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:
23486
Service:
DTV
Call Sign:
WTLH
Channel:
19 (UHF)
File Number:
0000028876
FRN:
0015435399
Date Submitted:
04/30/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NEW AGE MEDIA OF TALLAHASSEE LICENSE, LLC

Doing Business As: NEW AGE MEDIA OF TALLAHASSEE LICENSE, LLC

1181 HIGHWAY 315

WILKES-BARRE, PA 18701

United States

+1 (410) 568-1500 jparente1966@gmail.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. Yes
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-2
Year 2001
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 46 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/36
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 55 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? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

RF Combiner

RF Combiner

Eaton 9PX 3000 RT LV 120V

Eaton 9PX 3000 RT LV 120V

Electrical Installation

Electrical Installation

Additional Equipment

Additional 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 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: 655.0 kW
Manufacturer
Model ATW30H4-HTOU-49H
Year 2005

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? No
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: 354.0 kW
Manufacturer
Model TFU-24ETT/VP-R O4
Year 2017
Justification for New Antenna The 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

Additional parts

Additional parts

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? Yes
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 2
Number of Panels/Bays 16
Lower Limit 470.00 MHz
Upper Limit 598.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 200.0 kW
Manufacturer
Model TFU-24WB/VP
Year 2017
Justification for New Antenna Interim antenna is to be used to stay on the air and support both WTWC and WTLH while the main antenna undergoes construction for the post-auction channel change.

Interim 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 2
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? 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

Enter a list of RF channel numbers.

RF Channel Number
22
19

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 Waveguide
Diameter N/A
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 2124 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 2124 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. Larger transmission line to accommodate 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 Flexible Air
Diameter 4 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 700 feet per run
Justification for New Transmission Line Interim transmission line will feed the interim antenna for both WTWC and WTLH.

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 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? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1227719
Coordinates (NAD83) Latitude (NAD83) 30° 40' 50.3" N-
Longitude (NAD83) 083° 58' 20.6" W-
Overall Structure Height 1997.02 feet
Support Structure Height 1870.06 feet
Ground Elevation Above Mean Sea Level (AMSL) 154.85 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner SpectraSite Communications, LLC. through American Towers, LLC.
Date Constructed 02/05/2002

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
66908 WTWC-TV DTV

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 tower with candelabra
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 Candelabra
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower permit and building permit

Tower permit and building permit

Site Coordination Meeting

Site Coordination Meeting

Temporary License

Temporary License

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

Sinclair Internal Costs

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 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

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,959,127.71 $924,838.64 N/A $825,709.67 N/A
Total for all systems $4,526,365.61 $3,327,572.40 N/A $2,093,346.15 N/A
Primary Transmitter THU9evo/36 $1,959,127.71 $924,838.64 $825,709.67
Electrical Installation $19,975.00 $19,975.00 N/A $19,975.00 N/A
Eaton 9PX 3000 RT LV 120V $2,064.63 $2,064.63 N/A $2,064.63 N/A
RF Combiner $35,443.75 $35,443.75 N/A $35,443.75 N/A
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $20,000.00 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
Additional Equipment $17,844.33 $17,844.33 N/A $17,844.33 N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $758,210.93 N/A $750,381.96 N/A

Components

Actual Information Description File Name
Electrical Installation

Component Description:
Electrical work cost. #21385
Amount:
$19,975.00
Eaton 9PX 3000 RT LV 120V

Component Description:
Transmitter related cost. #WZF5121
Amount:
$2,064.63
RF Combiner

Component Description:
Transmitter related cost. #9500117404
Amount:
$35,443.75
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.
Additional Equipment

Component Description:
Transmitter related cost. #9500115121
Amount:
$8,427.32

Component Description:
Additional transmitter parts. #9500115119
Amount:
$2,413.38

Component Description:
Additional parts. #9500125692
Amount:
$7,003.63

Component Description:
Additional transmitter parts. #9500115121
Amount:
$8,427.32
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Transmitter related cost 75%. #9500116824
Amount:
$574,053.84

Component Description:
Transmitter cost. 25% of the comparable amount. #9500089596
Amount:
$176,328.12

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 $439,086.90 $396,692.84 N/A $206,167.96 N/A
Total for all systems $4,526,365.61 $3,327,572.40 N/A $2,093,346.15 N/A
Interim Antenna TFU-24WB/VP $125,030.00 $80,000.00 $0.00
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $0.00 WTWC is buying the equipment for both WTWC and WTLH. N/A N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $0.00 WTWC is buying the equipment for both WTWC and WTLH. N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 N/A N/A N/A
UHF - High Power, Side Mount, broadband panel, 16 bay,, 200 kW input, directional,, elliptically or circularly polarized $0.00 $0.00 WTWC is buying the equipment for both WTWC and WTLH. $0.00 N/A
Sweep test of existing antenna $6,730.00 $0.00 WTWC is buying the equipment for both WTWC and WTLH. N/A N/A
Primary Antenna TFU-24ETT/VP-R O4 $314,056.90 $316,692.84 $206,167.96
Sweep test of existing antenna $6,730.00 $11,724.80 See Dielectric quotes. $11,724.80 N/A
Additional parts $2,576.90 $2,576.90 N/A $2,576.90 N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $27,391.14 See Dielectric quotes. $27,391.14 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $275,000.00 N/A $164,475.12 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) Information not provided.
New combiner, cost per channel (without antenna) Information not provided.
UHF - High Power, Side Mount, broadband panel, 16 bay,, 200 kW input, directional,, elliptically or circularly polarized Information not provided.
Sweep test of existing antenna Information not provided.
Sweep test of existing antenna

Component Description:
Antenna related cost reduced by 8.40%. #896015
Amount:
$5,862.40

Component Description:
Antenna related cost reduced by 8.40%. #774016
Amount:
$5,862.40
Additional parts

Component Description:
Antenna related cost reduced by 8.40%. #840009
Amount:
$2,576.90
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
Antenna related cost reduced by 8.40%. #844006
Amount:
$14,949.12

Component Description:
Total invoice amount reduced by 8.40%. #689010
Amount:
$12,442.02
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Total invoice amount reduced by 8.40%. #686006
Amount:
$164,475.12

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 $788,828.00 $700,920.00 N/A $422,224.47 N/A
Total for all systems $4,526,365.61 $3,327,572.40 N/A $2,093,346.15 N/A
Interim Transmission Line $51,800.00 $0.00 $0.00
Flexible Air Transmission Line - dielectric, 4" $51,800.00 $0.00 WTWC is buying the equipment for both WTWC and WTLH. N/A N/A
Primary Transmission Line $737,028.00 $700,920.00 $422,224.47
Rigid Transmission Line - copper, 8 3/16" $737,028.00 $700,920.00 N/A $422,224.47 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 4" Information not provided.
Rigid Transmission Line - copper, 8 3/16"

Component Description:
Total invoice amount reduced by 8.40%. #687007
Amount:
$413,101.11

Component Description:
Transmission line related cost reduced by 8.40%. #844006
Amount:
$4,561.68

Component Description:
Resubmitted under Eaton 9PX 3000 RT LV 120V. #WZF5121
Amount:
N/A

Component Description:
Transmission line related cost reduced by 8.40%. #746005
Amount:
$2,280.84

Component Description:
Transmission line related cost reduced by 8.40%. #770006
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 $894,260.00 $890,091.00 N/A $515,182.00 N/A
Total for all systems $4,526,365.61 $3,327,572.40 N/A $2,093,346.15 N/A
Primary Tower TOWER $894,260.00 $890,091.00 $515,182.00
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $19,800.00 N/A $19,800.00 N/A
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A $25,091.00 N/A
Tower permit and building permit $2,850.00 $2,850.00 N/A $2,850.00 N/A
Site Coordination Meeting $1,250.00 $1,250.00 N/A $1,250.00 N/A
Temporary License $28,160.00 $28,160.00 N/A $28,160.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $438,031.00 Please see FDH Infrastructure quote. $438,031.00 N/A

Components

Actual Information Description File Name
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Tower study cost. #160129286
Amount:
$9,500.00

Component Description:
Broadcast tower mapping. #160129287
Amount:
$10,300.00
Major tower reinforcement/modifications

Component Description:
Tower modification cost. #SIN006524
Amount:
$12,545.50

Component Description:
Tower related cost. #SIN002307
Amount:
$12,545.50
Tower permit and building permit

Component Description:
Tower related cost. #373449
Amount:
$2,850.00
Site Coordination Meeting

Component Description:
Tower related cost. #160135546
Amount:
$1,250.00
Temporary License

Component Description:
Site license. #153064760
Amount:
$28,160.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Tower cost. #153064759
Amount:
$10,240.00

Component Description:
Tower related credit memo. #SCR000123
Amount:
($29,976.00)

Component Description:
Tower related cost. #153064760
Amount:
$28,160.00

Component Description:
Tower related cost. #SIN006524
Amount:
$213,895.50

Component Description:
Tower related cost. #SIN002307
Amount:
$213,895.50

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 $220,660.98 $191,232.90 N/A $72,943.57 N/A
Total for all systems $4,526,365.61 $3,327,572.40 N/A $2,093,346.15 N/A
Outside Professional Services $220,660.98 $191,232.90 $72,943.57
Project management of the transition $74,260.00 $70,500.00 N/A $63,272.63 N/A
Sinclair Internal Costs $510.98 $510.98 N/A $510.98 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 $855.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $926.25 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,092.50 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $915.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $1,250.00 N/A
Prepare and or review reimbursement form $2,630.00 $3,000.00 Updated cost of estimated amount per FCC requirement. $2,899.29 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A 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 93 stations.
Amount:
$716.28

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 52 stations. #481318
Amount:
$814.01

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$43.71

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479829
Amount:
$458.99

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

Component Description:
Legal Service Cost. #479363
Amount:
$1,998.70

Component Description:
Legal Service Cost. #479886
Amount:
$1,718.65

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

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

Component Description:
Legal Service Cost. #478850
Amount:
$2,887.50

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

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

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 100 stations. #472173
Amount:
$311.78

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. #118
Amount:
$468.97

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

Component Description:
Consulting engineering costs. #882-11-0005
Amount:
$1,665.00

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

Component Description:
Legal services cost. #484356
Amount:
$126.25

Component Description:
Outside professional service cost. #373449
Amount:
$4,740.00

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 100 stations. #474809
Amount:
$395.77

Component Description:
Legal services cost. #476963
Amount:
$51.25

Component Description:
Outside professional service cost. #2054
Amount:
$300.00

Component Description:
Legal services cost. #478339
Amount:
$57.50

Component Description:
Legal services cost. #480817
Amount:
$115.00

Component Description:
Legal Service Cost. #465268
Amount:
$177.50

Component Description:
Outside professional service cost. #2046
Amount:
$225.00

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

Component Description:
Legal Service Cost. #480231
Amount:
$2,882.60

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 98 stations. #1079
Amount:
$177.14

Component Description:
Legal Service Cost. #464733
Amount:
$62.50

Component Description:
Outside professional service cost. #2033
Amount:
$1,725.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #480760
Amount:
$1,326.43

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. #1143
Amount:
$436.90

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. #1099
Amount:
$266.93

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

Component Description:
Legal services cost. #476456
Amount:
$425.00

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 100 stations. #473506
Amount:
$421.40

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 100 stations. #1111
Amount:
$159.58

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. #474900
Amount:
$108.75

Component Description:
Legal services cost. #472664
Amount:
$157.50

Component Description:
Outside professional service cost. #2025
Amount:
$1,125.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093
Amount:
$265.72

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

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

Component Description:
Outside professional service cost. #2050
Amount:
$75.00

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

Component Description:
Legal services cost. #474481
Amount:
$69.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations. #206
Amount:
$1,354.25

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

Component Description:
Legal services cost. #481951
Amount:
$688.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #480175
Amount:
$377.96

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

Component Description:
Outside professional service cost. #1991
Amount:
$525.00

Component Description:
Outside professional service cost. #2009
Amount:
$787.50

Component Description:
Outside professional service cost. #2018
Amount:
$1,500.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #483809
Amount:
$407.18

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476885
Amount:
$403.34

Component Description:
Project management cost. #882-11-0005
Amount:
$1,665.00

Component Description:
Legal services cost. #478285
Amount:
$477.00

Component Description:
Outside professional service cost. #1973
Amount:
$1,275.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479285
Amount:
$372.60

Component Description:
Legal services cost. #484782
Amount:
$183.75

Component Description:
Legal services cost. #485280
Amount:
$413.75

Component Description:
Legal services cost. #483858
Amount:
$233.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985
Amount:
$282.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations. #481976
Amount:
$965.23

Component Description:
Outside professional service cost. #2060
Amount:
$600.00

Component Description:
Legal services cost. #482394
Amount:
$565.00

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. #464392
Amount:
$115.00

Component Description:
Legal services cost. #471608
Amount:
$385.00

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 99 stations. #469573
Amount:
$377.14

Component Description:
Legal Service Cost. #477900
Amount:
$51.25

Component Description:
Repack Project Management. #1973
Amount:
$1,275.00

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

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

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

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. #1133
Amount:
$307.72

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. #1055
Amount:
$243.38

Component Description:
Legal Service Cost. #467803
Amount:
$120.00

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

Component Description:
Legal Service Cost. #466783
Amount:
$120.00

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:
Legal services cost. #473954
Amount:
$51.25

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

Component Description:
Legal services cost #460907
Amount:
$454.70

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 98 stations. #464321
Amount:
$683.07

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

Component Description:
Legal services cost. #462936
Amount:
$775.30

Component Description:
Legal services cost. #481381
Amount:
$183.75

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 98 stations.
Amount:
$185.10

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 98 stations. #461759
Amount:
$29.98

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

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 93 stations.
Amount:
$86.88

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

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

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:
$999.04

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

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 98 stations. #467861
Amount:
$470.30

Component Description:
Legal services cost. #470313
Amount:
$487.50

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 98 stations. #465173
Amount:
$654.26

Component Description:
Legal services cost. #473456
Amount:
$102.50

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

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. #1161
Amount:
$267.48

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 93 stations.
Amount:
$20.64

Component Description:
Legal Service Cost. #477385
Amount:
$57.50

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

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

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 98 stations. #1058
Amount:
$187.24
Sinclair Internal Costs

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations.
Amount:
$9.79

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:
$23.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations.
Amount:
$60.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations.
Amount:
$6.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations.
Amount:
$8.19

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:
$11.39

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:
$15.08

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

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations.
Amount:
$31.70

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:
$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:
$8.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.03

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:
$33.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations.
Amount:
$58.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations.
Amount:
$41.33

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

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
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. #882-11-0007
Amount:
$855.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Consulting engineering cost. #882-11-0008
Amount:
$926.25
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Consulting engineer cost. #882-11-0006
Amount:
$855.00

Component Description:
Consulting engineering cost.
Amount:
$1,237.50
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting engineering cost.
Amount:
$915.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Outside professional service cost. #160135546
Amount:
$1,250.00
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 98 stations. #461759
Amount:
$869.30

Component Description:
Legal services cost.
Amount:
$115.00

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

Component Description:
Legal services cost.
Amount:
$451.50
Comprehensive coverage verification via field study, if needed Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $224,402.02 $223,797.02 N/A $51,118.48 N/A
Total for all systems $4,526,365.61 $3,327,572.40 N/A $2,093,346.15 N/A
Other Expenses $224,402.02 $223,797.02 $51,118.48
Equipment Delivery and Handling Charges $36,212.02 $36,212.02 See Exhibit J. $36,212.02 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $50,000.00 $50,000.00 See Exhibit J. N/A N/A
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
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 $11,000.00 N/A $2,600.00 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 $75,000.00 $75,000.00 See Exhibit J. N/A N/A
Equipment Storage $15,000.00 $15,000.00 See Exhibit J. $12,306.46 N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
Equipment delivery and handling cost reduced by 8.40%. #750027
Amount:
$635.11

Component Description:
Equipment delivery and handling cost. #771010
Amount:
$3,049.52

Component Description:
Equipment delivery and handling cost reduced by 8.40%. #848015
Amount:
$8,158.83

Component Description:
Equipment delivery and handling reduced by 8.40%. #760010
Amount:
$17,668.49

Component Description:
Equipment delivery and handling reduced by 8.40%. #844006
Amount:
$6,700.07

Component Description:
Equipment delivery and handling reduced by 8.40%. #848015
Amount:
$8,158.83
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
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.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification cost. #1378
Amount:
$2,600.00
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. #844006
Amount:
$12,306.46

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,526,365.61 $3,327,572.40 $2,093,346.15

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.

John Parente

CEO


04/30/2021

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.

John Parente

CEO


04/30/2021

Attachments

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