TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
Nexstar Media Inc.	Elizabeth Ryder 545 E. JOHN CARPENTER FREEWAY SUITE 700 IRVING, TX 75062 United States	+1 (972) 373-8800	eryder@nexstar.tv	Corporation

Applicant

Address

Phone

Applicant Type

Nexstar Media Inc.

Elizabeth Ryder

545 E. JOHN CARPENTER FREEWAY

SUITE 700

IRVING, TX 75062

United States

+1 (972) 373-8800

eryder@nexstar.tv

Corporation

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
Elizabeth Ryder General Counsel Nexstar Media Inc.	Elizabeth Ryder 545 E. John Carpenter Freeway Suite 700 Irving, TX 75062 United States	+1 (972) 373-8800	eryder@nexstar.tv

Applicant

Address

Phone

Elizabeth Ryder

General Counsel

Nexstar Media Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800

eryder@nexstar.tv

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.	No
Briefly describe transition plan	Replace transmitter and antenna using existing line. Acquire interim antenna and line for continued operation during construction and duration of the assigned phase. Map and analyze tower; design and implement modifications if required. See attached.

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	Visionary
	Year	2005
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	30 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?	No
	Manufacturer
	Model	HPTV-PRLX-U14
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	22.7 kW
	Justification for New Transmitter	The manufacturer of the existing IOT transmitter is out of business and no factory support is available. The purchase price of a new transmitter is based on a Proposal from Comark for an MSDC IOT as suggested by the FCC. See attachment.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	150 kVA
	Rigid Conduit and Wiring	Yes
	Size	3 inches
	Length	100.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Transmitter HVAC	New Transmitter requires adequate HVAC Please see Total Maintenance Inc. Quote # L17-0781 Attached
Decommissioning of Old Transmitter	Remove old transmitter and associated equipment to prepare for installation of new RePack Transmitter. Please see attached quote R Cleveland LLC dated 3/8/20
Transmitter Power Conditioner	New Transmitter requires Power Conditioning. Please see Staco Energy Products quote # QUO-18357-3CFVK5-3 Attached
Additional Interior RF System	Interior RF System Existing Transmitter to Interim Transmission line
Transmitter Battery Back-Up	Due to power fluctuations and outages at the site, battery backup is required to stay on the air and protect the RePack Transmitter/ Please see Staco Energy Quote # QUO-52084-2UKWL1-2 attached.
Transmitter Electrical and Installation	Transmitter Electrical and Installation

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	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:	615.0 kW
	Manufacturer
	Model	TFU-22JSC-R C152
	Year	2005

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	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	1000.0 kW
	Manufacturer
	Model	TFU-22ETT/VP-R C200
	Year	2019
	Justification for New Antenna	The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel. See Engineering statement regarding the relocation to a different transmitter site and the requirement for a top mounted antenna.

Primary Antenna

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?	Yes
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Wedding Cake Mounting Adapter	Wedding Cake Mounting Adapter
Additional Antenna Costs	Additional Antenna Costs
Antenna Input Feed-Through Complex	Antenna Input Feed-Through Complex
Antenna Support Pole	Antenna Support Pole

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	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:	615.0 kW
	Manufacturer
	Model	TBD
	Year	2018
	Justification for New Antenna	An interim antenna is necessary to keep station on the air during primary antenna replacement and for the duration of the assigned phase. Station will attempt to rent if renting is available at time of acquisition.

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	S
	Feed Line Size	4 1/16 inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an antenna?	Yes
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	Yes
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	1360 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	985 feet per run
	Justification for New Transmission Line	KGCW is moving to an alternate transmitter site; therefore the existing tranmission line cannot be used. See Engineering Technical Statement attached.

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Additional Transmission Line Components	Additional Transmission Line Components

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	Rigid
	Diameter	4 1/16 inches
	Segment Length	19 ½ '
	Other Segment Length
	Number of parallel runs	1
	Length	1210 feet per run
	Justification for New Transmission Line	An interim transmission line is necessary for the interim antenna to keep station on the air during primary antenna replacement and for the duration of the assigned phase. Station will attempt to rent if renting is available at time of acquisition.

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	Leased
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	Is tower documented for structural analysis?	No
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1222627
Coordinates (NAD83)	Latitude (NAD83)	41° 08' 08.0" N-
	Longitude (NAD83)	090° 48' 30.0" W-
	Overall Structure Height	1416.98 feet
	Support Structure Height	1416.98 feet
	Ground Elevation Above Mean Sea Level (AMSL)	631.88 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	American Tower, LLC
	Date Constructed	10/01/2008

Primary Tower

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

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Tower Foundation Ground work, modification, and Ice Bridge Construction	Excavation of Tower Foundation, pour Concrete Pad, remove and replace old Ice Bridge. Please see Precision Communications Inc. quote # 19385-5 attached
Tower Structural Analysis, Foundation Mapping, Geotechnical Survey and Report	Tower Analysis needed before major modifications can be made.
Weather Delays and Prorated Equipment	Weather Delays, Prorated Equipment and Freight on Bid materials. Please see Precision Communications Addendum to Proposal 19393-5 Attached.
Tower Site Preparation Costs	Gravel and grading to prep site required for tower crew work

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	277
	Explanation	Schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects. Internal accounting and Project management.
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)	Yes
	Negotiation of Lease and other Matter for Shared Locations	Yes
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	Yes
	Number of Days	17
	Justification	It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Prepare engineering portion of minor modification to CP application	Prepare engineering portion of minor modification to CP application

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	Yes
	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
Sales Taxes	Sales and use tax on goods and services
Microwave Rental	Microwave Rental During Transition
STL TSL Antenna Transmission Line.	STL / TSL microwave transmission line and Antenna. Please see Primus Electronics Quote # Q032180
STL Microwave Demod	Demodulator for Microwave signal to transmitter. Please see Heartland Video Systems Quote # WISQ63437 Attached
Equipment Rentals	Equipment Rentals

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	$1,420,583.61	$1,192,078.61	N/A	$970,335.61	N/A
Total for all systems	$4,057,968.39	$3,738,635.49	N/A	$2,769,748.12	N/A
Primary Transmitter HPTV-PRLX-U14	$1,420,583.61	$1,192,078.61		$970,335.61
Decommissioning of Old Transmitter	$15,000.00	$15,000.00	Remove old transmitter and associated equipment to prepare for installation of new RePack Transmitter. Please see attached quote R Cleveland LLC dated 3/8/20	N/A	N/A
Transmitter HVAC	$45,446.00	$45,446.00	New Transmitter requires adequate HVAC Please see Total Maintenance Inc. Quote # L17-0781 Attached	$45,446.00	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 - 150 KVA	$25,550.00	$24,300.00	N/A	N/A	N/A
Transmitter Battery Back-Up	$40,860.50	$40,860.50	Due to power fluctuations and outages at the site, battery backup is required to stay on the air and protect the RePack Transmitter/ Please see Staco Energy Quote # QUO-52084-2UKWL1-2 attached.	$39,617.50	N/A
Transmitter Electrical and Installation	$110,238.30	$110,238.30	See Land Communications estimate 1076	$110,238.30	N/A
Transmitter Power Conditioner	$53,088.81	$53,088.81	New Transmitter requires Power Conditioning. Please see Staco Energy Products quote # QUO-18357-3CFVK5-3 Attached	$53,088.81	N/A
Additional Interior RF System	$140,000.00	$140,000.00	N/A	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$721,945.00	See Hitachi quote P#3981PRLXU14-060519	$721,945.00	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Decommissioning of Old Transmitter	Information not provided.
Transmitter HVAC	Component Description: HVAC for transmitter building Amount: $45,446.00
3" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Transformer 3 phase/480v - 150 KVA	Information not provided.
Transmitter Battery Back-Up	Component Description: Battery backup for transmitter Amount: $39,617.50 Component Description: Battery back up for transmitter Amount: $39,617.50
Transmitter Electrical and Installation	Component Description: Transmitter electrical and installation, installment #1 Amount: $55,119.15 Component Description: Transmitter electrical and installation, installment #2 Amount: $55,119.15
Transmitter Power Conditioner	Component Description: Transmitter power conditioner Amount: $1,600.00 Component Description: Transmitter power conditioner Amount: $51,488.81
Additional Interior RF System	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: Transmitter, installment #1, items 1 & 2 from invoice Amount: $360,972.50 Component Description: Transmitter, installment #2, items 1 & 2 from invoice Amount: $324,875.25 Component Description: Transmitter, installment #3, items 1 & 2 from invoice Amount: $36,097.25
Switchgear - industrial 800 amp	Information not provided.

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	$762,201.00	$661,654.00	N/A	$376,525.00	N/A
Total for all systems	$4,057,968.39	$3,738,635.49	N/A	$2,769,748.12	N/A
Interim Antenna TBD	$279,710.00	$277,500.00		$0.00
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	N/A	N/A
UHF - High Power, Side Mount, basic slot antenna, 615 kW input, directional,, horizontally polarized	$235,000.00	$235,000.00	Used High Power Top Mount for budget because side mount is only rated for 500 kW	N/A	N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	$9,570.00	$9,100.00	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
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
Primary Antenna TFU-22ETT/VP-R C200	$482,491.00	$384,154.00		$376,525.00
Antenna Input Feed-Through Complex	$18,656.00	$18,656.00	See Dielectric quote 900083CMZ-1	$18,656.00	N/A
Antenna Support Pole	$109,220.00	$109,220.00	See Dielectric quote 900083CMZ-1	$109,220.00	N/A
Wedding Cake Mounting Adapter	$30,825.00	$30,825.00	See Dielectric quote 900083CMZ-1	$30,825.00	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
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$10,710.00	See Dielectric quote 900083CMZ-1	$10,710.00	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	$193,343.00	See Dielectric quote 900083CMZ-1 less vpol cost	$193,343.00	N/A
Additional Antenna Costs	$10,000.00	$10,000.00	See Dielectric change orders	$7,371.00	N/A

Components

Actual Information Description	File Name
Sweep test of existing antenna	Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 615 kW input, directional,, horizontally polarized	Information not provided.
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)	Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
Antenna Input Feed-Through Complex	Component Description: Feed through complex, balance due Amount: $1,865.60 Component Description: Feed through complex, installment #1 Amount: $8,395.20 Component Description: Feed through complex, installment #2 Amount: $8,395.20 Component Description: Feed through complex, installment #1 Amount: $8,395.20
Antenna Support Pole	Component Description: Antenna support pole, installment #1 Amount: $49,149.00 Component Description: Antenna support pole, balance due Amount: $10,922.00 Component Description: Antenna support pole, installment #1 Amount: $49,149.00 Component Description: Antenna support pole, installment #2 Amount: $49,149.00
Wedding Cake Mounting Adapter	Component Description: Wedding cake mounting adapter, installment #1 Amount: $13,871.25 Component Description: Wedding cake mounting adapter, balance due Amount: $3,082.50 Component Description: Wedding cake mounting adapter, installment #1 Amount: $13,871.25 Component Description: Wedding cake mounting adapter, installment #2 Amount: $13,871.25
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: Elbow complex, installment #1 Amount: $4,819.50 Component Description: Elbow complex, balance due Amount: $1,071.00 Component Description: Elbow complex, installment #2 Amount: $4,819.50 Component Description: Elbow complex, installment #1 Amount: $4,819.50
Sweep test of existing antenna	Component Description: Sweep test Amount: $6,400.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: Antenna, installment #1 Amount: $87,004.35 Component Description: Antenna, balance due Amount: $19,334.30 Component Description: Antenna, installment #2 Amount: $87,004.35 Component Description: Antenna, installment #1 Amount: $87,004.35
Additional Antenna Costs	Component Description: Additional antenna costs Amount: $1,687.00 Component Description: Additional antenna costs Amount: $3,423.00 Component Description: Additional antenna costs Amount: $2,261.00

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	$375,790.00	$312,860.10	N/A	$148,925.10	N/A
Total for all systems	$4,057,968.39	$3,738,635.49	N/A	$2,769,748.12	N/A
Interim Transmission Line	$171,820.00	$163,350.00		$0.00
Rigid Transmission Line - copper, 4 1/16"	$171,820.00	$163,350.00	N/A	N/A	N/A
Primary Transmission Line	$203,970.00	$149,510.10		$148,925.10
Additional Transmission Line Components	$5,000.00	$5,000.00	See Dielectric change orders	$4,424.00	N/A
Rigid Transmission Line - copper, 6 1/8"	$198,970.00	$144,510.10	See Dielectric quote 900083CMZ-1	$144,501.10	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 4 1/16"	Information not provided.
Additional Transmission Line Components	Component Description: Additional transmission line Amount: $2,604.00 Component Description: Additional transmission line Amount: $1,820.00
Rigid Transmission Line - copper, 6 1/8"	Component Description: Transmission line, installment #1 Amount: $65,029.55 Component Description: Transmission line, installment #3 Amount: $9,286.50 Component Description: Transmission line, installment #2, lines 6 and 10 of invoice Amount: $65,029.55 Component Description: Transmission line Amount: $5,155.50 Component Description: Transmission line, installment #1, lines 6 and 10 of invoice Amount: $65,029.55

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	$1,062,440.00	$1,127,740.00	N/A	$1,118,140.00	N/A
Total for all systems	$4,057,968.39	$3,738,635.49	N/A	$2,769,748.12	N/A
Primary Tower GTOWER	$1,062,440.00	$1,127,740.00		$1,118,140.00
Tower Site Preparation Costs	$8,000.00	$8,000.00	See CCS Hauling & Excavating quote	$8,000.00	N/A
Weather Delays and Prorated Equipment	$118,800.00	$118,800.00	Weather Delays. Please see Precision Communications Addendum to Proposal 19393-5 and 20422-5A.	$118,800.00	N/A
Tower Foundation Ground work, modification, and Ice Bridge Construction	$248,400.00	$248,400.00	Excavation of Tower Foundation, pour Concrete Pad, remove and replace old Ice Bridge. Please see Precision Communications Inc. quote # 19385-5 attached	$248,400.00	N/A
Major tower reinforcement/modifications	$421,000.00	$198,600.00	See PCI quote 19393-5	$198,600.00	N/A
Tower Structural Analysis, Foundation Mapping, Geotechnical Survey and Report	$29,440.00	$29,440.00	See proposals Paul J Ford & Co A00018-0122.001, A00018-0122.003 and A00018-0122.005	$29,440.00	N/A
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	$15,400.00	N/A
Tall Tower (greater than 500')	$210,500.00	$499,500.00	See PCI quote 19394-5 and Precison Communications LLC proposals 20369-5 and 20422-5A	$499,500.00	N/A

Components

Actual Information Description	File Name
Tower Site Preparation Costs	Component Description: Tower site ground prep Amount: $8,000.00
Weather Delays and Prorated Equipment	Component Description: Weather delays Amount: $115,200.00 Component Description: Weather delay Amount: $3,600.00
Tower Foundation Ground work, modification, and Ice Bridge Construction	Component Description: Tower mods and ice shield, installment #1 Amount: $165,600.00 Component Description: Tower mods and ice shield, installment #2 Amount: $82,800.00
Major tower reinforcement/modifications	Component Description: Tower modifications, installment #2 Amount: $66,200.00 Component Description: Tower modifications, installment #1 Amount: $132,400.00
Tower Structural Analysis, Foundation Mapping, Geotechnical Survey and Report	Component Description: Structural analysis Amount: $1,000.00 Component Description: Tower modification drawings Amount: $3,000.00 Component Description: Structural analysis, foundation mapping and geotechnical report Amount: $25,440.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: Tower modification drawings Amount: $2,800.00 Component Description: Tower mapping Amount: $11,750.00 Component Description: Structure surveying Amount: $850.00
Tall Tower (greater than 500')	Component Description: Antenna removal, installment #3 Amount: $63,200.00 Component Description: Antenna removal, installment #2 Amount: $63,200.00 Component Description: Main antenna installation, installment #1 Amount: $199,000.00 Component Description: Main antenna installation, installment #2 Amount: $99,500.00 Component Description: Antenna removal, installment #1 Amount: $63,200.00 Component Description: Dish removal Amount: $11,400.00

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	$119,791.00	$126,300.00	N/A	$68,231.50	N/A
Total for all systems	$4,057,968.39	$3,738,635.49	N/A	$2,769,748.12	N/A
Outside Professional Services	$119,791.00	$126,300.00		$68,231.50
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,050.00	N/A	$550.00	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,500.00	N/A	N/A	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$4,000.00	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 - 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	$2,050.00	$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	$3,000.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$7,000.00	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$2,500.00	N/A
Project management of the transition	$43,766.00	$52,500.00	Estimated 350 hours at $150 per hour	$49,556.50	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$625.00	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 engineering portion of minor modification to CP application	$5,000.00	$5,000.00	See Osborn invoices 31219 and	$5,000.00	N/A
Additional Field Engineering Service, 17 Days	$34,000.00	$34,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Component Description: Prepare and submit FAA filing, item 9 from invoice summary Amount: $550.00
Attorney Fees - Prepare and File request for Special Temporary Authorization	Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Information not provided.
Prepare request for Special Temporary Authorization	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Vendor has issued a revised invoice; see 29362R Amount: ($3,000.00) Component Description: Prepare engineering section of FCC Form 2100, item 4 from invoice summary Amount: $3,000.00 Component Description: Vendor has issued a revised invoice; see 29362R Amount: $3,000.00
Perform engineering study for new channel assignment and antenna development	Component Description: Perform engineering study, item 3 from invoice summary Amount: $7,000.00 Component Description: Vendor has issued a revised invoice; see 29362R Amount: $7,000.00 Component Description: Vendor has issued a revised invoice; see 29362R Amount: ($7,000.00)
Prepare and or review reimbursement form	Component Description: Prepare reimbursement form, item 2 from invoice summary Amount: $2,500.00 Component Description: Vendor has issued a revised invoice; see 29362R Amount: $2,500.00 Component Description: Vendor has issued a revised invoice; see 29362R Amount: ($2,500.00)
Project management of the transition	Component Description: Project management services, items 1-4, 6-7 from invoice summary Amount: $1,796.50 Component Description: Project management services 3.2.19 through 3.29.19 Amount: $75.00 Component Description: Project management services Aug 2019 Amount: $200.00 Component Description: Project management services Dec 2020 Amount: $575.00 Component Description: Project management services May 2020 Amount: $65.00 Component Description: Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates. Services from January 27, 2018 through February 23, 2018. Amount: $3,675.00 Component Description: Project management services Amount: $1,909.00 Component Description: Project management services Nov 2019 Amount: $235.00 Component Description: Project management services Amount: $1,210.00 Component Description: Project management services June 2019 Amount: $227.50 Component Description: Project management services 7.27.19 through 8.30.19 Amount: $1,580.00 Component Description: Project management services Amount: $7,782.50 Component Description: Project management services Sep 2020 Amount: $70.00 Component Description: Project management services Oct 2020 Amount: $85.00 Component Description: Project management services Aug 2020 Amount: $55.00 Component Description: Project management services April 2019 Amount: $45.50 Component Description: Project management services Mar 2020 Amount: $65.00 Component Description: Project management services Feb 2020 Amount: $145.00 Component Description: Project management services Jun 2020 Amount: $130.00 Component Description: Project management services 6.1.19 through 6.28.19 Amount: $375.00 Component Description: Prepare FCC Schedule 387, item 5 from invoice summary Amount: $300.00 Component Description: Project management services 7.28.18 through 9.28.18 Amount: $650.00 Component Description: Project management services 3.30.19 through 4.26.19 Amount: $1,425.00 Component Description: Project management services Jan 2020 Amount: $395.00 Component Description: Project management services, item 7 from invoice summary Amount: $5,758.00 Component Description: Project management services, item 1 from invoice summary Amount: $7,350.00 Component Description: Project management services 9.29.18 through 10.26.18, items 1 and 2 from invoice summary Amount: $525.00 Component Description: Vendor has issued a revised invoice; see 29362R Amount: ($1,000.00) Component Description: Project management services 4.27.19 through 5.31.19 Amount: $1,800.00 Component Description: Vendor has issued a revised invoice; see 29362R Amount: $1,000.00 Component Description: Project management services Amount: $948.00 Component Description: Project Management for Structural Analysis and Tower Modifications for services from June 30, 2018 through July 27, 2018. Amount: $825.00 Component Description: Project management services Apr 2020 Amount: $35.00 Component Description: Project management services 10.27.18 through 11.30.18 Amount: $4,150.00 Component Description: Project management services Amount: $79.00 Component Description: Project management services Amount: $316.00 Component Description: Project management services 1.1.18 through 1.26.18 Amount: $750.00 Component Description: Project management services 1.1.18 through 1.26.18 Amount: $375.00 Component Description: Project management services 12.1.18 through 1.31.19 Amount: $1,325.00 Component Description: Prepare FCC Schedule 387, item 6 from invoice summary Amount: $150.00 Component Description: Project management services 5.26.18 through 6.29.18 Amount: $420.00 Component Description: Project management services 8.31.19 through 9.27.19 Amount: $1,106.00 Component Description: Project management services 2.1.19 through 3.1.19 Amount: $450.00 Component Description: Project management services February 2019 Amount: $123.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Prepare License to Cover Application Amount: $625.00
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare engineering portion of minor modification to CP application	Component Description: Amendment application provides community of license compliance exhibits and Longley-Rice verification Amount: $2,500.00 Component Description: Prepare engineering portion of minor modification of CP permit to change antenna models Amount: $2,500.00
Additional Field Engineering Service, 17 Days	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	$317,162.78	$318,002.78	N/A	$87,590.91	N/A
Total for all systems	$4,057,968.39	$3,738,635.49	N/A	$2,769,748.12	N/A
Other Expenses	$317,162.78	$318,002.78		$87,590.91
Equipment Delivery and Handling Charges	$30,000.00	$30,000.00	See related invoices	$29,222.88	N/A
Sales Taxes	$165,800.00	$165,800.00	N/A	$45,140.01	N/A
Equipment Rentals	$7,121.02	$7,121.02	See related invoices	$7,121.02	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$25,000.00	$25,000.00	N/A	N/A	N/A
Non-zoning permits	$25,000.00	$25,000.00	N/A	N/A	N/A
STL Microwave Demod	$1,215.32	$1,215.32	Microwave Demod needed for signal to Transmitter from Studio. Please see Attached Quote # WISQ63437 from Heartland Video Systems	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$2,012.00	N/A
STL TSL Antenna Transmission Line.	$15,971.44	$15,971.44	N/A	N/A	N/A
Microwave Rental	$3,895.00	$3,895.00	Microwave rental during transition	N/A	N/A
MVPD Notification of Channel Change	$2,000.00	$2,000.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$3,500.00	$3,500.00	N/A	N/A	N/A
Equipment Storage	$25,000.00	$25,000.00	N/A	$1,595.00	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$2,500.00	Time involved for Modification/Amendment of Post- Transition Construction Permit Application	$2,500.00	N/A

Components

Actual Information Description	File Name
Equipment Delivery and Handling Charges	Component Description: Freight costs on tower modification materials Amount: $2,500.00 Component Description: Freight cost for antenna component Amount: $1,317.82 Component Description: Battery back up freight Amount: $1,243.00 Component Description: Freight costs for tower modification materials Amount: $1,500.00 Component Description: Antenna shipping and freight, lines 1-3 of invoice Amount: $13,244.28 Component Description: Battery back up freight cost Amount: $1,243.00 Component Description: Antenna freight costs, lines 1-3 of invoice Amount: $13,244.28 Component Description: Antenna shipping costs Amount: $6,675.20 Component Description: Antenna shipping costs Amount: $2,742.58
Sales Taxes	Component Description: Tax on transmitter, installment #1 Amount: $22,560.78 Component Description: Tax on forklift rental Amount: $18.45 Component Description: Tax on transmitter, installment #2 Amount: $20,304.70 Component Description: Tax on transmitter, installment #3 Amount: $2,256.08 Component Description: Tax on forklift rental Amount: $18.45
Equipment Rentals	Component Description: Equipment rentals for tower modifications Amount: $4,000.00 Component Description: Forklift rental Amount: $3,121.02 Component Description: Forklift rental Amount: $3,121.02
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
Non-zoning permits	Information not provided.
STL Microwave Demod	Information not provided.
DTV Medical Facility Notification	Component Description: Notification of medical facilities Amount: $2,012.00
STL TSL Antenna Transmission Line.	Information not provided.
Microwave Rental	Information not provided.
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: Antenna storage Amount: $1,595.00 Component Description: Antenna storage Amount: $1,595.00
FCC Filing Fees - Form 2100 minor change CP application	Component Description: Prepare Engineering Portion, item 8 from invoice summary Amount: $2,500.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$4,057,968.39	$3,738,635.49	$2,769,748.12

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.	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

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.	Elizabeth Ryder General Counsel 07/19/2021

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.

Elizabeth Ryder

General Counsel

07/19/2021

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.	Elizabeth Ryder General Counsel 07/19/2021

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.

Elizabeth Ryder

General Counsel

07/19/2021

(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

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