TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
IDEASTREAM Doing Business As: IDEASTREAM	KEVIN E. MARTIN IDEA CENTER 1375 EUCLID AVENUE CLEVELAND, OH 44115 United States	+1 (216) 916-6455	kevin.martin@ideastream.org	Not-for-Profit

Applicant

Address

Phone

Applicant Type

IDEASTREAM

Doing Business As: IDEASTREAM

KEVIN E. MARTIN

IDEA CENTER

1375 EUCLID AVENUE

CLEVELAND, OH 44115

United States

+1 (216) 916-6455

kevin.martin@ideastream.org

Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Jerrold Francis Wareham Repack Coordinator ideastream	JERRY WAREHAM IDEA CENTER 1375 EUCLID AVENUE CLEVELAND, OH 44115 United States	+1 (216) 916-6120	jerry.wareham@ideastream.org

Applicant

Address

Phone

Jerrold Francis Wareham

Repack Coordinator

ideastream

JERRY WAREHAM

IDEA CENTER

1375 EUCLID AVENUE

CLEVELAND, OH 44115

United States

+1 (216) 916-6120

jerry.wareham@ideastream.org

Broadcaster Information and Transition Plan

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	WVIZ must replace its main antenna and transmitter in order to move it its new channel. It will need to install interim facilities in order to be able to replace the main facility. See attached narrative.

Transmitters

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

Primary Transmitter

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	Innovator
	Year	2009
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	15 kW

Primary Transmitter

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	ULXTE40
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	23 kW
	Justification for New Transmitter	The new transmitter is required because higher TPO for higher ERP to replicate the current signal on the new channel. The replication transmitter is the ULXTE30 (invoice attached). The ULXTE40 is an upgrade to achieve maximization (invoice attached)

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	Yes
	Description	Necessary conduit, wiring and fuse disconnects as quoted by electrical contractor.
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

Other Transmitter Cost Not Listed

Name	Description
Dummy Load	New dummy load required for new transmitter see attached quote from Bird
Transmitter Site Suvey	Survey of transmitter site to determine exact facility needs
Switch	Switch, cable and controller for new transmitter and dummy load Dielectric Switch Quote Attached
Bypass Switch	To provide electrical engineering services for new electrical circuits that need to be added to allow simultaneous operation of the transmitters to maintain service on the original channel during the test period. Osborn Engineering Quote Attached

Antennas

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

Primary Antenna

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	Top
	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:	150.0 kW
	Manufacturer
	Model	TFU-10GTH-R C170
	Year	2009

Primary Antenna

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	Top
	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:	181.0 kW
	Manufacturer
	Model	TFU-10GTH-R C170 SP
	Year	2019
	Justification for New Antenna	Existing main antenna is a coaxial slot antenna that is channel specific and cannot be reused on the new channel.

Primary Antenna

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?	No
	Broadband or Single Channel?	N/A
	Feed Line Size	N/A
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Slot
	Number of Stations Supported	1
	Number of Panels/Bays	8
	Lower Limit	470.00 MHz
	Upper Limit	698.00 MHz
	Design power capacity in use	40.0 %
	Other Antenna Type	N/A
	ERP:	150.0 kW
	Manufacturer
	Model	TFU-8WB-R
	Year	2019
	Justification for New Antenna	WVIZ needs an interim antenna for operation . while it replaces the primary antenna Dielectric Quote Attached

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	No
	Broadband or Single Channel?	N/A
	Feed Line Size	N/A
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Interim Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1207 feet per run

Primary Transmission Line

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	1207 feet per run
	Justification for New Transmission Line	Current transmission line has 19.5" segment lengths which will not work for the WVIZ assigned repack Ch. 35. See attached quote.

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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	1000 feet per run
	Justification for New Transmission Line	WVIZ will need an interim transmission line for operation while it replaces its primary transmission line. Dielectric quote attached.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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?	Yes
	Is tower compliant with Rev G?	Yes
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	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
73195	WKYC	DTV

Primary Tower

Tower Modification Costs

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

Primary Tower

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	Other
Helicopter Services Required	Are helicopter services required?	Yes

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	160
	Explanation	Project manager needed to manage all work required coordinate vendor and contractor specification development, selection of list for bid solicitation, bid evaluation, vendor/contractor selection/contracting and contract enforcement. See Osborn estimate.
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	1
	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	1
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	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	No
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Cesium Communications LP	Work with Tower Crew to bring Xmission Line into specification

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Facility Expenses	Name	N/A
	Other Distributed Transmission System Expenses Not listed	N/A
	Name	N/A
	Is Notification of a Medical Facility required as a result of DTV broadcasting?	Yes
Permit and Filing Costs	Local Zoning	No
	Non-zoning permits	Yes
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	No
	FCC License to Cover Application	No
	FCC Special Temporary Authority Application	No
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

Other Expenses Not Listed

Name	Description
Employee Time	Time needed by ideastream employees to work on the transition to a new channel.
Test Antenna	Home test antenna to replicate user issues in home
Inside Transmission line	Cost associated with inside line transmission cost.

Cost Information

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	$1,034,637.04	$874,460.20	N/A	$753,807.15	N/A
Total for all systems	$2,882,515.24	$2,645,894.36	N/A	$2,221,874.07	N/A
Primary Transmitter ULXTE40	$1,034,637.04	$874,460.20		$753,807.15
Bypass Switch	$11,565.00	$11,565.00	WVIZ is not able to connect the new transmitter to the existing Bypass Switch during the interim period between transmitter changes with the existing. Osborn Engineering Quote Attached	$9,470.85	N/A
Switch	$19,712.00	$19,712.00	New switch needed for new transmitter and dummy load. Dielectric Quote Attached.	$19,712.00	N/A
Transmitter Site Suvey	$8,000.00	$8,000.00	Survey of transmitter site to determine needs	$7,900.00	N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$786,823.16	N/A	$668,364.26	N/A
Other Electrical Service: Necessary conduit, wiring and fuse disconnects as quoted by electrical contractor.	$29,700.00	$29,700.00	See attached electrical quote from Ullman Electric.	$29,700.00	N/A
Dummy Load	$18,660.04	$18,660.04	New dummy load required for new transmitter see quote from Bird attached.	$18,660.04	N/A

Components

Actual Information Description	File Name
Bypass Switch	Component Description: Payment due for fixed fee service to design necessary switch per vendor quote previously submitted. Amount: $206.00 Component Description: As requested by repack administrator more detail add by the vendor to the invoice for this fixed fee service. Quote attached to invoice. Required design and installation of switch. Amount: $5,679.96 Component Description: Fixed Fee required design and installation of switch per vendor quote previously submitted Amount: $3,584.89
Switch	Component Description: New switch Invoice and quote attached Amount: $19,712.00
Transmitter Site Suvey	Component Description: Site Survey Amount: $7,900.00
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: One third second payment for transmitter required for replication (total $634,927.60). The additional cost for maximization (total $151,895.56) second payment of one third invoice also attached is not reimbursable. Quote also attached. Amount: $211,642.53 Component Description: One third, third payment for transmitter required for replication (total $643,920.34). The additional cost for maximization (total $151,895.56) third payment of one third invoice also attached is not reimbursable. Quote also attached Amount: $164,784.28 Component Description: Pre-Repack transmitter de-installation Amount: $24,235.00 Component Description: Transmitter install and change order Q-80492 quote attached. The change order was to install the switch and test load. Amount: $56,059.92 Component Description: One third down payment for transmitter required for replication (total $634,927.60). The additional cost for maximization (total $151,895.56) also attached as JW3004459VI is not reimbursable. Amount: $211,642.53 Component Description: Onsite install of the transmitter. Amount: $26,927.75
Other Electrical Service: Necessary conduit, wiring and fuse disconnects as quoted by electrical contractor.	Component Description: This component covers the installation of the new electric service and grounding system for the new transmitter. Amount: $29,700.00
Dummy Load	Component Description: New Dummy Load Invoice for $18,660.04 attached along with quote. Amount: $18,660.04

Cost Information

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	$392,360.00	$275,446.00	N/A	$254,790.51	N/A
Total for all systems	$2,882,515.24	$2,645,894.36	N/A	$2,221,874.07	N/A
Interim Antenna TFU-8WB-R	$96,130.00	$51,325.00		$50,869.82
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	$89,400.00	$44,925.00	Dielectric Quote for Interim Antenna attached	$44,469.82	N/A
Primary Antenna TFU-10GTH-R C170 SP	$296,230.00	$224,121.00		$203,920.69
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	$217,721.00	Quoted cost of antenna from the manufacturer with the upgrade cost related to vertical polarization removed from the overall cost. See attached quote. Increase due to added shipping and storage cost of antenna.	$197,520.69	The original estimate is lower than actual costs.

Components

Actual Information Description	File Name
Sweep test of existing antenna	Component Description: Antenna Sweep Amount: $6,400.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	Component Description: Payment required before shipping. Invoice with quote attached. Amount: $4,037.32 Component Description: See attached Cover Letter. Reimbursement sought for down payment of the Interim Antenna portion of the invoice Amount: $20,216.25 Component Description: See attached cover letter. Reimbursement is sought for the second payment related to the Interim Antenna Amount: $20,216.25
Sweep test of existing antenna	Component Description: Please see attached letter Amount: $6,400.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: Please see attached letter Amount: $1,129.00 Component Description: Storage of antenna until install date. See quote #700078CMZ-6 WVIZ as requested. Amount: $2,020.00 Component Description: a single 3 foot section of 6 inch 50 to 75 ohm transition. Amount: $2,363.74 Component Description: Sweep repack antenna onsite Amount: N/A Component Description: Please see attached document Amount: $18,185.55 Component Description: See attached Cover Letter. Reimbursement requested for first payment for amount related to Main Antenna Antenna $67,726.80 Mounting $ 8,798.40 Feed Through $ 7,225.20 Elbow Complex $ 3,160.80 Total $86,911.20 Amount: $86,911.20 Component Description: See attached Cover Letter/ invoice/quote. Reimbursement request 2nd payment for amount of this invoice related to Main Antenna: Antenna $67,726.80 Mounting $ 8,798.40 Feed Through $ 7,225.20 Elbow Complex $ 3,160.80 Total $86,911.20 Amount: $86,911.20

Cost Information

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	$317,814.00	$318,648.26	N/A	$241,541.06	N/A
Total for all systems	$2,882,515.24	$2,645,894.36	N/A	$2,221,874.07	N/A
Interim Transmission Line	$74,000.00	$59,448.26		$54,245.41
Flexible Air Transmission Line - dielectric, 4"	$74,000.00	$59,448.26	Dielectric Quote attached. Line $53,048.26 Sweep $ 6,400.00 Total $59,448.26	$54,245.41	N/A
Primary Transmission Line	$243,814.00	$259,200.00		$187,295.65
Rigid Transmission Line - copper, 6 1/8"	$243,814.00	$259,200.00	N/A	$187,295.65	N/A

Components

Actual Information Description	File Name
Flexible Air Transmission Line - dielectric, 4"	Component Description: Reducer line that connects the interim facility to the transmitter switch. Amount: $741.97 Component Description: See attached Cover Letter. Reimbursement requested for down payment of the amount related to the Interim Transmission Line. Line $23,871.72 Sweep $ 2,880.00 Total $26,751.72 Amount: $26,751.72 Component Description: See attached cover letter. Reimbursement is requested for second payment of amount related to interim transmission line. Line $23,871.72 Sweep $ 2,880.00 Total $26,751.72 Amount: $26,751.72
Rigid Transmission Line - copper, 6 1/8"	Component Description: See attached Cover Letter/invoice/quote. Reimbursement is requested for down payment of amount related to the Main Transmission Line Line $74,759.96 TLSCR'S $ 2,485.69 Sweep $ 2,880.00 Total $80,125.65 Amount: $80,125.65 Component Description: Please see attached letter Amount: $5,881.00 Component Description: Cut to length pipes for final instillation and freight. Amount: $5,766.59 Component Description: Cut to length pipe for final instillation and freight. Amount: $9,934.79 Component Description: Order to cut lengths of pipe to complete instillation. Amount: $3,511.00 Component Description: 45-degree elbow to connect main transmission line to switch. Also listed is the bullet which goes inside to make the connection. Amount: $1,950.97 Component Description: See attached Cover Letter. Reimbursement is requested for down payment of amount related to the Main Transmission Line Line $74,759.96 TLSCR'S $ 2,485.69 Sweep $ 2,880.00 Total $80,125.65 Amount: $80,125.65 Component Description: Install transmission line inside building Amount: N/A

Actual Information Description

File Name

Flexible Air Transmission Line - dielectric, 4"

Component Description:: Reducer line that connects the interim facility to the transmitter switch.
Amount:: $741.97

Component Description:: See attached Cover Letter. Reimbursement requested for down payment of the amount related to the Interim Transmission Line. Line $23,871.72 Sweep $ 2,880.00 Total $26,751.72
Amount:: $26,751.72

Component Description:: See attached cover letter. Reimbursement is requested for second payment of amount related to interim transmission line. Line $23,871.72 Sweep $ 2,880.00 Total $26,751.72
Amount:: $26,751.72

Rigid Transmission Line - copper, 6 1/8"

Component Description:: See attached Cover Letter/invoice/quote. Reimbursement is requested for down payment of amount related to the Main Transmission Line Line $74,759.96 TLSCR'S $ 2,485.69 Sweep $ 2,880.00 Total $80,125.65
Amount:: $80,125.65

Component Description:: Please see attached letter
Amount:: $5,881.00

Component Description:: Cut to length pipes for final instillation and freight.
Amount:: $5,766.59

Component Description:: Cut to length pipe for final instillation and freight.
Amount:: $9,934.79

Component Description:: Order to cut lengths of pipe to complete instillation.
Amount:: $3,511.00

Component Description:: 45-degree elbow to connect main transmission line to switch. Also listed is the bullet which goes inside to make the connection.
Amount:: $1,950.97

Component Description:: See attached Cover Letter. Reimbursement is requested for down payment of amount related to the Main Transmission Line Line $74,759.96 TLSCR'S $ 2,485.69 Sweep $ 2,880.00 Total $80,125.65
Amount:: $80,125.65

Component Description:: Install transmission line inside building
Amount:: N/A

Cost Information

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	$802,100.00	$902,875.70	N/A	$740,875.70	N/A
Total for all systems	$2,882,515.24	$2,645,894.36	N/A	$2,221,874.07	N/A
Primary Tower TOWER	$802,100.00	$902,875.70		$740,875.70
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$568,302.00	Alternative contractor was needed due to original contractor was unable to complete by deadline. The new contractor will complete stacked antenna install with helicopter, quote includes cost for helicopter. Project quote is WVIZ Cleveland Quote.pdf	$568,302.00	N/A
Tower Helicopter Lift	$0.00	$0.00	Estimate for helicopter lift included complex tower estimate.	N/A	N/A
Minor tower reinforcement/modifications	$158,000.00	$150,000.00	N/A	$0.00	N/A
Tall Tower (greater than 500')	$210,500.00	$172,573.70	*System Notice: Estimate adjusted and locked because line has been superseded.*	$172,573.70	N/A
Structural engineering tower load study for well documented tower	$12,600.00	$12,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: Repack Antenna and Line Installation. Balance due Amount: $284,151.00 Component Description: 1/2 of project total. This was the deposit for the crew to begin work. Amount: $284,151.00
Tower Helicopter Lift	Information not provided.
Minor tower reinforcement/modifications	Information not provided.
Tall Tower (greater than 500')	Component Description: This component consists a few of items structural study/report, tower rigging, structural tower modifications, and the install of interim antenna transmission line. The quote is also attached. Amount: $172,573.70
Structural engineering tower load study for well documented tower	Information not provided.

Cost Information

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	$155,615.00	$102,125.00	N/A	$83,320.12	N/A
Total for all systems	$2,882,515.24	$2,645,894.36	N/A	$2,221,874.07	N/A
Outside Professional Services	$155,615.00	$102,125.00		$83,320.12
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$3,742.00	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$1,500.00	N/A	$1,344.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$150.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$1,575.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$975.00	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	N/A	N/A
Prepare and or review reimbursement form	$2,630.00	$7,500.00	Required to revise and resubmit Form 399 at the request of the FCC and respond to multiple requests for additional information and documentation regarding reimbursement requests	$6,248.25	Required to revise and resubmit 399 at the request of the FCC
Project management of the transition	$25,280.00	$23,000.00	Osborn Engineering Estimate attached. $21,000 Time $ 2,000 Reimbursable $23,000 Total	$21,323.94	N/A
Cesium Communications LP	$15,425.00	$15,425.00	N/A	$15,415.92	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$29,950.00	N/A	$29,843.01	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,500.00	N/A	$2,703.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: See attached cover letter. $296.50 is the amount of this invoice related to Outside Professional Services Attorney Fees Prepare and File FCC Form 2100 (main) Construction Permit. Amount: $296.50 Component Description: Only requesting $918.00 dollars of invoice due to other charges listed are non-reimbursable. Amount: $918.00 Component Description: Construction permit modifications. Amount: $1,458.00 Component Description: Legal Services on 7-24-2017 $195 Review of CP authorizations Amount: $195.00 Component Description: Legal Services on 5-3-2017 $117 email exchanges with consulting engineer regarding FCC release of TV study update Amount: $117.00 Component Description: See attached cover letter and invoice marked as requested. $39 is the portion of this invoice related to Outside Professional Services Attorney Fees Prepare and File FCC Form 2100 (main) Construction Permit. Amount: $39.00 Component Description: See attached cover letter. $328.50 is the portion of this invoice related to Outside Professional Services Attorney Fees Prepare and File FCC Form 2100 (main) Construction Permit. Amount: $328.50 Component Description: Legal Services on 6-7-2017 $117 Review of public notice & email to client 6-20-2017 $117 Review draft construction permit modification appliecation and associated emails Amount: $234.00 Component Description: Includes revised cover letter correcting typo in amount of cost as requested. Legal Services 9-27-2017 $78 Memo to client reports due for CP holders and second filing window notice Amount: $78.00 Component Description: Legal Services on 2-10-2017 $78 email exchange with client regarding channel change Amount: $78.00
Prepare request for Special Temporary Authorization	Component Description: STA Filling Amount: $594.00 Component Description: TPO Calculations and coverage map for interim facility. STA preparation for interim facility. Amount: $750.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Prep-Application to cover Amount: $150.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Modiify construction permit to lower ERP Amount: $225.00 Component Description: Prepare CP Application for WVIZ 6.0 Amount: $900.00 Component Description: Extend Construction permit Amount: $450.00
Perform engineering study for new channel assignment and antenna development	Component Description: WVIZ Assignment - Review of Population Loss, Preliminary Antenna Comparison (TUA-C4-08) and Potential Interfering Stations 1.5 $225.00 Amount: $225.00 Component Description: Total Power Output Calculations for final configuration Amount: $75.00 Component Description: WVIZ - Review of Proposed Dielectric Antenna Pattern and Subsequently Revised Pattern. Conference Call to Discuss Status and Options 3.0 $450.00 Amount: $450.00 Component Description: WVIZ Repack Call and Data Review 1.5 $225.00 Amount: $225.00
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare and or review reimbursement form	Component Description: See attached cover letter. $195.00 is the amount of this invoice related to Prepare and or Review Reimbursement Form Amount: $195.00 Component Description: See attached cover letter. $558 is the amount of this invoice related to Prepare and or Review Reimbursement form Amount: $558.00 Component Description: Legal Services on 8-4-2017 $117 Rev of 399 revision request 8-7-2017 $117 Rev add documentation 8-11-2017 $41.25 File amended 399 8-11-2017 $312 Review amended 399 8-17-2017 $117 Resp client regard CORES Amount: $704.25 Component Description: See attached cover letter and invoice marked as requested. $273.00 is the portion of this invoice relating to Prepare and or Review Reimbursement Form Amount: $273.00 Component Description: Review of FCC Requested 399 Changes, Conference Call and Preparation 4.0 $600 Services provided by engineer Benjamin Pidek Amount: $600.00 Component Description: -Help Prepare 399 1.0 $150.00 - Review of 399 1.0 $150.00 - 399 Narrative Review and Conference Call 2.0 $300.00 - 399 Questions1.0 $150.00 Amount: $750.00 Component Description: - Preliminary Widelity Cost Spreadsheet for WVIZ 1.0 $150.00 Amount: $150.00 Component Description: Review of and Reponse to WVIZ 399 Questions .5 $75.00 Amount: $75.00 Component Description: See attached Cover Letter with invoice marked as requested. Prepare and or Review Reimbusement Amount: $604.50 Component Description: Legal Services on 7-5-2017 $117 Resp to client re empl. time reimb 7-6-2017 $156 Review empl. time exhibit 7-10-2017 $49.50 File forms 7-10-2017 $468 Rev final 399 and confirm to file Amount: $790.50 Component Description: Review and categorize past invoices to provide information required for reimbursement Invoice reissued to include Tax ID and who did the work Amount: $75.00 Component Description: Legal Services on 5-2-2017 Review of Widelity catalog with client Amount: $156.00 Component Description: 6-14-2017 $195 Resp to client re reimbursement 6-19-2017 $117 Resp to client re 399 6-20-2017 $195 Review Draft Reimburse App 6-28-2017 $624 Review 399 narr conf call & follow up Amount: $1,131.00 Component Description: See attached Cover Letter and invoice marked as requested. Prepare and or Review Reimbursement Amount: $186.00
Project management of the transition	Component Description: Interim invoice for Project Management per vendor quote previously submitted Amount: $225.00 Component Description: Project manager to coordinate antenna shipping and installation. Review project timeline with all stakeholders, onsite meeting. Amount: $1,639.18 Component Description: Project Management Services per estimate previously submitted Amount: $675.00 Component Description: Project management, progress calls, schedule aux antenna sweep calls. Amount: $375.00 Component Description: Initial invoice for Project Management Services per Osborn Engineering with estimate attached. Amount: $8,400.00 Component Description: Interim payment for project management based on vendor estimate previously submitted Amount: $825.00 Component Description: Third payment for Project Management per Osborn Engineering estimate previously submitted. Amount: $2,610.00 Component Description: Interim invoice for Project Management per vendor quote previously submitted Amount: $2,584.76 Component Description: Second invoice for Project Management per Osborn Engineering estimate attached. Amount: $915.00 Component Description: Repack Project Management Services Amount: $2,325.00 Component Description: Interim payment for project management based on vendor estimate previously submitted. Amount: $750.00
Cesium Communications LP	Component Description: Credit as per FCC instructions. Amount: ($4.64) Component Description: Work with Tower Crew to bring Xmission Line into specification Amount: $15,420.56
Comprehensive coverage verification via field study, if needed	Component Description: RF Testing Amount: $6,987.50 Component Description: RF Field Testing minus the $5.73 laundry charge. Amount: $13,154.86 Component Description: RF Testing Amount: $7,911.85 Component Description: RF Field Testing Amount: $1,788.80
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: Fees for STA Amount: $1,323.00 Component Description: Fees for STA Amount: $1,380.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.

Cost Information

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	$179,989.20	$172,339.20	N/A	$147,539.53	N/A
Total for all systems	$2,882,515.24	$2,645,894.36	N/A	$2,221,874.07	N/A
Other Expenses	$179,989.20	$172,339.20		$147,539.53
Test Antenna	$86.39	$86.39	N/A	$86.39	N/A
Employee Time	$120,000.00	$120,000.00	Labor on project was greater than originally estimated due to project delay and tower crew changes.	$115,989.21	The actual labor was greater than the estimated labor.
MVPD Notification of Channel Change	$1,935.00	$1,935.00	This was the only vendor that could preform notification at this price on the needed timeline.	$1,935.00	N/A
Develop and air announcement of upcoming channel change	$5,000.00	$5,000.00	N/A	N/A	N/A
Equipment Storage	$5,000.00	$5,000.00	N/A	N/A	N/A
Equipment Delivery and Handling Charges	$28,117.81	$28,117.81	Shipping and offloading for transmitter and main, switch and interim antennas and transmission lines. See attached quotes.	$23,336.78	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$5,000.00	$5,000.00	N/A	N/A	N/A
Non-zoning permits	$1,000.00	$1,000.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$3,900.00	N/A	$3,900.00	N/A
Inside Transmission line	$2,300.00	$2,300.00	N/A	$2,292.15	N/A

Components

Actual Information Description	File Name
Test Antenna	Component Description: Test antenna to replicate repack related reception issues Amount: $86.39
Employee Time	Component Description: Invoice as requested, summary of hours to be reimbursed by position, labor rate calculation, individual time records, paystubs for the first date and last date for which reimbursement is requested. Amount: $28,710.50 Component Description: See attached cover letter and invoice updated per request. This invoice is for the period 10-1-2017 through 9-30-2018. Attached is detailed labor rate calculation for the period along with individual hours and pay stubs. Also revised estimate. Amount: $41,871.90 Component Description: Internal labor related to Repack of WVIZ through 09-30-2019 Amount: $45,406.81
MVPD Notification of Channel Change	Component Description: Vendor provided MVPD Notification Service Amount: $1,935.00
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Information not provided.
Equipment Delivery and Handling Charges	Component Description: See attached cover letter, quote and invoice for shipping for interim antenna and transmission line. Amount: $7,586.50 Component Description: Please see attached letter Amount: $930.00 Component Description: ForkLift to unload transmitter and associated components into the building. Amount: $538.68 Component Description: Monthly rental cost for scissor lift for transmitter and transmission line install. Amount: $698.97 Component Description: Lift used to connect transmission line to transmitter Amount: $698.97 Component Description: Scissor Lift for the installition of the transmitter components, transmission line, and switch. Amount: $986.47 Component Description: Lift to install transmission line to transmitter Amount: $698.97 Component Description: See attached cover letter and invoice for shipping for necessary switch Amount: $731.31 Component Description: Lift used to connect transmission line to transmitter Amount: $698.97 Component Description: Monthly rental cost for scissor lift for transmitter and transmission line install. Amount: $698.97 Component Description: Monthly rental cost for scissor lift for transmitter and transmission line install. Amount: $698.97 Component Description: See attached cover letter/invoice/quote. Reimbursement is requested for the second payment of the amount related to Equipment Delivery and Handling Main Antenna and Transmission Line Amount: $4,185.00 Component Description: See attached cover letter. Reimbursement is requested for the down payment of the amount related to Equipment Delivery and Handling Main Antenna and Transmission Line Amount: $4,185.00
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
Non-zoning permits	Information not provided.
DTV Medical Facility Notification	Component Description: Provide Medical Notification Service Amount: $3,900.00
Inside Transmission line	Component Description: Moved invoice per Repack admin. Cost was for inside transmission line install Amount: $2,292.15

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,882,515.24	$2,645,894.36	$2,221,874.07

Reimbursement Status

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

Certification

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.
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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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). 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Christian Siebeneck Chief Technologist 05/18/2021

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.

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.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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).
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Christian Siebeneck

Chief Technologist

05/18/2021

Certification

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).
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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) . 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. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Christian Siebeneck Chief Technologist 05/18/2021

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).

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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) .
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.
The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Christian Siebeneck

Chief Technologist

05/18/2021

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Christian Siebeneck Chief Technologist 05/18/2021

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Christian Siebeneck

Chief Technologist

05/18/2021

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

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

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components