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:
49326
Service:
DTV
Call Sign:
KDTN
Channel:
43 (UHF)
File Number:
0000028095
FRN:
0009436411
Date Submitted:
08/07/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

COMMUNITY TELEVISION EDUCATORS OF DFW, INC.

Doing Business As: COMMUNITY TELEVISION EDUCATORS OF DFW, INC.

Arnold Torres

3901 HIGHWAY 121 SOUTH

BEDFORD, TX 76021

United States

+1 (817) 571-1229 ARNOLD.TORRES@DAYSTAR.COM Private Not-for-Profit Educational Institution

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

Samuel Hariton

Engineer

COMMUNITY TELEVISION EDUCATORS OF DFW, INC.

Samuel Hariton

4031 University Drive

Ste 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.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. Yes
Briefly describe transition plan See attached narrative describing KDTN's transition plan.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Vissionary
Year 2004
Type Inductive Output Tube
IOT Power Type Two
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? Yes
Manufacturer
Model TXUD40000ALC
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 40 kW
Justification for New Transmitter Transmitter is not capable if the power level that will be needed. Current transmitter cannot be retuned to new antenna due to banding issues. Current transmitter will remain on air transmitting pre auction channel during transition.

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 500 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 1102.0 feet
Other Electrical Service Yes
Description Minimal electric services not listed above will be needed to implement new facility.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 25 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 550.0 square feet
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

3 Inch Rigid Conduit and Wiring

3 inch Rigid Conduit and wiring at 500 feet required for repack per ATC

Mask Filter

Mask Filter

Electrical Sub-Panels

Electrical sub-panels required for operation of repack equipment

Transmitter Installation

Installation of primary transmitter

Ice Shield

ice Shield for HVAC equipment

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 Lease New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner American Tower Corporation
Site N/A
Is the existing antenna shared with another station or stations? Yes
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 Broadband Panel
Number of Stations Supported 4
Number of Panels 36
Design power capacity in use 90.0 %
Lower Limit 605.00 MHz
Upper Limit 665.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model PHP36C
Year 2003

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
22201 KDAF
67910 KDTX-TV
42359 KTXD-TV

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 Lease New
Is this a request for upgraded equipment? Yes
Ownership Leased
Owner American Tower Corporation
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Class A
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 5
Number of Panels/Bays 54
Lower Limit 482.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 14.0 %
Other Antenna Type N/A
ERP: 757.0 kW
Manufacturer
Model TUM-AP-C4-14/48H-2-R-B
Year 2017
Justification for New Antenna Current Broadband antenna is in a frequency range outside of new transition channel's frequency.

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? Yes
Type New
Number of channels supported 5
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 7 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Enter a list of RF channel numbers.

RF Channel Number
21
18
19
23
29

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Installation

Installation of the combiner; Dual chain combiner system, Single chain of 2 constant impedance waveguide modules, and or single chain of 2 directional filter modules per Dielectric layout plus a third low power filter for the wideband port.

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 Lease New
Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner American Tower Corporation
Site N/A
Is the existing transmission line shared with another station or stations? Yes
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 Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1675 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
22201 KDAF
42359 KTXD-TV
67910 KDTX-TV

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 Lease New
Is this a request for upgraded equipment? Yes
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1650 feet per run
Justification for New Transmission Line New line runs for new line feeding new broadband array at new tower site.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Nitrogen Generator

Nitrogen Generator required for repack 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

Primary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
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 1055009
Coordinates (NAD83) Latitude (NAD83) 32° 35' 22.0" N-
Longitude (NAD83) 096° 58' 12.9" W-
Overall Structure Height 1550.83 feet
Support Structure Height 1453.07 feet
Ground Elevation Above Mean Sea Level (AMSL) 829.71 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Tower, LLC
Date Constructed 11/04/2008

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
35841 KUVN-DT DTV
41380 KLNO FM
26950 KATA-CD DTV
59702 KKDA-FM FM
47739 KDMX FM
14524 KCBI FM
9620 KDGE FM
11451 WRR FM
6378 KZPS FM
23084 KHKS FM
18114 KEGL FM

Other Types of Users

Users
KODF-LD
KNAV-LP
KJJM-LD
KHPK-LD
K31GL-D
KVFW-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: Serious Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Ground and Building A and E Permit Drawing Package

Ground and Building A and E Permit Drawing Package

Tower Permit Drawing package

The generation of a construction drawing package for one broadcaster.

Construction project management Tower Modification reinforcements and facilties

60 hours on Modification project management and RF installation project management

Tower Load Study

Rigorous analysis to access the structural capacity and modifications needed to accommodate the repack equipment.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1059733
Coordinates (NAD83) Latitude (NAD83) 32° 32' 36.0" N-
Longitude (NAD83) 096° 57' 33.0" W-
Overall Structure Height 1635.15 feet
Support Structure Height 1523.60 feet
Ground Elevation Above Mean Sea Level (AMSL) 813.97 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 06/18/2000

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
63779 KJKK FM
23440 KMVK FM
67910 KDTX-TV DTV
67195 KLUV FM
17037 KDFI DTV
49324 KERA-TV DTV
49323 KERA FM
22201 KDAF DTV
23422 KTVT DTV
1087 KRLD-FM FM
55768 KKXT FM
68834 KPXD-TV DTV
9627 KBFB FM
60534 KSTR-DT DTV
42359 KTXD-TV DTV
51517 KTXA DTV
41380 KLNO FM
49326 KDTN DTV
28624 KVIL FM

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Permit Drawing Package

The generation of a construction drawing package for one broadcasters/customers.

Ground and Building A and E Permit Drawing Package

The generation of a construction drawing package for one broadcasters/customers.

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 595
Explanation KDTN lacks sufficient resources in house to handle all activities for on-time completion of build and requires the aid of outside project management services to fulfill repack requirements. KDTN will hire an outside firm to support KDTN's transition.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 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 No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 No
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 10
Justification Installation of transmitter and supervision of antenna installation.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Site Coordination Meeting

Site coordination meetings with all broadcasters, contractors and vendors involved with the site deliveries and construction.

RF System Test

Testing of the combiner to ensure all, but specifically this broadcaster frequencies are tuned for optimal patterns.

Migratory Bird Assessment Permitting if needed

Migratory Bird Assessment Permitting if needed

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 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

Cost of Construction and Electrical permits

2% construction cost, excluding the material and equipment for electrical and building permits.

Site Secuirty Company during construction for theft prevention and vandalism

Site security for installation and storage of Transmission line and materials for 57 days X 12 hours. The materials are a high risk of theft due to the material makeup such as copper, brass and aluminum.

Transmission Line Bridge

New Ice Bridge required to support new transmission lines from all four repack tenants space to tower, estimated to be 200 linear ft. This cost includes the materials, foundations and installation.

Tree Clearing Tag Alley

This cost is for the removal of trees and vegetation to ensure the proper clearance of taglines and laydown areas, required for construction.

Leasing Application Fees

Leasing Application Fees incurred due to repack

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 $2,078,323.84 $1,461,257.81 N/A $1,340,150.71 N/A
Total for all systems $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A
Primary Transmitter TXUD40000ALC $2,078,323.84 $1,461,257.81 $1,340,150.71
Electrical Sub-Panels $7,500.00 $7,500.00 Please see ATC Customer Project Cost Estimation $7,500.00 N/A
4" Rigid Conduit and Wiring (Cost per foot) $111,302.00 $14,893.00 Please see ATC Customer Project Cost Estimation $14,893.00 N/A
3 Inch Rigid Conduit and Wiring $7,000.50 $7,000.50 Please see ATC Customer Project Cost Estimation $7,000.50 N/A
Transformer 3 phase/480v - 500 KVA $48,400.00 $46,000.00 N/A $17,500.00 N/A
Other -- Building Addition Size: 550.0 $134,342.25 $134,342.25 see Estimated Cost Justification KDTN-110-1st Primary Transmitter - Building Addition, 550 Sq. Ft. v0 $132,543.05 N/A
Ice Shield $54,633.00 $54,633.00 see Estimated Cost Justification KDTN-110-1st Primary Transmitter - Ice Shield v0 $54,633.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $34,500.00 N/A
Transmitter Installation $25,546.09 $25,546.09 Please see KDTN Primary Transmitter Installation Revision Justification Cover Letter $25,271.17 N/A
Mask Filter $67,500.00 $67,500.00 See attached price quote. $867.02 N/A
25 Ton system $91,500.00 $46,400.00 N/A $35,114.71 N/A
Other Electrical Service: Minimal electric services not listed above will be needed to implement new facility. $5,000.00 $5,000.00 N/A $3,385.29 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A $4,500.00 N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,002,442.97 Please see Estimated Cost Justification KDTN-110-1st Primary Transmitter - UHF Liquid Cooled Solid State, 35-50 kW v3 $1,002,442.97 a

Components

Actual Information Description File Name
Electrical Sub-Panels

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$7,500.00
4" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$14,893.00
3 Inch Rigid Conduit and Wiring

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$7,000.50
Transformer 3 phase/480v - 500 KVA

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$17,500.00
Other -- Building Addition Size: 550.0

Component Description:
1. KDTN-110-1st Primary Transmitter - Building Addition, 550 Sq. Ft.
Amount:
$20,900.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$64,615.26

Component Description:
ITEM: Pluming Material
Amount:
$4,087.79

Component Description:
KDTN-110-1st Primary Transmitter - Building Addition, 550 Sq. Ft.
Amount:
$41,800.00

Component Description:
Weld Stands
Amount:
$1,140.00
Ice Shield

Component Description:
2. KDTN-110-1st Primary Transmitter - Ice Shield
Amount:
$10,000.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$24,633.00

Component Description:
KDTN-110-1st Primary Transmitter - Ice Shield
Amount:
$20,000.00
Switchgear - industrial 800 amp

Component Description:
Transport Stream Automatic Changeover Unit
Amount:
$22,500.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$12,000.00
Transmitter Installation

Component Description:
1-5/8" to type N female plate
Amount:
$966.00

Component Description:
Labor
Amount:
$686.95

Component Description:
Repack Travel Expenses
Amount:
$37.89

Component Description:
Repack Travel Expenses
Amount:
$274.92

Component Description:
Labor
Amount:
$696.34

Component Description:
Labor Transport
Amount:
$569.66

Component Description:
Labor
Amount:
$536.37

Component Description:
Labor
Amount:
$150.56

Component Description:
Repack Travel Expenses
Amount:
$481.40

Component Description:
Professional Fees
Amount:
$21,146.00
Mask Filter

Component Description:
1/2X100 H/C PEX Tube
Amount:
$867.02

Component Description:
LF 1 ID X 1 MIP
Amount:
$46.94
25 Ton system

Component Description:
CAPITAL CONTRIBUTION - MILTON/CEDAR HILL
Amount:
$11,600.00

Component Description:
5/8-11 X 2" Hex
Amount:
$314.71

Component Description:
Capital Contribution
Amount:
$23,200.00
Other Electrical Service: Minimal electric services not listed above will be needed to implement new facility.

Component Description:
73405WS 008100
Amount:
$931.20

Component Description:
Belden Wire & Cable
Amount:
$185.77

Component Description:
EMT
Amount:
$424.54

Component Description:
Welding on rack at TV Tower Cedar Hill, TX
Amount:
$812.50

Component Description:
508 2-1/2 MI Beam Clamp 1/2-13
Amount:
$1,031.28
Service entrance 3 phase/800 amp/208 volt

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$4,500.00
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
Elettronika TXUD40.000ALC UHF Digital TV Transmitter.
Amount:
$981,566.30

Component Description:
Bleeder Kit
Amount:
$13,607.00

Component Description:
Invoice moved to correct budget category per RFI.
Amount:
N/A

Component Description:
Shipping and Handling
Amount:
$7,269.67

Component Description:
Invoice moved to correct budget category per RFI.
Amount:
N/A

Component Description:
Invoice moved to correct budget category per RFI.
Amount:
N/A

Component Description:
Invoice moved to correct budget category per RFI.
Amount:
N/A

Component Description:
Invoice moved to correct budget category per RFI.
Amount:
N/A

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 $278,996.43 $287,416.68 N/A $274,593.88 N/A
Total for all systems $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A
Primary Antenna TUM-AP-C4-14/48H-2-R-B $278,996.43 $287,416.68 $274,593.88
Combiner Installation $13,369.00 $13,369.00 see Estimated Cost Justification KDTN-210-Primary Antenna - Combiner Installation v0 $13,369.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $100,634.00 Please see KDTN American Towers Cost Estimation and KDTN Main 75253 Dallas Milton Repack Cost Estimates $87,961.20 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,250.00 N/A
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed) $16,850.00 $9,166.25 see Estimated Cost Justification KDTN-210-Primary Antenna - 7 3_16 Broadband Elbow Complex v0 $9,166.25 N/A
UHF - Lower Power, Top Mount, Class A, broadband panel, 54 bay,, 757 kW input, directional,, elliptically or circularly polarized $157,847.43 $157,847.43 see Estimated Cost Justification KDTN-210-Primary Antenna - UHF Lower Power Top Mount Broadband E-POL v0 $157,847.43 N/A

Components

Actual Information Description File Name
Combiner Installation

Component Description:
7. KDTN-210-Primary Antenna - Combiner Installation
Amount:
$1,562.50

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$3,351.00

Component Description:
KDTN-210-Primary Antenna - Combiner Installation
Amount:
$3,125.00

Component Description:
KDTN-210-Primary Antenna - Combiner Installation
Amount:
$5,330.50
New combiner, cost per channel (without antenna)

Component Description:
4. KDTN-210-Primary Antenna - Combiner
Amount:
$15,000.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$2,327.20

Component Description:
KDTN-210-Primary Antenna - Combiner
Amount:
$30,000.00

Component Description:
CAPITAL CONTRIBUTION
Amount:
$40,634.00
Sweep test of existing antenna

Component Description:
5. KDTN-210-Primary Antenna - Sweep Test
Amount:
$937.50

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$937.50

Component Description:
KDTN-210-Primary Antenna - Sweep Test
Amount:
$2,500.00

Component Description:
KDTN-210-Primary Antenna - Sweep Test
Amount:
$1,875.00
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed)

Component Description:
6. KDTN-210-Primary Antenna - 7 3/16" Broadband Elbow Complex
Amount:
$1,625.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$4,291.25

Component Description:
KDTN-210-Primary Antenna - 7 3/16" Broadband Elbow Complex
Amount:
$3,250.00
UHF - Lower Power, Top Mount, Class A, broadband panel, 54 bay,, 757 kW input, directional,, elliptically or circularly polarized

Component Description:
3. KDTN-210-Primary Antenna - UHF Lower Power Top Mount Broadband E-POL
Amount:
$33,666.70

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$56,847.33

Component Description:
KDTN-210-Primary Antenna - UHF Lower Power Top Mount Broadband E-POL
Amount:
$67,333.40

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,102,606.00 $336,165.44 N/A $335,715.43 N/A
Total for all systems $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A
Primary Transmission Line $1,102,606.00 $336,165.44 $335,715.43
Nitrogen Generator $3,706.00 $3,706.00 Please see ATC Customer Project Cost Estimation $3,706.00 N/A
Rigid Transmission Line - copper, 7 3/16" broadband $1,098,900.00 $332,459.44 see Estimated Cost Justification KDTN-310-Primary Transmission Line - 7 3_16 Broadband Rigid Copper v0 $332,009.43 N/A

Components

Actual Information Description File Name
Nitrogen Generator

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$3,706.00
Rigid Transmission Line - copper, 7 3/16" broadband

Component Description:
8. KDTN-310-Primary Transmission Line - 7 3/16" Broadband Rigid Copper
Amount:
$50,163.75

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$144,022.36

Component Description:
4-1/2" IEC flange male to 4-1/16" flange female
Amount:
$1,033.89

Component Description:
Comb Invoice KDTN-310-Primary Transmission Line - 7 3-16in Broadband Rigid Copper American Towers LLC 460203772
Amount:
$101,227.50

Component Description:
6-1/8" 50 ohm fixed flanged
Amount:
$4,930.25

Component Description:
6-1/8" EIA 50 ohm fixed flanged rigid line section
Amount:
$30,631.68

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 $1,948,260.40 $246,765.40 N/A $229,028.17 N/A
Total for all systems $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A
Primary Tower GTOWER $421,000.00 $0.00 $0.00
Tower Permit Drawing Package $0.00 $0.00 This appears as a duplicate entry N/A N/A
Ground and Building A and E Permit Drawing Package $0.00 $0.00 This appears as a duplicate entry. N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $0.00 This appears as a duplicate entry. N/A N/A
Primary Tower GTOWER $1,527,260.40 $246,765.40 $229,028.17
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $63,845.00 N/A $51,502.50 N/A
Serious tower reinforcement/modifications $1,052,000.00 $150,000.00 N/A $147,065.27 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $4,960.00 Please see 75253 Dallas Milton Repack Cost Estimates $4,960.00 N/A
Construction project management Tower Modification reinforcements and facilties $14,650.40 $14,650.40 see Estimated Cost Justification KDTN-410-Existing Primary Tower - Construction Project Management, Tower and Facilities v0 $14,650.40 N/A
Tower Load Study $3,910.00 $3,910.00 Please see 75253 Dallas Milton Repack Cost Estimates $3,800.00 N/A
Tower Permit Drawing package $4,700.00 $4,700.00 See attached AMT quote. $3,525.00 N/A
Ground and Building A and E Permit Drawing Package $4,700.00 $4,700.00 See attached AMT quote. $3,525.00 N/A

Components

Actual Information Description File Name
Tower Permit Drawing Package Information not provided.
Ground and Building A and E Permit Drawing Package Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
13. KDTN-410-Existing Primary Tower - Tower Rigging, Complex Tower
Amount:
$15,961.30

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$3,618.60

Component Description:
KDTN-410-Existing Primary Tower - Tower Rigging, Complex Tower
Amount:
$31,922.60
Serious tower reinforcement/modifications

Component Description:
12. KDTN-410-Existing Primary Tower - Serious Tower Reinforcement/Modifications
Amount:
$37,500.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$34,565.27

Component Description:
KDTN-410-Existing Primary Tower - Serious Tower Reinforcement/Modifications
Amount:
$75,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
10. KDTN-410-Existing Primary Tower - Tower Mapping
Amount:
$1,240.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$1,240.00

Component Description:
KDTN-410-Existing Primary Tower - Tower Study
Amount:
$2,480.00
Construction project management Tower Modification reinforcements and facilties

Component Description:
16. KDTN-410-Existing Primary Tower - Construction Project Management, Tower and Facilities
Amount:
$1,875.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$9,025.40

Component Description:
KDTN-410-Existing Primary Tower - Construction Project Management, Tower and Facilities
Amount:
$3,750.00
Tower Load Study

Component Description:
11. KDTN-410-Existing Primary Tower - Tower Load Study, Documented Tower
Amount:
$977.50

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$867.50

Component Description:
KDTN-410-Existing Primary Tower - Tower Load Study, Documented Tower
Amount:
$1,955.00
Tower Permit Drawing package

Component Description:
14. KDTN-410-Existing Primary Tower - Tower Permit Drawing Package
Amount:
$1,175.00

Component Description:
KDTN-410-Existing Primary Tower - Tower Permit Drawing Package
Amount:
$2,350.00
Ground and Building A and E Permit Drawing Package

Component Description:
15. KDTN-410-Existing Primary Tower - Ground and Building Permit Drawing Package
Amount:
$1,175.00

Component Description:
KDTN-410-Existing Primary Tower - Ground and Building Permit Drawing Package
Amount:
$2,350.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $208,600.00 $212,578.50 N/A $117,595.40 N/A
Total for all systems $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A
Outside Professional Services $208,600.00 $212,578.50 $117,595.40
Perform engineering study for new channel assignment and antenna development $7,360.00 $10,000.00 Please see KDTN American Towers Cost Estimation and KDTN Main 75253 Dallas Milton Repack Cost Estimates $10,000.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $2,500.00 N/A
Project management of the transition $94,010.00 $118,635.00 see Estimated Cost Justification KDTN-510-Project Management v0 $83,429.40 invoices
RF System Test $9,000.00 $9,000.00 Please see KDTN American Towers Cost Estimation and KDTN Main 75253 Dallas Milton Repack Cost Estimates $8,800.00 N/A
Site Coordination Meeting $2,500.00 $2,500.00 See attached AMT quote. $2,000.00 N/A
Migratory Bird Assessment Permitting if needed $350.00 $350.00 See attached AMT quote. $262.50 N/A
Additional Field Engineering Service, 10 Days $20,000.00 $20,000.00 N/A $0.00 N/A
RF Exposure Measurements $21,050.00 $3,000.00 N/A $2,250.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A $0.00 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A $0.00 N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A $0.00 N/A
NEPA Section 106 environmental review, if needed $6,310.00 $1,800.00 N/A $810.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A $1,043.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $712.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 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 $745.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $5,043.50 Estimated Cost Justification KDTN-590-Prepare and_or Review Reimbursement v0 $5,043.50 N/A

Components

Actual Information Description File Name
Perform engineering study for new channel assignment and antenna development

Component Description:
19. KDTN-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$1,250.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$1,250.00

Component Description:
KDTN-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$2,500.00

Component Description:
KDTN-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$5,000.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
18. KDTN-590-Transition Timing and Coordination
Amount:
$625.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$625.00

Component Description:
KDTN-590-Transition Timing and Coordination
Amount:
$1,250.00
Project management of the transition

Component Description:
17. KDTN-510-Project Management
Amount:
$2,370.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$2,370.00

Component Description:
Project Management
Amount:
$3,385.70

Component Description:
Project Management
Amount:
$6,804.60

Component Description:
Project Management
Amount:
$1,803.40

Component Description:
Project Management
Amount:
$3,518.70

Component Description:
KDTN-510-Project Management
Amount:
$4,740.00

Component Description:
Project Management
Amount:
$4,937.95

Component Description:
Project Management
Amount:
$1,528.75

Component Description:
Project Management
Amount:
$9,673.50

Component Description:
Project Management
Amount:
$6,433.70

Component Description:
Project Management
Amount:
$93.90

Component Description:
Project Management
Amount:
$4,724.35

Component Description:
Project Management
Amount:
$10,323.90

Component Description:
Project Management
Amount:
$1,620.15

Component Description:
KDTN-510-Project Management
Amount:
$9,480.00

Component Description:
Project Management
Amount:
$1,514.90

Component Description:
Project Management
Amount:
$2,543.65

Component Description:
Project Management
Amount:
$1,519.30

Component Description:
Project Management
Amount:
$4,042.95
RF System Test

Component Description:
24. KDTN-580-Field Engineering Service - RF System Test
Amount:
$1,000.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$800.00

Component Description:
KDTN-580-Field Engineering Service - RF System Test
Amount:
$2,000.00

Component Description:
KDTN-580-Field Engineering Service - RF System Test
Amount:
$5,000.00
Site Coordination Meeting

Component Description:
22. KDTN-590-Site Coordination Meeting
Amount:
$625.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$125.00

Component Description:
KDTN-590-Site Coordination Meeting
Amount:
$1,250.00
Migratory Bird Assessment Permitting if needed

Component Description:
23. KDTN-590-Migratory Bird Assessment and Permitting
Amount:
$87.50

Component Description:
KDTN-590-Migratory Bird Assessment and Permitting
Amount:
$175.00
Additional Field Engineering Service, 10 Days Information not provided.
RF Exposure Measurements

Component Description:
21. KDTN-580-Field Engineering Service - RF Exposure Measurements
Amount:
$750.00

Component Description:
KDTN-580-Field Engineering Service - RF Exposure Measurements
Amount:
$1,500.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed

Component Description:
20. KDTN-590-NEPA Section 106 Review
Amount:
$270.00

Component Description:
KDTN-590-NEPA Section 106 Review
Amount:
$540.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Total Professional Services
Amount:
$1,043.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Total Professional Services
Amount:
$69.50

Component Description:
Total Professional Services
Amount:
$74.50

Component Description:
Total Professional Services
Amount:
$223.50

Component Description:
Total Professional Services
Amount:
$131.00

Component Description:
Total Professional Services
Amount:
$69.50

Component Description:
Total Professional Services
Amount:
$69.50

Component Description:
Total Professional Services
Amount:
$74.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Total Professional Services
Amount:
$745.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare and or review reimbursement form

Component Description:
Total Professional Services
Amount:
$786.00

Component Description:
Total Professional Services
Amount:
$4,257.50

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 $103,695.50 $101,330.50 N/A $81,974.94 N/A
Total for all systems $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A
Other Expenses $103,695.50 $101,330.50 $81,974.94
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A $4,279.75 N/A
Local Zoning $4,700.00 $4,700.00 See attached AMT quote. $3,541.20 N/A
Leasing Application Fees $2,500.00 $2,500.00 Please see ATC Customer Project Cost Estimation $2,500.00 N/A
Tree Clearing Tag Alley $1,600.00 $1,600.00 See attached AMT quote. $1,200.00 N/A
Transmission Line Bridge $36,241.50 $36,241.50 see Estimated Cost Justification KDTN-610-Transmission Line Bridge v0 $36,241.50 N/A
Site Secuirty Company during construction for theft prevention and vandalism $8,500.00 $8,500.00 See attached AMT quote. $6,412.50 N/A
Cost of Construction and Electrical permits $10,000.00 $10,000.00 See attached AMT quote. $7,500.00 N/A
MVPD Notification of Channel Change $2,964.00 $2,964.00 see Estimated Cost Justification KDTN-610-MVPD Notifications v0 $2,964.00 N/A
Develop and air announcement of upcoming channel change $500.00 $500.00 N/A N/A N/A
Equipment Storage $3,500.00 $3,500.00 See attached AMT quote. $3,422.50 N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 See attached AMT quote. $4,876.49 N/A
Non-zoning permits $10,000.00 $10,000.00 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 $335.00 see Estimated Cost Justification KDTN-610-FCC Filing Fees - License to Cover Application v0 $335.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $9,230.00 N/A $8,702.00 N/A

Components

Actual Information Description File Name
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$4,279.75
Local Zoning

Component Description:
25. KDTN-610-Local Zoning
Amount:
$1,175.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$16.20

Component Description:
KDTN-610-Local Zoning
Amount:
$2,350.00
Leasing Application Fees

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$2,500.00
Tree Clearing Tag Alley

Component Description:
29. KDTN-610-Tree Clearing Tag Alley
Amount:
$400.00

Component Description:
KDTN-610-Tree Clearing Tag Alley
Amount:
$800.00
Transmission Line Bridge

Component Description:
9. KDTN-610-Transmission Line Bridge
Amount:
$5,625.00

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$19,366.50

Component Description:
KDTN-610-Transmission Line Bridge
Amount:
$11,250.00
Site Secuirty Company during construction for theft prevention and vandalism

Component Description:
27. KDTN-610-Site Security
Amount:
$2,137.50

Component Description:
KDTN-610-Site Security
Amount:
$4,275.00
Cost of Construction and Electrical permits

Component Description:
28. KDTN-610-Construction and Electrical Permits
Amount:
$2,500.00

Component Description:
KDTN-610-Construction and Electrical Permits
Amount:
$5,000.00
MVPD Notification of Channel Change

Component Description:
MVPD Notification Services
Amount:
$2,964.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Capital Contribution Milton-Cedar Hill
Amount:
$3,422.50
Equipment Delivery and Handling Charges

Component Description:
26. KDTN-610-Equipment Delivery and Handling
Amount:
$1,250.00

Component Description:
30' Single Manlift Push-Type
Amount:
$431.78

Component Description:
5500LB 19' Shooting Boom Forklift
Amount:
$694.71

Component Description:
KDTN-610-Equipment Delivery and Handling
Amount:
$2,500.00
Non-zoning permits Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application

Component Description:
KDTN-610-FCC Filing Fee - License to Cover Application
Amount:
$335.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
DTV Notification Service
Amount:
$8,702.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $5,720,482.17 $2,645,514.33 $2,379,058.53

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.

Arnold Torres

Business Administrator


08/07/2020

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.

Arnold Torres

Business Administrator


08/07/2020

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.

Arnold Torres

Business Administrator


08/07/2020

Attachments

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