Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Reimbursement Request

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

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

Facility ID:
51568
Service:
DTV
Call Sign:
WTXF-TV
Channel:
31 (UHF)
File Number:
0000027336
FRN:
0005795067
Date Submitted:
06/11/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

FOX TELEVISION STATIONS, LLC

Joe DiScipio

400 N. CAPITOL STREET, NW

SUITE 890

WASHINGTON, DC 20001

United States

+1 (202) 824-6522 Joe.Discipio@fox.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Dennis Wallace

Managing Partner

Meintel, Sgrignoli & Wallace, LLC

Dennis Wallace

1282 Smallwood Drive

Suite 372

Waldorf, MD 20603

United States

+1 (202) 251-7589 Dennis.Wallace@mswdtv.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan WTXF will change channel of its licensed Aux facilities with new antenna, transmission line and transmitter. It will operate on its new channel from Aux facilities while the main site main antenna, aux antenna, tx line, and transmitters are changed.

Transmitters

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

Auxiliary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Licensed Aux Site
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DCX P3
Year 1998
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 75 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9-40 EVO
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 61 kW
Justification for New Transmitter Previously planned to re-tune Comark transmitter but vendor issued end of life certificate. Transmitter no longer supported.

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 500 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 200.0 feet
Other Electrical Service Yes
Description Installation Electrical for new transmitter.
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Demolition

Analog backup demolition

Remote Control Wiring

Wire up existing remote control to new transmitter.

Remove Existing Equipment

Remove Existing Equipment

Aux Transmitter Build Out

Labor, materials, travel for aux transmitter build out

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Paragon P3
Year 2007
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 75 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9-EVO
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 106 kW
Justification for New Transmitter Originally planned to retune 3 tube IOT but manufacturer (Comark) issued end of life and retune was no longer possible.

Primary Transmitter

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Other Transmitter Costs

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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Impedance Filter and Interconnect

Impedance Filter and Interconnect

Demolition

Demolition and removal of old transmitter

Antennas

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

Auxiliary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Licensed Aux Site Antenna
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model ATW22H3-ETO-42H
Year 1999

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Licensed Aux Antenna
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
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 ATW18HS3-ETO-31H
Year 2017
Justification for New Antenna New Antenna for Licensed Aux Facility for new Channel.

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Auxiliary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Auxiliary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Main Site Backup Antenna
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
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: 530.0 kW
Manufacturer
Model ATW22H3-ESC2-42H
Year 2007

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Main Site Backup Antenna
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
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: 530.0 kW
Manufacturer
Model ATW26H6-CSS-31H
Year 2019
Justification for New Antenna New Antenna for Main Site Backup Antenna for new RF Channel. Existing slot will not work on new channel. See quote 0919_ERI 20180822-046 Rev A

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
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? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

Installation

Remove old antenna, install new antenna

Rigid Line Removal

Work to remove rigid RCA line

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type 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 N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 620.0 kW
Manufacturer
Model ATW12HS3-ETOC-42S
Year 2009

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
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: 499.0 kW
Manufacturer
Model ATW18HS9-ETO-31H
Year 2017
Justification for New Antenna Existing antenna will not work on the new channel and will require replacement.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 8 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Installation and Rigging

Installation and Rigging

Transmission Line

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

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Main Site Backup Antenna Line
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 1100 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use Main Site Backup Antenna
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 1100 feet per run
Justification for New Transmission Line New channel requires 20' lengths. Old channel was 19.5'. Replacement of transmission line required for new channel.

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Licensed Aux Site Antenna Line
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 400 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use Licensed Aux Antenna Line
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 400 feet per run
Justification for New Transmission Line New channel requires 20Ft Lengths. Existing line is 19.5 ft lengths. will not work for new channel.

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1350 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1350 feet per run
Justification for New Transmission Line New Channel requires 20' lengths. Existing line will not work on new channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Auxiliary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use Licensed Aux Site
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1026546
Coordinates (NAD83) Latitude (NAD83) 40° 03' 29.7" N-
Longitude (NAD83) 075° 14' 19.2" W-
Overall Structure Height 382.87 feet
Support Structure Height 311.02 feet
Ground Elevation Above Mean Sea Level (AMSL) 410.76 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Tower, LLC
Date Constructed 12/01/2008


Auxiliary Tower

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Tower Modification Costs

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

Auxiliary Tower

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Tower Rigging Costs

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

Auxiliary Tower

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Other Tower Expenses Not Listed

Information not provided.

Auxiliary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Auxiliary (Backup)
Description of Use Main Site Backup Antenna
Ownership Owned
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1037800
Coordinates (NAD83) Latitude (NAD83) 40° 02' 26.0" N-
Longitude (NAD83) 075° 14' 18.0" W-
Overall Structure Height 1124.99 feet
Support Structure Height 1076.43 feet
Ground Elevation Above Mean Sea Level (AMSL) 225.06 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Fox Television Stations, LLC
Date Constructed 06/12/2009


Auxiliary Tower

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Tower Rigging Costs

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

Auxiliary Tower

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Other Tower Expenses Not Listed

Information not provided.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex?
Is this tower currently shared with any other stations? 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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1037800
Coordinates (NAD83) Latitude (NAD83) 40° 02' 26.0" N-
Longitude (NAD83) 075° 14' 18.0" W-
Overall Structure Height 1124.99 feet
Support Structure Height 1076.43 feet
Ground Elevation Above Mean Sea Level (AMSL) 225.06 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Fox Television Stations, LLC
Date Constructed 06/12/2009


Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 650
Explanation Outside project management of project required.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

FCC Progress Reporting

Prepare and file FCC Progress Reports. See attached quote.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $6,529,560.50 $3,963,246.50 N/A $2,869,143.32 N/A
Total for all systems $10,391,297.30 $7,680,314.49 N/A $4,718,585.45 N/A
Primary Transmitter THU9-EVO $3,052,521.00 $2,525,596.00 $1,591,295.52
Other Electrical Service: New circuit breakers, cabling, wiring and conduit. Includes City of Philadelphia electrical permits and inspection. $148,840.00 $148,840.00 Installation of 6 cabinet main transmitter $2,013.31 N/A
Demolition $31,481.00 $31,481.00 Labor and equipment for old transmitter removal. See quote: 'Fox 29 Tx Demo Proposal 1.0 $31,029.21 N/A
Impedance Filter and Interconnect $242,200.00 $242,200.00 N/A $242,200.00 N/A
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW $2,630,000.00 $2,103,075.00 N/A $1,316,053.00 N/A
Auxiliary Transmitter THU9-40 EVO $3,477,039.50 $1,437,650.50 $1,277,847.80
Aux Transmitter Build Out $54,254.50 $54,254.50 Labor, materials, expenses for aux transmitter build out $54,254.50 N/A
Remove Existing Equipment $26,404.00 $26,404.00 Removal of existing equipment. $25,655.94 N/A
Remote Control Wiring $3,600.00 $3,600.00 Wire up existing remote control to new transmitter. See attached vendor quote. N/A N/A
Demolition $31,481.00 $31,481.00 Demo of analog standby transmitter $31,326.36 N/A
Other Electrical Service: Installation Electrical for new transmitter. $99,500.00 $99,500.00 Electrical from HB Frazer quote $0.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $10,400.00 $9,800.00 Catalog N/A N/A
Transformer 3 phase/480v - 500 KVA $48,400.00 $46,000.00 Catalog N/A N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $508,584.45 N/A $508,584.45 N/A
Three IOT system (75 kW) $1,415,000.00 $658,026.55 ***System Notice: Estimate adjusted and locked because line has been superseded.***See Rohde and Schwarz quotes attached to invoice #802-054178.1 $658,026.55 N/A

Components

Actual Information Description File Name
Other Electrical Service: New circuit breakers, cabling, wiring and conduit. Includes City of Philadelphia electrical permits and inspection.

Component Description:
Horitzonal tee for transmitter install
Amount:
$232.02

Component Description:
Elbows for transmitter install
Amount:
$390.20

Component Description:
Tees, elbows, plates for transmitter install
Amount:
$1,391.09
Demolition

Component Description:
Demo of Comark Main Transmitter and RF system.
Amount:
$15,289.21

Component Description:
Transmitter demo, 50% down.
Amount:
$15,740.00
Impedance Filter and Interconnect

Component Description:
Impedance filter and interconnect
Amount:
$242,200.00
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW

Component Description:
10% down for main transmitter. Includes variance.
Amount:
$131,605.30

Component Description:
50% DP on main transmitter. Includes variance sheet requesting 50% of like for like cost.
Amount:
$658,026.50

Component Description:
30% down on main transmitter. Includes variance.
Amount:
$394,815.90

Component Description:
10% down for main transmitter. Includes variance.
Amount:
$131,605.30
Aux Transmitter Build Out

Component Description:
Labor, expenses, materials for aux transmitter build out
Amount:
$54,254.50
Remove Existing Equipment

Component Description:
Transmitter demo. Progress payment upon completion.
Amount:
$7,921.20

Component Description:
Transmitter demo final payment
Amount:
$4,532.74

Component Description:
Demolition of Analog Transmitter- 50% down payment.
Amount:
$13,202.00
Remote Control Wiring Information not provided.
Demolition

Component Description:
Demo of analog standby transmitter
Amount:
$31,326.36
Other Electrical Service: Installation Electrical for new transmitter. Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 500 KVA Information not provided.
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Aux transmitter 30% down upon delivery plus variance
Amount:
$275,262.25

Component Description:
Aux transmitter 10% down proof of performance
Amount:
$116,661.10

Component Description:
Aux transmitter final 10%
Amount:
$116,661.10
Three IOT system (75 kW)

Component Description:
Broadcast Transmitter system 50% down payment
Amount:
$658,026.55

Component Description:
Aux Transmitter 10% down upon successful proof of performance
Amount:
N/A

Component Description:
Aux Transmitter 30% down upon delivery of all products
Amount:
N/A

Component Description:
Aux transmitter final 10%
Amount:
N/A

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,643,711.80 $1,840,293.80 N/A $1,648,951.02 N/A
Total for all systems $10,391,297.30 $7,680,314.49 N/A $4,718,585.45 N/A
Primary Antenna ATW18HS9-ETO-31H $543,266.00 $768,444.03 $753,944.01
Installation and Rigging $231,786.00 $231,786.00 Main antenna install and rigging $231,786.00 N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $14,500.00 Catalog N/A N/A
Sweep test of existing antenna $6,730.00 $0.00 Included in antenna quote and invoices $0.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $522,158.03 Antenna, transmission line, system sweep and freight. Also see attached ERI _Quote_20171211-538 Rev C. $522,158.01 N/A
Auxiliary Antenna ATW18HS3-ETO-31H $503,483.00 $477,226.97 $465,526.75
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 Catalog N/A N/A
Sweep test of existing antenna $6,730.00 $0.00 Included in antenna quote and invoice N/A N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $270,573.97 This cost includes antenna and the first down payment for transmission line that was paid. See attached 052919_narrative. Also see attached ERI _Quote_20171211-540 Rev E. $270,573.75 N/A
Antenna Install and Rigging $194,953.00 $194,953.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Antenna installation and rigging $194,953.00 N/A
Auxiliary Antenna ATW26H6-CSS-31H $596,962.80 $594,622.80 $429,480.26
Rigid Line Removal $44,412.00 $44,412.00 Rigid line removal of old RCA line $21,306.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 Catalog N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 Catalog N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 530 kW input, elliptically or circularly polarized $349,169.80 $349,169.80 Antenna, custom mounts, transmission line and system sweep. See quote ERI 20190416-252. $252,233.26 N/A
Installation $155,941.00 $155,941.00 Remove old antenna, install new antenna $155,941.00 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 Catalog N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Catalog N/A N/A

Components

Actual Information Description File Name
Installation and Rigging

Component Description:
30% prior to mobilization. Main antenna install and rigging.
Amount:
$69,535.80

Component Description:
50% payment with order. Main antenna install and rigging.
Amount:
$115,893.00

Component Description:
20% upon substantial completion. Main antenna install and rigging.
Amount:
$46,357.20
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
30% of System Sweep amount ($6,250 times 30%equals $1,875). Inv includes transmission line system & antenna amts which will be submitted for reimb under each of the appropriate cost categories (Antenna, antenna sweep and transmission line).
Amount:
$1,875.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
30% payment prior to shipment of primary antenna, transmission line and sweep. Includes freight.
Amount:
$163,638.85

Component Description:
Transmitting Antenna and system sweep- 30% down payment
Amount:
$153,651.07

Component Description:
30% payment 30 day ARO on primary antenna, transmission line and system sweep.
Amount:
$153,651.07

Component Description:
30% of antenna amount ($206,750 times 30% equals $62,025). Inv includes transmission line system & system sweep amts which will be submitted for reimb under each of the appropriate cost categories (Antenna, antenna sweep and transmission line).
Amount:
$62,025.00

Component Description:
10% net invoice for primary antenna, transmission line and sweep.
Amount:
$51,217.02
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna Information not provided.
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
30% payment prior to shipment plus freight on aux antenna and transmission line.
Amount:
$85,724.45

Component Description:
Trasar Antenna- Transmission Line System 30% down payment
Amount:
$79,221.13

Component Description:
10% net invoice on aux antenna and transmission line.
Amount:
$26,407.04

Component Description:
30% payment 30 day ARO on aux transmitter and transmission line.
Amount:
$79,221.13
Antenna Install and Rigging

Component Description:
50% payment with order. Aux antenna install and rigging.
Amount:
$97,476.50

Component Description:
20% upon substantial completion. Aux antenna install and rigging.
Amount:
$38,990.60

Component Description:
30% prior to mobilization. Aux antenna install and rigging.
Amount:
$58,485.90
Rigid Line Removal

Component Description:
RCA line removal. 40% prior to mobilization.
Amount:
$17,084.80

Component Description:
RCA line removal. 10% upon substantial completion.
Amount:
$4,221.20
Side mount brackets for high 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) Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 530 kW input, elliptically or circularly polarized

Component Description:
30% payment with order for antenna, custom mounts, transmission line and system sweep.
Amount:
$104,750.94

Component Description:
30% down 30 days ARO. Transmitter, transmission line system and sweep.
Amount:
$104,750.94

Component Description:
10% plus freight
Amount:
$42,731.38

Component Description:
UHF Antenna- remaining balance due
Amount:
$15,161.88

Component Description:
UHF Antenna- 50% deposit
Amount:
$14,506.00
Installation

Component Description:
Antenna install - remove old antenna, install new antenna. 30% prior to mobilization.
Amount:
$46,782.30

Component Description:
Antenna install balance payment.
Amount:
$31,188.20

Component Description:
Antenna install - remove old antenna, install new. 50% payment with order.
Amount:
$77,970.50
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $771,450.00 $497,419.19 N/A $0.00 N/A
Total for all systems $10,391,297.30 $7,680,314.49 N/A $4,718,585.45 N/A
Primary Transmission Line $468,450.00 $209,419.19 $0.00
Rigid Transmission Line - copper, 8 3/16" $468,450.00 $209,419.19 This cost was reduced. Initial down payment ($89,751.07) was paid under the antenna category. See attached 052919_narrative. Also see attached ERI _Quote_20171211-538 Rev C. $0.00 N/A
Auxiliary Transmission Line $222,200.00 $211,200.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $222,200.00 $211,200.00 Catalog N/A N/A
Auxiliary Transmission Line $80,800.00 $76,800.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $80,800.00 $76,800.00 Catalog N/A N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 8 3/16"

Component Description:
30% of transmission line system amount ($299,170.25 times 30%equals $89,751.07). Inv includes antenna & system sweep amts which will be submitted for reimb under each of the appropriate cost categories (Antenna, antenna sweep and transmission line).
Amount:
$89,751.07
Rigid Transmission Line - copper, 6 1/8" Information not provided.
Rigid Transmission Line - copper, 6 1/8" Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,084,300.00 $1,031,820.00 N/A $26,820.00 N/A
Total for all systems $10,391,297.30 $7,680,314.49 N/A $4,718,585.45 N/A
Primary Tower TOWER $605,300.00 $576,820.00 $26,820.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $26,820.00 Catalog. Mapping Main Transmitter Site Tower. $26,820.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 Catalog. Main Transmitter Site Complex Antenna Removal and Installation of new Main Transmitting Antenna and associated rigging costs. N/A N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 Catalog. Main Transmitter Site Tower Structural Steel Modifications and Reinforcement. N/A N/A
Auxiliary Tower TOWER $210,500.00 $200,000.00 $0.00
Tall Tower (greater than 500') $210,500.00 $200,000.00 Catalog. Tower Work, Rigging, and Installation for Aux Antenna Side Mount at Main Transmitter Site. N/A N/A
Auxiliary Tower LTOWER $268,500.00 $255,000.00 $0.00
Minor tower reinforcement/modifications $158,000.00 $150,000.00 Catalog. Structural Reinforcement and Modifications Required for Aux Site Tower. N/A N/A
Short Tower (less than 500') $84,200.00 $80,000.00 Catalog. Rigging and Installation costs for Aux Tower Site. N/A 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 Catalog. Mapping Aux Site Tower. N/A N/A

Components

Actual Information Description File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Structuring Engineering Tower Load Study
Amount:
$10,475.00

Component Description:
Tower Mapping
Amount:
$16,345.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Minor tower reinforcement/modifications

Component Description:
Labor, hydraulic equipment, materials to plumb and tension tower
Amount:
$61,260.00
Tall Tower (greater than 500') Information not provided.
Minor tower reinforcement/modifications Information not provided.
Short Tower (less than 500') Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $256,645.00 $243,950.00 N/A $112,411.11 N/A
Total for all systems $10,391,297.30 $7,680,314.49 N/A $4,718,585.45 N/A
Outside Professional Services $256,645.00 $243,950.00 $112,411.11
FCC Progress Reporting $21,200.00 $21,200.00 Quarterly Progress Reports to FCC Preparation and Filing. See attached vendor quote. N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 Catalog $57,500.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 Catalog N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 Catalog N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 Catalog N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 Catalog N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 Catalog N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 Catalog N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 Catalog N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 Catalog N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 Catalog N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 Catalog N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 Catalog N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 Catalog N/A N/A
Project management of the transition $102,700.00 $97,500.00 Catalog $54,911.11 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 Catalog N/A N/A

Components

Actual Information Description File Name
FCC Progress Reporting Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Full site Survey 4 Cabinent Transmitter
Amount:
$57,500.00
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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form Information not provided.
Project management of the transition

Component Description:
RF Consulting/Project Management 1/1/18 - 12/31/18
Amount:
$28,552.50

Component Description:
Project Management 1/4/18-12/31/18
Amount:
$594.03

Component Description:
Project Management 1/1/19 - 12/31/19
Amount:
$1,077.08

Component Description:
RF Consulting/Project Management 1/5/17 - 12/31/17
Amount:
$3,583.75

Component Description:
Project Management 1/5/17 - 12/31/17
Amount:
$3,583.75

Component Description:
Project Management 1/1/18 - 12/31/18
Amount:
$28,552.50

Component Description:
RF Consulting/Project Management 1/1/19 - 12/31/19
Amount:
$21,103.75

Component Description:
Project Management 1/1/19 - 12/31/19
Amount:
$21,280.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $105,630.00 $103,585.00 N/A $0.00 N/A
Total for all systems $10,391,297.30 $7,680,314.49 N/A $4,718,585.45 N/A
Other Expenses $105,630.00 $103,585.00 $0.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,500.00 $1,500.00 N/A N/A N/A
Equipment Delivery and Handling Charges $15,000.00 $15,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $20,000.00 $20,000.00 Disposal of old equipment. Two sites. $0.00 N/A
Non-zoning permits $12,000.00 $12,000.00 Local Permits for mechanicals including electrical, HVAC, fire protection, and plumbing permits. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 Catalog N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 Catalog N/A N/A
AM Pattern Disturbance -- Remedy $21,050.00 $20,000.00 Catalog N/A N/A
AM Pattern Disturbance -- Impact study $7,890.00 $7,500.00 Catalog N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 Catalog N/A N/A
Equipment Storage $10,000.00 $10,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $10,391,297.30 $7,680,314.49 $4,718,585.45

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Angelo Servedio

SVP Controller


06/11/2021

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

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

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

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

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

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

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

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

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

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

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

Angelo Servedio

SVP Controller


06/11/2021

Attachments

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