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:
41210
Service:
DTV
Call Sign:
WJTC
Channel:
35 (UHF)
File Number:
0000028828
FRN:
0022238794
Date Submitted:
10/12/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Deerfield Media (Mobile) Licensee, LLC

1776 Park Ave

4-135

Park City, UT 84060

United States

+1 (435) 649-0045 scott.flick@pillsburylaw.com Limited Liability Company

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

Paul A. Cicelski , Esq .

Lerman Senter PLLC

2001 L Street NW

Suite 400

Washington, DC 20036

United States

+1 (202) 416-6756 sinclair399s@summitridgegroup.com

Broadcaster Information and Transition Plan

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

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 DCX Millenium
Year 2002
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 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 THU9evo-48
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 73.5 kW
Justification for New Transmitter Per the manufacturer, the current transmitter cannot be retuned. See Exhibit B.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 800.0 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

Transmitter Building

Transmitter Building

Consolidation Storage

Consolidation Storage

Electrical Installation

Electrical Installation

Additional parts

Additional parts

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 Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model ATW27H5-HTP5L-44H
Year 2002

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 826.0 kW
Manufacturer
Model TFU-18ETT/VP-R 4 C 160
Year 2017
Justification for New Antenna Current antenna is a single channel antenna that cannot be used for the new post-auction channel.

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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 8 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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Mounting Support Pole

Mounting Support Pole

Wedding Cake Mounting Adapter

Wedding Cake Mounting Adapter

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 Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 598.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 100.0 kW
Manufacturer
Model TFU-8WB-1-R
Year 2017
Justification for New Antenna Interim antenna to be used to stay on the air while the main antenna undergoes construction for the post-auction channel change.

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 4 1/16 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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1550 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1550 feet per run
Justification for New Transmission Line The section sizes are frequency-specific and the current transmission line cannot be used with the post-repack channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 4 1/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 500 feet per run
Justification for New Transmission Line Interim transmission line will feed the interim antenna.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
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? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1030889
Coordinates (NAD83) Latitude (NAD83) 30° 35' 16.7" N-
Longitude (NAD83) 087° 33' 12.7" W-
Overall Structure Height 1500.97 feet
Support Structure Height 1446.83 feet
Ground Elevation Above Mean Sea Level (AMSL) 136.15 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Deerfield Media (Mobile) Licensee, LLC
Date Constructed 08/20/2002

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
52230 WPCS FM

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

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 470
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
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 Yes
RF exposure measurements No
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

Station Project Manager Internal Costs

Project Manager Internal Employee Time Costs

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 No
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

Tree Removal

Tree Removal

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 $2,347,320.07 $1,435,221.75 N/A $1,293,492.96 N/A
Total for all systems $4,549,949.18 $5,896,715.20 N/A $5,158,613.10 N/A
Primary Transmitter THU9evo-48 $2,347,320.07 $1,435,221.75 $1,293,492.96
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW $1,999,000.00 $1,136,166.68 N/A $1,086,537.89 N/A
Additional parts $60,080.80 $60,080.80 N/A $60,080.80 N/A
Electrical Installation $65,900.00 $65,900.00 N/A $65,900.00 N/A
Consolidation Storage $24,094.45 $24,094.45 N/A $24,094.45 N/A
Transmitter Building $41,944.82 $41,944.82 N/A $41,944.82 N/A
10 Ton system $60,500.00 $14,935.00 N/A $14,935.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $20,800.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW

Component Description:
Transmitter credit memo. #9500808929
Amount:
($49,628.79)

Component Description:
Transmitter related cost 25%. #9500101177
Amount:
$250,444.37

Component Description:
Transmitter related cost. #9500118002
Amount:
$49,628.79

Component Description:
Transmitter related cost 75%. #9500113588
Amount:
$836,093.52
Additional parts

Component Description:
Transmitter related cost. #9500114631
Amount:
$55,546.40

Component Description:
Transmitter related cost. #9500115292
Amount:
$4,534.40
Electrical Installation

Component Description:
Transmitter related cost. #126324
Amount:
$65,900.00
Consolidation Storage

Component Description:
Transmitter related cost. #9500122639
Amount:
$24,094.45
Transmitter Building

Component Description:
Transmitter related cost. #356
Amount:
$24,985.00

Component Description:
Transmitter building cost. #354
Amount:
$2,500.00

Component Description:
Transmitter building cost. #355
Amount:
$11,157.00

Component Description:
Transmitter related cost. #361
Amount:
$3,302.82
10 Ton system

Component Description:
Transmitter related cost. #310343831
Amount:
$6,435.00

Component Description:
HVAC System cost. #COM32952
Amount:
$8,500.00
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.

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 $548,711.01 $438,982.89 N/A $390,637.81 N/A
Total for all systems $4,549,949.18 $5,896,715.20 N/A $5,158,613.10 N/A
Interim Antenna TFU-8WB-1-R $143,930.00 $90,464.00 $60,818.37
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $10,400.00 N/A $3,291.97 Second item should be removed.
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized $103,100.00 $51,664.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $51,664.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,862.40 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
Primary Antenna TFU-18ETT/VP-R 4 C 160 $404,781.01 $348,518.89 $329,819.44
Wedding Cake Mounting Adapter $28,235.70 $28,235.70 N/A $28,235.70 N/A
Mounting Support Pole $65,065.31 $65,065.31 N/A $65,065.31 N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $37,757.88 See Dielectric quote. $37,757.88 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $211,060.00 See Response to August 11 Inquiry. $192,898.15 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,862.40 N/A

Components

Actual Information Description File Name
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
Elbow complex.
Amount:
$4,116.00

Component Description:
Total amount reduced by 20.02%. #25014
Amount:
$3,291.97
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized

Component Description:
Antenna cost
Amount:
$51,664.00
Sweep test of existing antenna

Component Description:
Antenna related cost reduced by 8.40%. #763025
Amount:
$5,862.40
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Wedding Cake Mounting Adapter

Component Description:
Total invoice amount reduced by 8.4%. #696021
Amount:
$28,235.70
Mounting Support Pole

Component Description:
Total invoice amount reduced by 8.4%. #696021
Amount:
$65,065.31
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
Antenna related cost reduced by 8.4%. #696021
Amount:
$16,797.61

Component Description:
Antenna related cost reduced by 8.4%. #696010
Amount:
$12,442.02

Component Description:
Antenna related cost reduced by 8.4%. #693018
Amount:
$8,518.25
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Antenna related cost reduced by 8.4%. #696010
Amount:
$192,898.15
Sweep test of existing antenna

Component Description:
Antenna related cost reduced by 8.40%. #815014
Amount:
$5,862.40

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 $608,850.00 $654,106.89 N/A $461,263.13 N/A
Total for all systems $4,549,949.18 $5,896,715.20 N/A $5,158,613.10 N/A
Interim Transmission Line $71,000.00 $142,606.89 $142,606.89
Rigid Transmission Line - copper, 4 1/16" $71,000.00 $142,606.89 Please see quote attached to Dielectric invoice #689012. $142,606.89 N/A
Primary Transmission Line $537,850.00 $511,500.00 $318,656.24
Rigid Transmission Line - copper, 8 3/16" $537,850.00 $511,500.00 N/A $318,656.24 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 4 1/16"

Component Description:
Total invoice amount reduced by 8.40%. #689012
Amount:
$86,858.28

Component Description:
Total amount reduced by 20.02%. #55007
Amount:
$55,748.61
Rigid Transmission Line - copper, 8 3/16"

Component Description:
Transmission line related cost reduced by 8.4%. #693007
Amount:
$1,269.11

Component Description:
Resubmitted under Interim Transmission Line. #689012
Amount:
N/A

Component Description:
Total invoice amount reduced by 8.4%. #711002
Amount:
$315,106.29

Component Description:
Transmission line related cost reduced by 8.40%. #771012
Amount:
$2,280.84

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 $644,100.00 $2,994,332.40 N/A $2,885,624.40 N/A
Total for all systems $4,549,949.18 $5,896,715.20 N/A $5,158,613.10 N/A
Primary Tower TOWER $644,100.00 $2,994,332.40 $2,885,624.40
Structural engineering tower load study for well documented tower $12,600.00 $16,500.00 See FDH quotes $16,500.00 N/A
Major tower reinforcement/modifications $421,000.00 $2,706,062.40 See quote attached to FDH Infrastructure invoice. $2,706,062.40 N/A
Tall Tower (greater than 500') $210,500.00 $271,770.00 Please see quote attached to FDH Infrastructure invoice. $163,062.00 N/A

Components

Actual Information Description File Name
Structural engineering tower load study for well documented tower

Component Description:
Tower related cost. #E-186359
Amount:
$3,500.00

Component Description:
Tower related cost. #E-187957
Amount:
$2,500.00

Component Description:
Structural tower analysis cost. #E186359
Amount:
$3,500.00

Component Description:
Tower related cost. #SIN000482
Amount:
$2,250.00

Component Description:
Structural tower evaluation cost. #E187957
Amount:
$2,500.00

Component Description:
Structural Analysis cost. #E-186347
Amount:
$3,500.00

Component Description:
Structural Analysis Cost. #E-188223
Amount:
$2,500.00

Component Description:
Broadcast analysis 50% down payment. #SIN000276
Amount:
$2,250.00
Major tower reinforcement/modifications

Component Description:
Tower related cost. #SIN005742
Amount:
$165,102.00

Component Description:
Tower related cost. #SIN005582
Amount:
$37,395.30

Component Description:
Tower related cost. #SIN002339
Amount:
$224,371.80

Component Description:
Tower related cost. #SIN002255
Amount:
$112,185.90

Component Description:
Tower related cost. #SIN002303
Amount:
$1,390,317.60

Component Description:
30% down payment. #SIN000003
Amount:
$776,689.80
Tall Tower (greater than 500')

Component Description:
Resubmitted under Tree Removal in Other Expenses. #33835
Amount:
N/A

Component Description:
Tower related cost. #SIN002303
Amount:
$163,062.00

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 $230,150.00 $203,818.17 N/A $53,808.96 N/A
Total for all systems $4,549,949.18 $5,896,715.20 N/A $5,158,613.10 N/A
Outside Professional Services $230,150.00 $203,818.17 $53,808.96
Project management of the transition $74,260.00 $70,500.00 N/A $42,034.38 N/A
Station Project Manager Internal Costs $10,000.00 $10,000.00 N/A $283.62 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $0.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $0.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $221.92 N/A $221.92 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $1,567.50 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $6,596.25 See Carl T. Jones invoice $6,596.25 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $772.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,332.79 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations. #153
Amount:
$1,287.27

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations. #170
Amount:
$1,374.71

Component Description:
Legal Service Cost. #478819
Amount:
$3,675.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #132
Amount:
$589.44

Component Description:
Legal services cost. #466749
Amount:
$120.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$29.98

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1045
Amount:
$185.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$20.91

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1123
Amount:
$342.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473885
Amount:
$318.62

Component Description:
Legal services cost. #467437
Amount:
$120.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #107
Amount:
$602.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1010
Amount:
$86.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1072
Amount:
$237.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #1086
Amount:
$275.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #461759
Amount:
$709.74

Component Description:
Legal Service Cost. #467945
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465173
Amount:
$654.26

Component Description:
Legal services cost. #476933
Amount:
$102.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476367
Amount:
$364.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #468718
Amount:
$349.51

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472583
Amount:
$279.89

Component Description:
Legal services cost. #472213
Amount:
$157.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477820
Amount:
$320.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #466690
Amount:
$446.87

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1141
Amount:
$406.17

Component Description:
Legal services cost. #461782
Amount:
$318.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173
Amount:
$297.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473506
Amount:
$421.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475744
Amount:
$305.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1111
Amount:
$159.58

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1055
Amount:
$243.38

Component Description:
Legal services cost. #465234
Amount:
$240.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1151
Amount:
$388.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470237
Amount:
$436.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985
Amount:
$308.18

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477305
Amount:
$393.53

Component Description:
Legal Service Cost. #478309
Amount:
$275.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$32.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809
Amount:
$395.77

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1078
Amount:
$215.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1105
Amount:
$216.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475283
Amount:
$384.08

Component Description:
Legal services cost. #464748
Amount:
$115.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457851
Amount:
$818.59

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1167
Amount:
$313.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173
Amount:
$311.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1117
Amount:
$282.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026
Amount:
$801.57

Component Description:
Legal services fee. #473569
Amount:
$421.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$43.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1161
Amount:
$267.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #469573
Amount:
$377.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457331
Amount:
$836.44

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1145
Amount:
$369.98

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1130
Amount:
$281.49

Component Description:
Legal services Cost. #476422
Amount:
$108.75

Component Description:
Legal Service Cost. #477866
Amount:
$2,214.85

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809
Amount:
$361.32

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453972
Amount:
$716.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467378
Amount:
$576.96

Component Description:
Legal services cost. #460891
Amount:
$625.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173
Amount:
$297.68

Component Description:
Legal services cost. #474453
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #141
Amount:
$1,800.46

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #450412
Amount:
$999.04

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1133
Amount:
$307.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1051
Amount:
$105.97

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1099
Amount:
$266.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1069
Amount:
$246.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1079
Amount:
$177.14

Component Description:
Legal services cost. #471578
Amount:
$163.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093
Amount:
$269.71

Component Description:
Legal services cost. #474866
Amount:
$166.25

Component Description:
Legal services cost. #470330
Amount:
$713.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1141
Amount:
$406.17

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #118
Amount:
$468.97

Component Description:
Legal services cost. #472632
Amount:
$157.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1058
Amount:
$187.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985
Amount:
$308.18

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1039
Amount:
$30.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1143
Amount:
$436.90

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1114
Amount:
$242.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1090
Amount:
$176.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1156
Amount:
$399.52

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463567
Amount:
$566.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478780
Amount:
$271.41

Component Description:
26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for Invoice 461759 (correct reimbursement amount is $709.74). #CM-11-21-2019-461759
Amount:
($289.46)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1012
Amount:
$20.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$91.50

Component Description:
$207.48 credit to be split across 52 Sinclair stations reimbursed $269.71 for invoice #1093 (correct reimbursement amount is $265.72). #CM-7-29-2019-1093
Amount:
($3.99)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474405
Amount:
$490.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$731.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$1,954.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809
Amount:
$361.32

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1063
Amount:
$262.29

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465001
Amount:
$596.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #464321
Amount:
$683.07

Component Description:
Legal Service Cost. #479331
Amount:
$2,742.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$912.82

Component Description:
Legal services cost. #464406
Amount:
$62.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$107.53

Component Description:
Legal Service Cost. #477351
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478288
Amount:
$194.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1098
Amount:
$238.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453686
Amount:
$943.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470923
Amount:
$406.65

Component Description:
Legal Service Cost. #479861
Amount:
$217.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467861
Amount:
$470.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #471524
Amount:
$322.83
Station Project Manager Internal Costs

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$5.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$6.09

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$17.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$16.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$23.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$1.69

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$26.93

Component Description:
Internal time expense for April - D.S.
Amount:
$41.43

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$8.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$9.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$25.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$33.53

Component Description:
Internal time expense for April - D.S.
Amount:
$41.43

Component Description:
Internal time expense for April - H.A.
Amount:
$85.05

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$32.09

Component Description:
Internal time expense for April - H.A.
Amount:
$85.05

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$15.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.39

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.86

Component Description:
Portion of general repack matter internal time card attributable to this station - divided by 100.
Amount:
$66.55
Comprehensive coverage verification via field study, if needed Information not provided.
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 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 Information not provided.
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

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$99.92

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$122.00
Prepare request for Special Temporary Authorization

Component Description:
Outside professional service cost. #324-05-0006
Amount:
$997.50

Component Description:
Outside professional service cost. #324-05-0007
Amount:
$570.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Outside professional Service Cost. #324-05-0005
Amount:
$1,140.00

Component Description:
Consulting engineering cost.
Amount:
$1,597.50

Component Description:
Outside professional service cost. #324-05-0004
Amount:
$3,858.75
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting engineering cost.
Amount:
$772.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$152.01

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$1,311.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$869.30

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 $170,818.10 $170,253.10 N/A $73,785.84 N/A
Total for all systems $4,549,949.18 $5,896,715.20 N/A $5,158,613.10 N/A
Other Expenses $170,818.10 $170,253.10 $73,785.84
Equipment Delivery and Handling Charges $36,724.14 $36,724.14 See Exhibit J. $35,161.08 N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 See Exhibit J. N/A N/A
Develop and air announcement of upcoming channel change $28,050.00 $28,050.00 See Response to August 11 Inquiry. N/A N/A
Equipment Storage $15,397.96 $15,397.96 See Exhibit J. $15,397.96 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $28,566.00 $28,566.00 See Response to August 11 Inquiry. $4,476.80 The line item with attachment name WJTC 2-3-2020 WM OF AL-MOBILE Inv 2748886-2131-6.pdf and status Need More Information can be removed. A new version was uploaded.
Non-zoning permits $10,000.00 $10,000.00 See Exhibit J. N/A N/A
Local Zoning $20,000.00 $20,000.00 See Exhibit J. 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
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,750.00 N/A
Tree Removal $15,000.00 $15,000.00 N/A $15,000.00 The old 33835 can be deleted.

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
Equipment delivery and handling cost reduced by 8.40%. #837038
Amount:
$1,740.00

Component Description:
Equipment delivery and handling cost reduced by 8.40%. #781017
Amount:
$1,563.06

Component Description:
Equipment delivery and handling cost reduced by 8.40%. #837012
Amount:
$16,289.10

Component Description:
Equipment delivery and handling cost reduced by 8.40%. #838030
Amount:
$5,737.82

Component Description:
Total invoice amount reduced by 8.4%. #697004
Amount:
$1,061.03

Component Description:
Transmitter related cost. #271462-0001
Amount:
$2,862.23

Component Description:
Equipment delivery and handling cost. #271462-0002
Amount:
$182.18

Component Description:
Total invoice amount reduced by 8.4%. #695022
Amount:
$1,631.28

Component Description:
Total invoice amount reduced by 8.4%. #727006
Amount:
$5,657.44
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Equipment storage cost reduced by 8.40%. #838030
Amount:
$10,277.52

Component Description:
Equipment storage cost reduced by 8.40%. #837012
Amount:
$5,120.44
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal related cost. #2752281-2131-3
Amount:
$510.91

Component Description:
Disposal related cost. #2754583-2131-0
Amount:
$32.15

Component Description:
Disposal related cost. #2747761-2131-2
Amount:
$11.37

Component Description:
Disposal related cost. #2755756-2131-1
Amount:
$83.37

Component Description:
Equipment disposal cost. #2755698-2131-5
Amount:
$182.15

Component Description:
Disposal related cost. #2754523-2131-6
Amount:
$660.67

Component Description:
Disposal related cost. #2751180-2131-8
Amount:
$515.30

Component Description:
Equipment disposal cost. #2746579-2131-9
Amount:
$194.63

Component Description:
Disposal cost. #2750057-2131-9
Amount:
$676.20

Component Description:
Disposal cost. #2748886-2131-6
Amount:
$529.20

Component Description:
Equipment disposal cost. #2747714-2131-1
Amount:
$593.32

Component Description:
Disposal related cost. #2747761-2131-2
Amount:
$11.37

Component Description:
Disposal related cost. #2747717-2131-4
Amount:
$531.05

Component Description:
Disposal related cost. #2748886-2131-6
Amount:
$534.07
Non-zoning permits Information not provided.
Local Zoning 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.
DTV Medical Facility Notification

Component Description:
Medical notification cost. #1368
Amount:
$3,750.00
Tree Removal

Component Description:
Tree disposal cost. #33835
Amount:
$15,000.00

Component Description:
Tree removal cost. #33835
Amount:
$15,000.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,549,949.18 $5,896,715.20 $5,158,613.10

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Stephen Mumblow

President of Licensee's Sole Member


10/12/2020

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.

Stephen Mumblow

President of Licensee's Sole Member


10/12/2020

Attachments

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