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:
73195
Service:
DTV
Call Sign:
WKYC
Channel:
19 (UHF)
File Number:
0000028022
FRN:
0024376642
Date Submitted:
03/19/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WKYC-TV, LLC

Denise Branson, Sr. Paralegal

TEGNA Inc.

8350 Broad Street, Suite 2000

Tysons, VA 22102

United States

+1 (703) 873-6606 dbranson@TEGNA.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

Gary Davis

Regional Head of Technology and Operations

TEGNA

Gary Davis

8350 Broad Street

Suite 2000

Tysons, VA 22102

United States

+1 (404) 873-9199 gadavis@tegna.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 WKYC operates on a shared tower with WVIZ. Each stations has separate transmitters antennas and transmission lines. WKYC Will be replacing the Primary and Aux antenna, transmission line and transmitter.

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 PWR60 D2
Year 2008
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 60 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 ULXTE 90
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 56.4 kW
Justification for New Transmitter Station has in excess of 10% TPO headroom and is eligible for a 1-Step-Up Allowance. Reimbursable TPO is 49.6 kW based on initial 90-day filing CP. This would require a ULXTE-80. A 1-Step-Up is the ULXTE-90 and is therefore reimbursable.

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) No
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service Yes
Description Additional electrical services required for transmitter installation, including heat exchangers, transformers, cooling pumps, etc.
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? Yes
Size 900.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Change Orders

Change Orders

OH Sales Tax

OH Sales Tax

Installation and Proof

Installation and Proof

Mask Filter

Mask Filter

Freight

Freight

RF Accessories

RF Accessories

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Use during maintenance or tower work
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack 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: 930.0 kW
Manufacturer
Model TFU24DSC-R 4C150
Year 2008

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use used during line repair or other tower maintenance
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 24
Lower Limit 488.00 MHz
Upper Limit 494.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 930.0 kW
Manufacturer
Model TFU-24WB-R C160
Year 2019
Justification for New Antenna Station has a licensed AUX facility and must be replaced. It is necessary to keep station on air during primary antenna replacement & for duration of assigned phase. A TFU-24WB cost is equivalent to a single-channel slot AUX antenna.

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
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? Broadband
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

Shipping

$5,400

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 Bottom
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: 868.0 kW
Manufacturer
Model TFU-20EBT-R 4C150
Year 2008

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 Bottom
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: 911.0 kW
Manufacturer
Model TFU-20EBT/VP -R 4C150
Year 2019
Justification for New Antenna Licensed top-mount, bottom-stack antenna cannot be re-tuned for new post-transition frequency and must be replaced. The station is opting to Upgrade the antenna changing to Elliptical polarization.

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 6 1/8 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

New Top Plate

Existing top-plate and/or bolt pattern may not work for new top-mount antenna

Shipping

Shipping

Structural Study

Structural Study

Transmission Line

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

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use backup for tower work and maintenance
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 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1160 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use Backup for maintenance and tower work
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 875 feet per run
Justification for New Transmission Line Existing AUX TX line will not work on new channel assignment. Therefore, station must replace existing AUX TX line with new 19-3/4 ft section line for CH19.

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

TX Line Sweep

Sweep required to verify post-transition channel measures well on new line.

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 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1170 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 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1170 feet per run
Justification for New Transmission Line Existing 6-1/8" rigid transmission line uses section lengths that are prohibited for post-transition Channel 19. Therefore, station must replace existing line with new 6-1/8" rigid transmission line made up of 20 ft sections.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

TX Line Sweep

Sweep required to verify post-transition channel measures well on new line.

Tower Equipment And Rigging Costs

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

Primary Tower

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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?
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? No
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1265403
Coordinates (NAD83) Latitude (NAD83) 41° 23' 09.9" N-
Longitude (NAD83) 081° 41' 20.7" W-
Overall Structure Height 912.06 feet
Support Structure Height 912.06 feet
Ground Elevation Above Mean Sea Level (AMSL) 1040.01 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner 6600 Broadview LLC
Date Constructed 06/05/2009

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
18753 WVIZ 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 undocumented/poorly 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 Other
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 1000
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399s. Station does not have available personnel or personnel trained in project management for such complex projects.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 20
Justification $2,500 per site visit including expenses x 20 days. It is necessary to survey the site, plan the equipment, develop specifications for purchasing, & oversee multiple vendor RF projects. Station does not have available personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Installation Services

This cost originally listed under installation services. Relocated per FCC staff instructions.

Other Legal Services

Other Legal Services related to the DTV Repack

Other Engineering Services

Other Engineering Services

Pre filing site review

outside engineering firm to review facilities before filling

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
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

Internal labor

Local and Corporate Labor

Viewer call assistance service

Viewer call assistance service

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 $3,014,798.76 $2,609,595.02 N/A $2,572,810.74 N/A
Total for all systems $5,569,679.71 $5,179,049.70 N/A $4,367,100.69 N/A
Primary Transmitter ULXTE 90 $3,014,798.76 $2,609,595.02 $2,572,810.74
RF Accessories $50,110.12 $50,110.12 See attached / uploaded PDF files titled "Gates US0326478 v200524jgv2.pdf" and "Digikey 61383132 v200420pmv1.pdf" $50,110.12 N/A
Freight $17,159.48 $17,159.48 See attached / uploaded PDF file titled "Gates US0326478 v200524jgv2.pdf" $17,159.48 N/A
Mask Filter $70,609.60 $70,609.60 See attached / uploaded PDF file titled "Gates US0326478 v200524jgv2.pdf" $70,609.60 N/A
OH Sales Tax $130,554.06 $130,554.06 See attached / uploaded PDF file titled "Gates US0326478 v200524jgv2.pdf" $130,554.06 N/A
Change Orders $0.00 $0.00 See attached / uploaded PDF file titled "Gates US0326478 v200524jgv2.pdf" ($7,160.23) N/A
Other -- Building Addition Size: 900.0 $809,675.00 $809,675.00 900 square foot expansion for new transmitter, including professional fees. See attached WKYC Building justification. $697,525.61 N/A
Other Electrical Service: Additional electrical services required for transmitter installation, including heat exchangers, transformers, cooling pumps, etc. $25,000.00 $25,000.00 Additional electrical services required for transmitter installation, including heat exchangers, transformers, cooling pumps, etc. $14,690.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $11,474.39 See attached / uploaded PDF file titled "Gates US0326478 v200524jgv2.pdf" $11,474.39 N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,408,421.87 See attached / uploaded PDF file titled "Gates US0326478 v200524jgv2.pdf" $1,506,157.21 x
Installation and Proof $81,690.50 $81,690.50 See attached / uploaded PDF file titled "Gates US0326478 v200524jgv2.pdf" $81,690.50 N/A

Components

Actual Information Description File Name
RF Accessories

Component Description:
Gates US0326478 v200524jgv2
Amount:
$24,864.99

Component Description:
Gates inv #JW30004450-1A TX RF accessories 1 6th dp UL20190214jgv1
Amount:
$8,288.32

Component Description:
Inv JW30004450-1 WKYC TX RF accessories 1 3rd dp UL20180713jg v1
Amount:
$16,576.65

Component Description:
Digikey 61383132 v200420pmv1
Amount:
$380.16
Freight

Component Description:
Gates US0326478 v200524jgv2
Amount:
$17,159.48
Mask Filter

Component Description:
Gates US0326478 v200524jgv2
Amount:
$35,304.81

Component Description:
Inv JW30004450-1 WKYC TX Mask Filter 1 3rd dp UL20180713jg v1
Amount:
$23,536.53

Component Description:
Gates inv #JW30004450-1A TX Mask Filter 1 6th dp UL20190214jgv1
Amount:
$11,768.26
OH Sales Tax

Component Description:
Gates US0326478 v200524jgv2
Amount:
$130,554.06
Change Orders

Component Description:
Gates US0326478 v200524jgv2
Amount:
($7,160.23)
Other -- Building Addition Size: 900.0

Component Description:
WKYC Osborn inv #29267 Civil Eng UL20180801jg v2
Amount:
$3,909.60

Component Description:
Donleys inv #1105-02 TX Bldg Addition pmt 2 UL20190130jgv1
Amount:
$241,164.27

Component Description:
Donleys 1105-05 v191003pmv1
Amount:
$28,589.02

Component Description:
Donleys inv #1105-03 TX Bldg Addition pmt 3 UL20190402jgv1
Amount:
$242,920.58

Component Description:
Donleys 1105-105 v191003pmv1
Amount:
$14,604.46

Component Description:
WKYC Osborn inv #29512 Civil Eng UL20180815jg v1
Amount:
$7,457.20

Component Description:
Vocon inv #265447 Design Devel UL20181026jg v1
Amount:
$5,476.41

Component Description:
Donleys 1105-04 v191003pmv1
Amount:
$36,684.41

Component Description:
Donleys inv #1105-01 TX Bldg Addition UL20181106jgv1
Amount:
$119,311.20

Component Description:
Inv 265370 WKYC Design Devel UL20180705jg v1
Amount:
$2,884.87
Other Electrical Service: Additional electrical services required for transmitter installation, including heat exchangers, transformers, cooling pumps, etc.

Component Description:
Die 594036 v200116pmv1
Amount:
$500.00

Component Description:
Vocon inv #267251 Tech Eng Srvcs UL20190222jgv1
Amount:
$14,190.00
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA

Component Description:
Gates US0326478 v200524jgv2
Amount:
$5,737.20

Component Description:
Inv JW30004450-1 WKYC TX Electrical 1 3rd dp UL20180713jg v1
Amount:
$3,824.80

Component Description:
Gates inv #JW30004450-1A TX Electrical 1 6th dp UL20190214jgv1
Amount:
$1,912.39
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Gates US0326478 v200524jgv2
Amount:
$704,210.94

Component Description:
Gates US0326478 v191003pmv1
Amount:
$97,735.34

Component Description:
Inv JW30004450-1 WKYC Transmitter 1 3rd dp UL20180713jg v1
Amount:
$469,473.96

Component Description:
Gates inv #JW30004450-1A Transmitter 1 6th dp UL20190214jgv1
Amount:
$234,736.97
Installation and Proof

Component Description:
Gates US0326478 v200524jgv2
Amount:
$40,845.25

Component Description:
Gates inv #JW30004450-1A TX Install 1 6th dp UL20190214jgv1
Amount:
$13,615.08

Component Description:
Inv JW30004450-1 WKYC TX Install 1 3rd dp UL20180713jg v1
Amount:
$27,230.17

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 $560,978.34 $541,192.08 N/A $459,362.08 N/A
Total for all systems $5,569,679.71 $5,179,049.70 N/A $4,367,100.69 N/A
Primary Antenna TFU-20EBT/VP -R 4C150 $344,380.00 $327,033.74 $295,233.74
Structural Study $4,050.00 $4,050.00 See attached / uploaded PDF file titled, "v200608pmv1" $4,050.00 N/A
Shipping $6,800.00 $6,800.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $21,113.74 See attached invoices & quotes $21,113.74 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $263,670.00 N/A $263,670.00 N/A
New Top Plate $25,000.00 $25,000.00 Existing top-plate and/or bolt pattern may not work for new top-mount antenna N/A N/A
Auxiliary Antenna TFU-24WB-R C160 $216,598.34 $214,158.34 $164,128.34
Shipping $7,278.34 $7,278.34 See attached invoices $7,278.34 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A 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
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $13,000.00 N/A $0.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 930 kW input, directional,, horizontally polarized $160,480.00 $160,480.00 N/A $150,450.00 N/A

Components

Actual Information Description File Name
Structural Study

Component Description:
Die 611026 v200608pmv1
Amount:
$4,050.00
Shipping Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Die inv #MAN01146 Elbow complex 45 pct pmt 2 UL20190418jgv1
Amount:
$4,633.87

Component Description:
Die 495002 v190716pmv1
Amount:
$1,029.75

Component Description:
Die inv #MAN00845 Elbow complex 45 pct pmt 1 UL20190123jgv1
Amount:
$4,633.87

Component Description:
Die inv #MAN00845 Elbow complex 45 pct pmt 1 UL20190412jgv3
Amount:
$4,633.87

Component Description:
Die 543010 v190808pmv1
Amount:
$10,816.25
Sweep test of existing antenna

Component Description:
Die inv #MAN01146 Sweep 45 pct pmt 2 UL20190418jgv1
Amount:
$2,880.00

Component Description:
Die inv #MAN00845 Sweep 45 pct pmt 1 UL20190412jgv3
Amount:
$2,880.00

Component Description:
Die 613023 v200408pmv1
Amount:
$640.00

Component Description:
Die inv #MAN00845 Sweep 45 pct pmt 1 UL20190123jgv1
Amount:
$2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Die 518008 v200408pmv1
Amount:
$26,367.00

Component Description:
Die inv #MAN00845 Primary ant 45 pct pmt 1 UL20190412jgv3
Amount:
$118,651.50

Component Description:
Die inv #MAN01146 Primary ant 45 pct pmt 2 UL20190418jgv1
Amount:
$118,651.50
New Top Plate Information not provided.
Shipping

Component Description:
Die 389007 v190716pmv1
Amount:
$6,340.00

Component Description:
Die inv #464003 Freight for Sales Order 1696505 UL20190418jgv1
Amount:
$938.34
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
Die inv #MAN00841 Aux sweep 45 pct pmt 1 UL20190124jgv1
Amount:
$2,880.00

Component Description:
Die 543020 v190723pmv1
Amount:
$640.00

Component Description:
Die inv #MAN00880 Aux sweep 45 pct pmt 2 UL20180706jgv1
Amount:
$2,880.00
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 930 kW input, directional,, horizontally polarized

Component Description:
Die inv #MAN00841 Aux TX ant 45 pct pmt 1 UL20190124jgv1
Amount:
$67,702.50

Component Description:
Die inv #MAN00880 Aux TX ant 45 pct pmt 2 UL20180706jgv1
Amount:
$67,702.50

Component Description:
Die 373001 v190716pmv1
Amount:
$15,045.00

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 $425,890.00 $379,348.54 N/A $349,239.68 N/A
Total for all systems $5,569,679.71 $5,179,049.70 N/A $4,367,100.69 N/A
Primary Transmission Line $242,740.00 $195,331.45 $187,146.28
TX Line Sweep $6,400.00 $6,400.00 N/A N/A N/A
Rigid Transmission Line - copper, 6 1/8" $236,340.00 $188,931.45 Dielectric's transmission line prices increased. See attached / uploaded PDF file titled, "Warmus 18024 v200408pmv1" $187,146.28 N/A
Auxiliary Transmission Line $183,150.00 $184,017.09 $162,093.40
Rigid Transmission Line - copper, 6 1/8" $176,750.00 $177,617.09 Dielectric's transmission line prices increased. $162,093.40 N/A
TX Line Sweep $6,400.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
TX Line Sweep Information not provided.
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Die 588023 v191004pmv1
Amount:
$15,427.50

Component Description:
Die 601012 v200408pmv1
Amount:
($2,455.00)

Component Description:
Warmus 18024 v200520pmv2
Amount:
$18,108.55

Component Description:
Die inv #444012 Cut TX line pc freight UL20190328jgv1
Amount:
$828.32

Component Description:
Die inv #MAN00845 Main line 45 pct pmt 1 UL20190123jgv1
Amount:
$69,856.61

Component Description:
Die inv #MAN01146 Main line 45 pct pmt 2 UL20190418jgv1
Amount:
$69,856.61

Component Description:
Die inv #MAN00845 Main line 45 pct pmt 1 UL20190412jgv3
Amount:
$69,856.61

Component Description:
Die 495002 v190716pmv1
Amount:
$15,523.69
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Die 373001 v190716pmv1
Amount:
$16,209.34

Component Description:
Die inv #MAN00880 Aux line 45 pct pmt 2 UL20180706jgv1
Amount:
$72,942.03

Component Description:
Die inv #MAN00841 Aux line 45 pct pmt 1 UL20190124jgv1
Amount:
$72,942.03
TX Line Sweep Information not provided.

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 $868,300.00 $947,533.45 N/A $806,684.45 N/A
Total for all systems $5,569,679.71 $5,179,049.70 N/A $4,367,100.69 N/A
Primary Tower TOWER $868,300.00 $947,533.45 $806,684.45
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A N/A N/A
Major tower reinforcement/modifications $421,000.00 $522,533.45 See attached invoice and quotes; See attached / uploaded PDF file titled, "Warmus 18087 v200408pmv1" $522,533.45 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A $284,151.00 N/A

Components

Actual Information Description File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study Information not provided.
Major tower reinforcement/modifications

Component Description:
Warmus 17975 v190930jgv3
Amount:
$233,792.45

Component Description:
Warmus 18087 v200508pmv2
Amount:
$4,590.00

Component Description:
Warmus 17975 v190514jgv1
Amount:
$233,792.45

Component Description:
Deep South 9210 v200116pmv1
Amount:
$284,151.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Deep South 8961 v200207jgv2
Amount:
$284,151.00

Component Description:
Deep South 8961 v200207jgv1
Amount:
$142,075.50

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 $512,983.55 $516,656.55 N/A $122,090.69 N/A
Total for all systems $5,569,679.71 $5,179,049.70 N/A $4,367,100.69 N/A
Outside Professional Services $512,983.55 $516,656.55 $122,090.69
Other Engineering Services $25,895.00 $25,895.00 The Estimated Cost includes other engineering services such as RF calculations, evolving transition plan calculations, bid spec prep / distribution / award recommendation / etc and discussion, etc. $25,895.00 N/A
Pre filing site review $20,000.00 $20,000.00 N/A N/A N/A
Other Legal Services $10,000.00 $10,000.00 Other Legal Services related to the DTV Repack $424.09 N/A
Additional Field Engineering Service, 20 Days $50,000.00 $50,000.00 $2,500 per site visit including expenses x 20 days. It is necessary to survey the site, plan the equipment, develop specifications for purchasing, & oversee multiple vendor RF projects. Station does not have available personnel trained in such services. N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A 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 $550.00 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $3,000.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $22,718.00 The Estimate Cost includes Form 399 submissions including ongoing Actual Cost invoice prep and submission, and amendments as needed. $22,718.00 N/A
Project management of the transition $158,000.00 $150,000.00 It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399s. Station does not have available personnel or personnel trained in project management for such complex projects. $68,828.60 N/A
Installation Services $95,293.55 $95,293.55 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $675.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A N/A 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

Components

Actual Information Description File Name
Other Engineering Services

Component Description:
MSW 7315 v210319jgv1
Amount:
$15,370.00

Component Description:
Osborn 35813 v200721pmv1
Amount:
$9,947.50

Component Description:
Osborn 38611 v200720pmv1
Amount:
$577.50
Pre filing site review Information not provided.
Other Legal Services

Component Description:
Covington 60805585 v190513pmv1
Amount:
$34.53

Component Description:
Covington 60801029 v190712jgv2
Amount:
$144.71

Component Description:
Covington 60801029 v190513pmv1
Amount:
$164.44

Component Description:
Covington 60801032 v190715jgv2
Amount:
$70.43

Component Description:
Covington inv #60796723 Various Legal UL20181024jgv1
Amount:
$174.42

Component Description:
Covington 60801032 v190530jgv2
Amount:
$70.43

Component Description:
Covington 60801032 v190510pmv1
Amount:
$77.00
Additional Field Engineering Service, 20 Days Information not provided.
RF Exposure Measurements Information not provided.
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

Component Description:
Osborn 35004 v200513jgv1
Amount:
$550.00
ASR modification (prepare FCC Form 854) Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Osborn 34584 v190808jgv1
Amount:
$3,000.00

Component Description:
Osborn 34584 v190808jgv1
Amount:
$3,000.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Prepare and or review reimbursement form

Component Description:
Osborn 38316 v200724pmv1
Amount:
$290.00

Component Description:
Osborn 39674 v201218pmv1
Amount:
$695.00

Component Description:
Osborn 38974 v200721pmv1
Amount:
$2,285.00

Component Description:
Osborn 32833 v190613pmv1
Amount:
$1,300.00

Component Description:
Osborn 40953 v201218pmv1
Amount:
$50.00

Component Description:
Osborn 40287 v201218pmv1
Amount:
$105.00

Component Description:
Osborn 35813 v200721pmv1
Amount:
$745.00

Component Description:
Osborn 31135 v200330jgv1
Amount:
$675.00

Component Description:
Osborn 38611 v200720pmv1
Amount:
$1,175.00

Component Description:
Osborn 35004 v200513jgv1
Amount:
$1,205.00

Component Description:
Osborn 30007 v200326jgv1
Amount:
$1,235.00

Component Description:
Osborn 36190 v200924jgv2
Amount:
$905.00

Component Description:
Osborn 34584 v190808jgv1
Amount:
$1,388.00

Component Description:
Osborn 33858 v200408jgv2
Amount:
$1,475.00

Component Description:
Osborn 35399 v200721pmv1
Amount:
$1,315.00

Component Description:
Osborn 39379 v201116pmv1
Amount:
$2,400.00

Component Description:
Osborn 39990 v210107jgv2
Amount:
$1,400.00

Component Description:
Osborn 32204 v200330jgv1
Amount:
$1,600.00

Component Description:
Osborn 40650 v201218pmv1
Amount:
$200.00

Component Description:
Osborn 36541 v200326jgv1
Amount:
$2,275.00
Project management of the transition

Component Description:
Osborn 39674 v201218pmv1
Amount:
$208.00

Component Description:
Osborn 33668 v190618pmv1
Amount:
$300.00

Component Description:
Osborn inv #26015 Prof srvcs 170530 - 170728 UL20181107jg v1
Amount:
$14,548.92

Component Description:
Osborn 40953 v201218pmv1
Amount:
$237.00

Component Description:
Osborn 40287 v201218pmv1
Amount:
$316.00

Component Description:
Osborn 34594 v190808jgv1
Amount:
$3,075.00

Component Description:
Osborn 31792 v200326jgv1
Amount:
$93.20

Component Description:
Osborn 30486 v200408jgv2
Amount:
$2,235.00

Component Description:
Osborn 31135 v200330jgv1
Amount:
$300.00

Component Description:
Osborn 39990 v210107jgv2
Amount:
$474.00

Component Description:
Osborn inv #28588 Proj Mgt thru March 30, 2018 UL20180815jgv1
Amount:
$975.00

Component Description:
Osborn inv #28997 Proj Mgt March 31, 2018 - April 27, 2018 UL20190212jgv1
Amount:
$6,725.00

Component Description:
Osborn 35399 v200721pmv1
Amount:
$359.48

Component Description:
Osborn 30007 v200326jgv1
Amount:
$4,035.00

Component Description:
Osborn 40650 v201218pmv1
Amount:
$79.00

Component Description:
Osborn inv #29833 Prof srvcs 180526 - 180629 UL20190207jgv1
Amount:
$7,842.50

Component Description:
Osborn 33858 v200408jgv2
Amount:
$7,492.50

Component Description:
Osborn 36190 v200924jgv2
Amount:
$10,965.00

Component Description:
Osborn 39379 v201116pmv1
Amount:
$3,468.00

Component Description:
Osborn 35004 v200513jgv1
Amount:
$300.00

Component Description:
Inv 29214 WKYC Proj Mgt 180428-180525 UL20180706jg v1
Amount:
$4,350.00

Component Description:
Osborn 34124 v200326jgv1
Amount:
$15,112.50

Component Description:
Osborn 32204 v200330jgv1
Amount:
$300.00

Component Description:
Osborn 33858 v200408jgv2
Amount:
$150.00
Installation Services Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Osborn 35813 v200721pmv1
Amount:
$675.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Address transition timing and coordination issues w/ other stations and wireless 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 $186,729.06 $184,724.06 N/A $56,913.05 N/A
Total for all systems $5,569,679.71 $5,179,049.70 N/A $4,367,100.69 N/A
Other Expenses $186,729.06 $184,724.06 $56,913.05
Viewer call assistance service $18,278.06 $18,278.06 N/A $18,278.06 N/A
MVPD Notification of Channel Change $6,000.00 $6,000.00 to notify all MVPD's op up coming testing and transition plans for the market. $1,935.00 N/A
Develop and air announcement of upcoming channel change $6,000.00 $6,000.00 To create informational spot to notify public of the upcoming change. $3,270.00 N/A
Equipment Storage $15,000.00 $15,000.00 2 flat bed trailers for 6 Months to store equipment. $9,419.41 N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 N/A $18,946.75 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A $1,313.83 N/A
Non-zoning permits $25,000.00 $25,000.00 N/A N/A N/A
Local Zoning $1,200.00 $1,200.00 Local construction permit. 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
AM Pattern Disturbance -- Remedy $21,050.00 $20,000.00 N/A N/A N/A
AM Pattern Disturbance -- Impact study $7,890.00 $7,500.00 N/A N/A N/A
Internal labor $24,231.00 $24,231.00 N/A N/A N/A

Components

Actual Information Description File Name
Viewer call assistance service

Component Description:
Inktel 33905 v191018pmv1
Amount:
$18,278.06
MVPD Notification of Channel Change

Component Description:
Osborn 33858 v200408jgv2
Amount:
$1,935.00
Develop and air announcement of upcoming channel change

Component Description:
2C Media inv #203806 Creation of channel change announcement UL20181016jgv1
Amount:
$3,270.00
Equipment Storage

Component Description:
PMF 267186 v190614jgv1
Amount:
$97.20

Component Description:
PMF 278146 v190612jgv1
Amount:
$367.20

Component Description:
PMF 269251 v190510jgv1
Amount:
$367.20

Component Description:
PMF 278701 v190618jgv1
Amount:
$448.55

Component Description:
Sergius WKYC-190729 v200408pmv1
Amount:
$2,000.00

Component Description:
Die 614007 v200116pmv1
Amount:
$2,400.00

Component Description:
PMF 289363 v191211jgv1
Amount:
$464.40

Component Description:
PMF 266815 v190614jgv1
Amount:
$1,881.66

Component Description:
PMF 283422 v190808jgv1
Amount:
$464.40

Component Description:
PMF 280793 v191003pmv1
Amount:
$464.40

Component Description:
PMF 286437 v190905pmv1
Amount:
$464.40
Equipment Delivery and Handling Charges

Component Description:
Digikey 61383132 v200420pmv1
Amount:
$9.71

Component Description:
Die 573033 v191003pmv1
Amount:
$3,105.00

Component Description:
Die 588023 v191004pmv1
Amount:
$616.62

Component Description:
Die 610029 v200116pmv1
Amount:
$4,538.57

Component Description:
Die 547016 v191003pmv1
Amount:
$3,409.02

Component Description:
Die 601012 v200408pmv1
Amount:
$4,518.60

Component Description:
Die 597045 v200408pmv1
Amount:
$368.69

Component Description:
Die 597016 v200408pmv1
Amount:
$1,450.58

Component Description:
Warmus 18024 v200408pmv1
Amount:
N/A

Component Description:
United 170006813-001 v200508pmv2
Amount:
$929.96
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Republic 0224-008410402 v200129pmv1
Amount:
$1,313.83
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:
RF Notifs 1152 v200116pmv1
Amount:
$3,750.00
AM Pattern Disturbance -- Remedy Information not provided.
AM Pattern Disturbance -- Impact study Information not provided.
Internal labor Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $5,569,679.71 $5,179,049.70 $4,367,100.69

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. 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.

Jeffrey C Gehman

Engineering Associate


03/19/2021

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.

Jeffrey C Gehman

Engineering Associate


03/19/2021

Attachments

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