Types of Users

Users
kvvg-ld

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: No 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? Yes

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

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 795
Explanation Only One engineer in the department. Please see attached quotes from Widelity and Mark Quella
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 2
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 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
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 Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Interim Sight Lease, Rent

Interim operation sight, during installation of primary sight.

RF engineering interim STL

RF study and licensing for interim operation

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 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

Removal of existing ch-50 Transmitter.

Removal / Disposal of existing Ch-50 Transmitter.

STL-TSL For Interim Transmitter

Studio Microwave Link to feed PGM and remote control & Monitor Transmitter per FCC Rules see attached PDF Studio to Transmitter Link and Transmitter to Studio Link Declaration

Freight For Interim Line-Antenna

Freight charges for Interim Antenna and Transmission Line shipping

Freight For Primary Line-Antenna

Freight charges for Primary Main Antenna and Transmission Line shipping

Interim Transmitter Delivery

Interim Transmitter Shipping Offload and place in building.

Primary Transmitter Delivery

Primary Transmitter Shipping Offload and place in building.

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 $1,706,311.90 $1,626,361.90 N/A $1,279,148.20 N/A
Total for all systems $3,715,514.87 $3,104,269.71 N/A $1,808,173.14 N/A
Interim Transmitter Parallax U10 $1,026,803.80 $978,703.80 $796,201.04
CA Sales Tax $62,003.80 $62,003.80 N/A $55,803.39 N/A
UHF inside RF system including switching $147,500.00 $140,000.00 N/A $126,000.00 N/A
10 Ton system $60,500.00 $57,500.00 N/A $21,135.00 N/A
4" Rigid Conduit and Wiring (Cost per foot) $20,200.00 $19,200.00 N/A $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $0.00 N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $650,000.00 To maintain operations during removal and replacement of primary facilities. Please see Hitachi Comark Proposal P#4074R3-KNXT-PARLX-171207-R4 $585,000.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A $8,262.65 N/A
Primary Transmitter Parallax U8 $679,508.10 $647,658.10 $482,947.16
CA Sales Tax $36,258.10 $36,258.10 N/A $32,632.28 X
4" Rigid Conduit and Wiring (Cost per foot) $10,100.00 $9,600.00 N/A $0.00 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $0.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A $0.00 N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $470,000.00 Please see Hitachi Comark Proposal P#4074R3-KNXT-PARLX-171207-R4 $430,459.88 N/A
10 Ton system $60,500.00 $57,500.00 N/A $19,855.00 N/A

Components

Actual Information Description File Name
CA Sales Tax

Component Description:
KNXT Interim Transmitter California Sales Tax
Amount:
$21,701.30

Component Description:
KNXT Interim Transmitter California Sales Tax
Amount:
$21,701.30

Component Description:
55% deposit of CA sales tax for Interim Transmitter
Amount:
$34,102.09
UHF inside RF system including switching

Component Description:
KNXT Interim Transmitter- UHF Inside RF System
Amount:
$49,000.00

Component Description:
55% Deposit INTERIM TRANSMITTER UHF INSIDE RF
Amount:
$77,000.00

Component Description:
KNXT Interim Transmitter- UHF Inside RF System
Amount:
$49,000.00
10 Ton system

Component Description:
Construction
Amount:
$20,850.00

Component Description:
LABOR -Zeke Flores jr
Amount:
$285.00
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
SYSTEM, KNXT PRLX U10 D22
Amount:
$227,500.00

Component Description:
55% Deposit INTERIM TRANSMITTER PARALLAX U10 includes Installation and Proof
Amount:
$357,500.00

Component Description:
Interim Transmitter
Amount:
$227,500.00
Service entrance 3 phase/800 amp/208 volt

Component Description:
Electrical installation of new equipment at Blue Ridge Mountain per customer information
Amount:
$8,262.65
CA Sales Tax

Component Description:
KNXT 1st Primary Transmitter California Sales Tax
Amount:
$12,690.33

Component Description:
KNXT 1st Primary Transmitter California Sales Tax
Amount:
$12,690.33

Component Description:
55% deposit CA sales tax Primary transmitter
Amount:
$19,941.95
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 150 KVA

Component Description:
ELECTRICAL INSTALLATION OF NEW TRANSMITTERS AT BLUE RIDGE MOUNTAIN LOCATION AS DIRECTED.
Amount:
$21,196.21
Switchgear - industrial 800 amp Information not provided.
Service entrance 3 phase/800 amp/208 volt

Component Description:
KNXT-110-1st Primary Transmitter - Service Entrance 3 Phase/800 Amp/208 Volt
Amount:
$11,922.87
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
Demo existing electrical and install panel and transformer in middle room
Amount:
$7,459.88

Component Description:
KNXT 1st Primary Transmitter
Amount:
$164,500.00

Component Description:
KNXT 1st Primary Transmitter
Amount:
$164,500.00

Component Description:
55% Deposit PRIMARY TRANSMITTER PARALLAX U8 includes installation and proof
Amount:
$258,500.00
10 Ton system

Component Description:
Install 5ton Split
Amount:
$19,855.00

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 $356,098.82 $228,570.44 N/A $138,829.43 N/A
Total for all systems $3,715,514.87 $3,104,269.71 N/A $1,808,173.14 N/A
Interim Antenna i230ECW-8-22 $141,469.00 $61,525.09 $33,459.40
CA Sales Tax $7,589.00 $7,589.00 CA sales tax. $0.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 To Verify proper operation at sight. N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $12,296.28 Needed to mount Antenna to tower. See Quote #20180327-547 Rev A in attachments; see Justifying Invoice - KNXT ERI 52369 $9,922.83 N/A
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) $9,340.00 $8,880.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,674.74 need service to verify Specifications and operation, plus taxes. See ERI Quote #20180327-547 Rev A in attachments. $5,248.39 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $21,085.07 Please see attached ERI Quote 20180327-547 REV A. This estimated cost accounts for previously reimbursed amounts totaling $39,875.53 from ERI Invoice 52369 $18,288.18 N/A
Primary Antenna ATW12H7-HSC2-22L $214,629.82 $167,045.35 $105,370.03
CA Sales Tax $10,139.82 $10,139.82 CA sales tax N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 To check for signal integrity. N/A N/A
Sweep test of existing antenna $6,730.00 $6,250.00 Verify connections of antenna and transmission line are within design specifications before RF power is applied. $3,750.00 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $74,046.00 Please see attached ERI Proposal 20170710-089 REV C. This estimated cost accounts for previously reimbursed amounts totaling $31,734.00 from ERI Invoice 36188 $30,010.50 N/A
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized $103,100.00 $71,609.53 ***System Notice: Estimate adjusted and locked because line has been superseded.***Reimbursed amount in this category deducted from the appropriate categories. ERI Invoice 52369 (interim antenna) incorrectly allocated to this category and reimbursed. The reimbursed amount has been deducted from the estimated cost of the interim antenna $71,609.53 N/A

Components

Actual Information Description File Name
CA Sales Tax Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
KNXT-280-Interim Antenna - Side Mount Brackets for High Power Antenna
Amount:
$6,802.83

Component Description:
30% deposit for custom antenna mounts.
Amount:
$3,120.00
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
30% deposit on sweep test
Amount:
$1,875.00

Component Description:
KNXT-280-Interim Antenna - Sweep Test
Amount:
$3,373.39
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
30% deposit on Interim Antenna i230ecw-8-22
Amount:
$18,288.18
CA Sales Tax Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna

Component Description:
KNXT-210-Primary Antenna - Sweep Test
Amount:
$1,875.00

Component Description:
30% deposit Sweep test of Primary Antenna
Amount:
$1,875.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
ANTENNA ATW12H7-HSC2-22L TRANSMISSION LINE
Amount:
$30,010.50
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized

Component Description:
30% deposit of ERI Primary Trasar Antenna
Amount:
$31,734.00

Component Description:
Interim i230
Amount:
$39,875.53

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 $55,262.46 $87,130.78 N/A $55,005.89 N/A
Total for all systems $3,715,514.87 $3,104,269.71 N/A $1,808,173.14 N/A
Interim Transmission Line $29,512.46 $47,324.40 $31,638.19
Dryline Dehydrator $2,512.46 $2,512.46 To provide required dry air pressure to properly maintain line internal environment; plus taxes and freight. See ERI Proposal 20180327-547 Rev A $2,027.50 N/A
Rigid Transmission Line - copper, 3 1/8" broadband $27,000.00 $44,811.94 many directional changes with slant section and complex line layout between transmission room and antenna/tower. See ERI Proposal 20180327-547 Rev A $29,610.69 N/A
Primary Transmission Line $25,750.00 $39,806.38 $23,367.70
dehydrator $2,125.00 $2,125.00 Required pressurization of antenna and feed line. KNXT Proposal 20170710-089 Rev B $1,521.84 N/A
Flexible Air Transmission Line - dielectric, 5" $23,625.00 $37,681.38 KNXT quote # 20170711-089 Rev B 225 ft of 5 inch Line. $21,845.86 N/A

Components

Actual Information Description File Name
Dryline Dehydrator

Component Description:
KNXT-280-Interim Transmission Line - Dryline Dehydrator
Amount:
$1,390.00

Component Description:
30% deposit Interim Transmission Line dehydrator
Amount:
$637.50
Rigid Transmission Line - copper, 3 1/8" broadband

Component Description:
INTERIM TRANSMISSION LINE
Amount:
$5,665.33

Component Description:
KNXT-380-Interim Transmission Line - Rigid 3 1/8" Broadband
Amount:
$4,251.78

Component Description:
TRANSMISSION LINE SWEEP
Amount:
$6,250.00

Component Description:
30% deposit Interim transmission Line System
Amount:
$13,443.58
dehydrator

Component Description:
KNXT-310-Primary Transmission Line - Dehydrator
Amount:
$884.34

Component Description:
30% deposit Primary Transmission Line dehydrator
Amount:
$637.50
Flexible Air Transmission Line - dielectric, 5"

Component Description:
KNXT-310-Primary Transmission Line - Flexible Air Dielectric, 5"
Amount:
$10,541.45

Component Description:
30% deposit Primary Transmission Line System
Amount:
$11,304.41

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 $1,077,600.00 $639,000.00 N/A $139,052.20 N/A
Total for all systems $3,715,514.87 $3,104,269.71 N/A $1,808,173.14 N/A
Auxiliary Tower LTOWER $605,300.00 $377,000.00 $137,752.20
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A $15,980.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $0.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $202,000.00 N/A $121,772.20 N/A
Primary Tower TOWER $472,300.00 $262,000.00 $1,300.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $227,000.00 N/A $0.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $10,000.00 N/A $1,300.00 N/A
Tower Helicopter Lift $25,000.00 $25,000.00 antenna assembly cannot reach tower site via access road. $0.00 N/A

Components

Actual Information Description File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Site Visit
Amount:
$15,980.00
Minor tower reinforcement/modifications Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Remove inside elements of the exiting top mounted channel 26 antenna.
Amount:
$52,200.00

Component Description:
KNXT-450-Existing Auxiliary Tower - Tower Rigging, Complex Tower
Amount:
$1,890.00

Component Description:
Assemble inerim antenna Mount KNXT CH 22 antenna on North leg of tower at 70 ft.
Amount:
$69,572.20
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Inspect tower at Blue Ridge - Matt Vasquez, 3 hours
Amount:
$570.00

Component Description:
Engineering hours, four sets of drawings and calculations
Amount:
$6,930.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Analysis/Report
Amount:
$1,300.00
Tower Helicopter Lift 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 $317,970.00 $322,609.90 N/A $81,987.80 N/A
Total for all systems $3,715,514.87 $3,104,269.71 N/A $1,808,173.14 N/A
Outside Professional Services $317,970.00 $322,609.90 $81,987.80
Project management of the transition $125,610.00 $129,675.00 see quote Project_Mngr_Repack_Quot8-25-17 from Mark Quella and Widelity Project Management Quote. $53,674.30 N/A
RF engineering interim STL $6,460.00 $6,460.00 New STL to interim tower for STA operations and then moved to main tower after STA expires $0.00 N/A
Interim Sight Lease, Rent $30,000.00 $30,000.00 Short Term lease for Interim Transmitting location. Tower space and Building space. $0.00 N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A $0.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $5,963.60 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A $0.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A $0.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $8,875.00 Justifying Invoice - KNXT Fletcher, Heald and Hildreth 1995396-2 $5,750.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $0.00 N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A $0.00 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,851.80 see Estimated Cost Justification KNXT-530-RF Eng - Special Temporary Authorization v0 $3,851.80 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 N/A $0.00 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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 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 $1,250.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $375.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $625.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $10,498.10 see Estimated Cost Justification KNXT-530-RF Eng - Engineering Study for New Channel Assignment v0. See also KNXT New Channel Assignment Verified Budget Increase Justification v0 $10,498.10 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$3,068.00

Component Description:
Project Management
Amount:
$2,932.85

Component Description:
Project Management
Amount:
$1,921.25

Component Description:
Project Management
Amount:
$9,431.10

Component Description:
Project Management
Amount:
$151.25

Component Description:
Project Management
Amount:
$3,951.85

Component Description:
Project Management
Amount:
$4,052.55

Component Description:
Project Management
Amount:
$5,484.15

Component Description:
Project Management
Amount:
$2,382.70

Component Description:
Project Management
Amount:
$2,595.00

Component Description:
Project Management
Amount:
$3,244.20

Component Description:
Project Management
Amount:
$2,535.40

Component Description:
Project Management
Amount:
$2,767.10

Component Description:
Project Management
Amount:
$5,242.65

Component Description:
Project Management
Amount:
$2,171.05

Component Description:
Project Management
Amount:
$1,743.20
RF engineering interim STL Information not provided.
Interim Sight Lease, Rent Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Consultation on KNXT(DT).
Amount:
$2,607.00

Component Description:
Minor Modification Application for post-repack Channel 22.
Amount:
N/A

Component Description:
Population Chart. Custom TIREM coverage map.
Amount:
$3,356.60
ASR modification (prepare FCC Form 854) Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Advise client regarding MVPD and health services notification requirements
Amount:
$375.00

Component Description:
Consult with FCC staff and client regarding status of KNXT transition and CP extension request.
Amount:
$875.00

Component Description:
Consult with client regarding auction repacking rules
Amount:
$4,500.00
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 Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Consult with client regarding STA preparation
Amount:
$500.00

Component Description:
Consultation on STA for KNXT(DT).
Amount:
$3,351.80
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Construction Permit
Amount:
$1,250.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Repack timing related expenses
Amount:
$375.00
Prepare and or review reimbursement form

Component Description:
Prepare and review
Amount:
$625.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Evaluate the potential to convert KNXT(DT) to DTS.
Amount:
$2,498.10

Component Description:
Minor Modification application for post-repack ch-22
Amount:
$8,000.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application 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 $202,271.69 $200,596.69 N/A $114,149.62 N/A
Total for all systems $3,715,514.87 $3,104,269.71 N/A $1,808,173.14 N/A
Other Expenses $202,271.69 $200,596.69 $114,149.62
Primary Transmitter Delivery $17,822.00 $17,822.00 N/A $16,039.80 N/A
Interim Transmitter Delivery $20,652.00 $20,652.00 N/A $18,586.45 N/A
Freight For Primary Line-Antenna $17,830.89 $17,830.89 N/A N/A N/A
Freight For Interim Line-Antenna $9,148.43 $9,148.43 N/A $0.00 N/A
STL-TSL For Interim Transmitter $54,278.37 $54,278.37 Beckman Tower Invoice 181102-1; See Justifying Invoices - KNXT TALLEY 10310474, 10309207, 10308160. and 10312969 $54,278.37 N/A
Removal of existing ch-50 Transmitter. $25,000.00 $25,000.00 Existing Transmitter Removal / Disposal. $22,500.00 N/A
MVPD Notification of Channel Change $3,500.00 $3,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $2,800.00 $2,800.00 N/A N/A N/A
Equipment Storage $5,000.00 $5,000.00 staging space for equipment deliveries before special short bed trucking for mountain access roads N/A N/A
Equipment Delivery and Handling Charges $7,500.00 $7,500.00 Moving from storage and transfer to smaller vehicles for mountain road access N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $0.00 Notified by FCC that their will NOT be any charge due to Repack. N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,745.00 N/A
Non-zoning permits $550.00 $550.00 N/A N/A N/A

Components

Actual Information Description File Name
Primary Transmitter Delivery

Component Description:
KNXT Primary Transmitter Deliver
Amount:
$6,237.70

Component Description:
55% deposit on Shipping and Delivery
Amount:
$9,802.10

Component Description:
KNXT Primary Transmitter Deliver
Amount:
$6,237.70
Interim Transmitter Delivery

Component Description:
KNXT Interim Transmitter Delivery
Amount:
$7,227.85

Component Description:
KNXT Interim Transmitter Delivery
Amount:
$7,227.85

Component Description:
55% deposit on Shipping and delivery if Interim Transmitter
Amount:
$11,358.60
Freight For Primary Line-Antenna Information not provided.
Freight For Interim Line-Antenna Information not provided.
STL-TSL For Interim Transmitter

Component Description:
Travel to KNXT studio. Provide dish mount for new dish. Install dish mount. Assemble and install 6ft. Hp dish.
Amount:
$10,917.79

Component Description:
BEL7919A-1000 Cat5e 4 Pair, Outdoor Black Shield F/UTP CMX/UV Rate 1000'
Amount:
$962.63

Component Description:
ANDHSX8-59-P3A 5.925-6.425 GHz 8 Ft Dual Plzd Super Hi-Perf MW Ant
Amount:
$11,642.85

Component Description:
5.925-7.125 GHz 6 Ft Sngl Plzd Low Profile Hi-Perf MW Ant
Amount:
$1,111.21

Component Description:
Align new microwave link antenna for KNXT TV at the studio location.
Amount:
$1,575.00

Component Description:
STL Microwave without shipping
Amount:
$25,127.19

Component Description:
ANDVHLP6-6W-6WH/B 5.925-7.125 GHz 6 Ft Sngl Plzd Low Profile Hi-Perf MS Ant
Amount:
$2,941.70
Removal of existing ch-50 Transmitter.

Component Description:
55% Deposit on removal-disposal of Klystron
Amount:
$13,750.00

Component Description:
KNXT Removal of Existing Channel 50 Transmitter
Amount:
$8,750.00

Component Description:
KNXT Removal of Existing Channel 50 Transmitter
Amount:
$8,750.00
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
DTV Notification Service
Amount:
$2,745.00
Non-zoning permits Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,715,514.87 $3,104,269.71 $1,808,173.14

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.

Cynthia Martin

Chief Financial Officer


07/13/2020

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.

Cynthia Martin

Chief Financial Officer


07/13/2020

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.

Cynthia Martin

Chief Financial Officer


07/13/2020

Attachments

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