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:
71326
Service:
DTV
Call Sign:
WDBD
Channel:
14 (UHF)
File Number:
0000024800
FRN:
0021937883
Date Submitted:
07/06/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WDBD LICENSE SUBSIDIARY, LLC

Doing Business As: WDBD LICENSE SUBSIDIARY, LLC

Paul Eriksen

PO Box 28273

Charlotte, NC 28273

United States

+1 (706) 494-5426 periksen@americanspiritmedia.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

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Install interim (shared) antenna on existing interim tower Remove existing shared antenna and replace with individual antennas and lines Transmitter Plan attached

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Emergency Backup
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 TBA
Year 2003
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.2 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? No
Manufacturer
Model UAXTE-2
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.1 kW
Justification for New Transmitter Existing transmitter can not be retuned

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) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DCX
Year 2003
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-50
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 30.1 kW
Justification for New Transmitter Existing transmitter can not be retuned Headroom analysis attached

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description EMT distribution to transmitters from switchgear. Quote attached: WDBD Permanent TRANSMITTERS
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

Transmitter de-install

removal of existing transmitters and electrical prior to permanent tx install.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model ULXTE-60
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 30 kW
Justification for New Transmitter existing transmitters have to be removed prior to installing new mains due to space issues. Interim tx to be installed in leased building. Please see attachment: WDBD WLOO Plan rev c.docx

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description EMT conduit for distribution from switchgear to transmitters. Quote attached: WDBD WLOO Interim TRANSMITTERS
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 1
Inside RF System Is an additional interior RF system required to support this interim transmitter? Yes

Interim Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? Yes
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 Other
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 Broadband Slot
ERP: 981.0 kW
Manufacturer
Model ATW28h3-HST1-40H
Year 2003

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
84253 WLOO

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side 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: 555.0 kW
Manufacturer
Model TFU-28JSA/VP-R 3T180
Year 2019
Justification for New Antenna existing shared broadband slot can not be retuned. (cut for ch 40/41) Station will install a new single channel antenna as it is less expensive than installing a combined shared system. E-pol premium is not reimbursable

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? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 2
Number of Panels/Bays 24
Lower Limit 470.00 MHz
Upper Limit 584.00 MHz
Design power capacity in use 90.0 %
Other Antenna Type N/A
ERP: 350.0 kW
Manufacturer
Model TFU-24WB
Year 2019
Justification for New Antenna Interim during antenna and line change

Interim Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? Yes
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Enter a list of RF channel numbers.

RF Channel Number
41
40

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? Yes
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 Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 2060 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
84253 WLOO

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 2030 feet per run
Justification for New Transmission Line existing broadband can not be retuned to work at Ch-14 and will be used as shared interim facility with WLOO Network analysis composite attached

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 6 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 750 feet per run
Justification for New Transmission Line Justification and costs contained in attachment: WDWD WLOO Interim Line.docx

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Auxiliary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use interim
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? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 32° 12' 49.9" N-
Longitude (NAD83) 090° 22' 56.5" W-
Overall Structure Height 745.00 feet
Support Structure Height 700.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 410.00 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner WLBT
Date Constructed 02/02/2006


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

Name Description

Removal of dormant equip

To allow installation of interim antenna and line

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? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 32° 12' 49.9" N-
Longitude (NAD83) 090° 22' 56.5" W-
Overall Structure Height 1998.01 feet
Support Structure Height 1879.90 feet
Ground Elevation Above Mean Sea Level (AMSL) 410.10 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WLBT, LLC
Date Constructed 08/02/1999

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

Facility ID Call Sign Service
84253 WLOO DTV
59822 WMSI-FM FM
68542 WLBT DTV
37177 WSTZ-FM FM

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 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 N/A
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 300
Explanation Pattern analysis Antenna Spec Transmitter Spec Building drawings Installation Supervision Accounting Internal Legal
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement No
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

Attorney - Other Matters

Legal Services

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Equipment Shelter Repairs

Repair wall at the equipment shelter

Security service

Armed security provided by vendor to the equipment shelter site

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 $2,990,790.50 $2,657,871.54 N/A $2,295,265.06 N/A
Total for all systems $5,255,158.34 $4,710,318.17 N/A $4,057,021.65 N/A
Interim Transmitter ULXTE-60 $1,267,980.50 $1,214,995.18 $975,313.81
UHF inside RF system including switching $147,500.00 $93,930.00 Dielectric quote 981002 Line 1 attached $0.00 N/A
Channel 14 -- Additional field engineering time, 1 days $6,400.00 $6,400.00 N/A N/A N/A
Other Electrical Service: EMT conduit for distribution from switchgear to transmitters. Quote attached: WDBD WLOO Interim TRANSMITTERS $92,080.50 $92,080.50 Please see attached quote from WDBD H&H Electrical - Interim Transmitter $0.00 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $987,584.68 Quote attached (per change order Q-76402) $975,313.81 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $0.00 included in electrical quote N/A N/A
Primary Transmitter ULXTE-50 $1,407,310.00 $1,373,715.81 $1,257,111.28
Transmitter de-install $33,420.00 $33,420.00 Quote attached Raycom - Clinton Quote WDBD $0.00 N/A
Channel 14 Mask Filter $189,500.00 $0.00 included in main tx quote N/A N/A
RF Consulting Engineer $5,260.00 $5,000.00 N/A $5,000.00 N/A
Other Electrical Service: EMT distribution to transmitters from switchgear. Quote attached: WDBD Permanent TRANSMITTERS $157,130.00 $157,130.00 Please see attached quote from WDBD H&H Electrical - Primary Transmitter $139,776.75 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A $5,468.72 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $1,106,865.81 Quote attached; Headroom analysis attached; Justifying Quote - WDBD GatesAir revised Q-71345 (taxes and freight) & CDW Direct $1,106,865.81 .
Auxiliary Transmitter UAXTE-2 $315,500.00 $69,160.55 $62,839.97
Channel 14 Mask Filter $189,500.00 $0.00 included in backup transmitter quote N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $69,160.55 Quote attached $62,839.97 N/A

Components

Actual Information Description File Name
UHF inside RF system including switching Information not provided.
Channel 14 -- Additional field engineering time, 1 days Information not provided.
Other Electrical Service: EMT conduit for distribution from switchgear to transmitters. Quote attached: WDBD WLOO Interim TRANSMITTERS Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Interim Transmitter
Amount:
$312,445.80

Component Description:
ULXTE-60
Amount:
$361,452.99

Component Description:
Interim Transmitter
Amount:
$301,415.02
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
Transmitter de-install Information not provided.
Channel 14 Mask Filter Information not provided.
RF Consulting Engineer

Component Description:
RF consulting
Amount:
$5,000.00
Other Electrical Service: EMT distribution to transmitters from switchgear. Quote attached: WDBD Permanent TRANSMITTERS

Component Description:
Construction Draw
Amount:
$22,000.00

Component Description:
Construction Draw for electrical panels for the new transmitter building
Amount:
$20,700.00

Component Description:
Final Draw on temporary transmitter site
Amount:
$21,780.50

Component Description:
Construction Draw
Amount:
$28,980.00

Component Description:
Draw for electrical installation on new transmitters
Amount:
$20,700.00

Component Description:
Final Construction Draw on permanent transmitter site
Amount:
$25,616.25
Transformer 3 phase/480v - 300 KVA

Component Description:
WDBD-110-1st Primary Transmitter - 3 Phase, 480 V, 300 KVA Transformer
Amount:
$2,968.72

Component Description:
TRANSFORMER 6-50 / 6-75 UHF 3 ST
Amount:
$2,500.00
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter, Mask Filter Saystem, RF Accessories, Electrical
Amount:
$243,428.87

Component Description:
A. Transmitter
Amount:
$78,740.37

Component Description:
Primary Transmitter
Amount:
$522,717.42

Component Description:
STARTECH 50 PKG 10-32 Screws & Nuts
Amount:
$620.44

Component Description:
Primary Transmitter
Amount:
$156,815.23

Component Description:
ULXTE-50
Amount:
$104,543.48
Channel 14 Mask Filter Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
UAXTE-2-E
Amount:
$6,916.06

Component Description:
Transmitter, Mask Filter Saystem, Electrical, Installation & Proof
Amount:
$10,374.08

Component Description:
Transmitter, Mask Filter Saystem, Electrical, Installation & Proof
Amount:
$34,580.28

Component Description:
UAXTE-2 Transmitter
Amount:
$10,349.11

Component Description:
WDBD-150-1st Auxiliary Transmitter - UHF Air Cooled Solid State, 1-2.5 kW
Amount:
$620.44

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 $612,571.36 $690,073.13 N/A $660,383.13 N/A
Total for all systems $5,255,158.34 $4,710,318.17 N/A $4,057,021.65 N/A
Interim Antenna TFU-24WB $397,163.00 $476,407.87 $451,717.87
New combiner, cost per channel (without antenna) $84,200.00 $264,464.87 per Estimated Cost Justification WDBD-280-Interim Antenna - New Combiner v0 $264,464.87 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,760.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 350 kW input, directional,, horizontally polarized $180,233.00 $180,233.00 Estimated Cost Justification WDBD-280-Interim Antenna - UHF High Power Side Mount, Directional, H-POL v0 $176,173.00 N/A
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $25,310.00 Dielectric Quote 981002 line 3 and Justifying Change Order WDBD Dielectric 1052003 CO 07172018 $5,320.00 N/A
Primary Antenna TFU-28JSA/VP-R 3T180 $215,408.36 $213,665.26 $208,665.26
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 $0.00 N/A
Sweep test of existing antenna $6,730.00 $6,646.90 see Estimated Cost Justification WDBD-210-Sweep test New Primary Antenna V0 $6,646.90 N/A
UHF - High Power, Side Mount, basic slot antenna, 555 kW input, directional,, elliptically or circularly polarized $180,268.36 $180,268.36 See Estimated Cost Justification WDBD-210-Primary Antenna - UHF High Power Side Mount, Directional, E-POL V0 $180,268.36 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $21,750.00 Quote attached $21,750.00 N/A

Components

Actual Information Description File Name
New combiner, cost per channel (without antenna)

Component Description:
INTERCONNECTS FOR COMBINER BYPASS. 6-60 T/L AND ELBOWS
Amount:
$13,455.00

Component Description:
RF SYSTEM 60KW TUNABLE
Amount:
$18,120.36

Component Description:
INTERCONNECTS FOR COMBINER
Amount:
$1,495.00

Component Description:
Combiner
Amount:
$115,697.25

Component Description:
Interim Antenna Combiner
Amount:
$57,848.63

Component Description:
Interim Combiner
Amount:
$57,848.63
Sweep test of existing antenna

Component Description:
WDBD-280-Interim Antenna - Sweep Test
Amount:
$5,760.00
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 350 kW input, directional,, horizontally polarized

Component Description:
Antennas, Elbow, EIA Length, Reducer, Test Transition, Repack Sweep
Amount:
$17,519.30

Component Description:
OTHER - INCLUDES ONE FIELD ENGINEER ON-SITE FOR ONE DAY, TRAVEL, EXPENSES AND REPORT / FREIGHT, SHIPPING, AND HANDLING
Amount:
$6,400.00

Component Description:
Interim Antenna
Amount:
$87,596.50

Component Description:
Antennas, Elbow, EIA Length, Reducer, Test Transition, Repack Sweep
Amount:
$15,818.95

Component Description:
Antennas, elbow, EIA length, reducer, test transition, on-site engineer
Amount:
$43,798.25

Component Description:
Elbow
Amount:
$5,040.00
Combiner output splitting/switching for dual feed lines, if applicable

Component Description:
OTHER FR SCOUT PLUS MONITOR W/2 STD PWR
Amount:
$5,320.00
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

Component Description:
Sweep Test
Amount:
$3,200.00

Component Description:
INCLUDES ONE FIELD ENGINEER ON-SITE FOR ONE DAY, TRAVEL, EXPENSES AND REPORT
Amount:
$960.00

Component Description:
Sweep Test
Amount:
$1,600.00

Component Description:
Sweep Test
Amount:
$640.00

Component Description:
WDBD Jackson, MS engineering services
Amount:
$246.90
UHF - High Power, Side Mount, basic slot antenna, 555 kW input, directional,, elliptically or circularly polarized

Component Description:
Antenna
Amount:
$18,487.50

Component Description:
UHF - LOWER POWER SIDE MOUNT
Amount:
$5,334.38

Component Description:
FREIGHT, SHIPPING, AND HANDLING
Amount:
$11,158.36

Component Description:
Side Mount, Side Mount Brackets, Elbow Complex, Rigid Transmission Line, Repack Sweep, Repack Vpol
Amount:
$16,911.00

Component Description:
Primary Antenna
Amount:
$42,277.50

Component Description:
ELBOW COMPLEX, SINGLE CHANNEL
Amount:
$1,544.62

Component Description:
Lower power side mount, side mount brackets,
Amount:
$84,555.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
SIDE MOUNT BRACKETS FOR HIGH POWER ANTENNAS (IF NOT INCLUDED IN ANTENNA BASE COST)
Amount:
$3,262.50

Component Description:
Side Mount Bracket
Amount:
$2,175.00

Component Description:
Primary Antenna - Side Mount Brackets
Amount:
$5,437.50

Component Description:
Side Mount Bracket
Amount:
$10,875.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $584,060.00 $432,131.75 N/A $424,734.89 N/A
Total for all systems $5,255,158.34 $4,710,318.17 N/A $4,057,021.65 N/A
Interim Transmission Line $174,000.00 $121,011.15 $115,251.15
Rigid Transmission Line - copper, 6 1/8" broadband $174,000.00 $121,011.15 Estimated Cost Justification WDBD-380-Interim Transmission Line - Broadband, Rigid Copper, 6 1:8" v0 $115,251.15 N/A
Primary Transmission Line $410,060.00 $311,120.60 $309,483.74
Rigid Transmission Line - copper, 6 1/8" $410,060.00 $311,120.60 see Estimated Cost Justification WDBD-310-Primary Transmission Line - Rigid Copper, 6 1_8_ v2 $309,483.74 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8" broadband

Component Description:
transmission line, engineer on-site
Amount:
$53,240.31

Component Description:
RIGID TRANSMISSION LINE - COPPER
Amount:
$6,151.18

Component Description:
FREIGHT, SHIPPING, AND HANDLING
Amount:
$878.84

Component Description:
Invoice moved to correct category
Amount:
N/A

Component Description:
Transmission line, field engineer
Amount:
$53,240.31

Component Description:
FREIGHT, SHIPPING, AND HANDLING
Amount:
$1,740.51
Rigid Transmission Line - copper, 6 1/8"

Component Description:
WDBD-310-Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$5,528.50

Component Description:
WDBD-310-Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$17,297.67

Component Description:
Measure TX line
Amount:
$3,527.17

Component Description:
Primary Transmission Line
Amount:
$121,713.20

Component Description:
Primary Transmission Line
Amount:
$24,342.64

Component Description:
WDBD-310-Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$15,520.00

Component Description:
Rigid Transmission Line Cooper
Amount:
$30,985.46

Component Description:
Primary Transmission Line
Amount:
$60,856.60

Component Description:
OTHER FLANGE ASSY 6 1/8 UHF SOLDER
Amount:
$1,174.19

Component Description:
WDBD-310-Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$28,538.31

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 $823,870.00 $604,327.40 N/A $496,251.90 N/A
Total for all systems $5,255,158.34 $4,710,318.17 N/A $4,057,021.65 N/A
Primary Tower TOWER $381,100.00 $382,438.40 $288,697.40
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $200,000.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $32,438.40 per invoices received: FDH Infrastructure Services, LLC. invoices E-162622 & E-162623. $32,438.40 Per invoices received
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $56,259.00 N/A
Auxiliary Tower GTOWER $442,770.00 $221,889.00 $207,554.50
Tall Tower (greater than 500') $210,500.00 $150,000.00 Per Tower King II, Inc Proposal additional cost estimate for installing interim 6" line (700'). Antenna install cost contained in main tower estimate $150,000.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $5,750.00 Structural analysis Quote attached $4,500.00 N/A
Minor tower reinforcement/modifications $158,000.00 $18,169.00 Stainless quote (parts): $10,169 quote attached. Labor to install estimate: $8,000 $5,084.50 N/A
Removal of dormant equip $47,970.00 $47,970.00 Quote from Centerline; Centerline Invoice #2414 $47,970.00 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
Completion of Structural Modification for Repack Antenna Installation
Amount:
$100,000.00

Component Description:
Down payment and mobilization for the Repack Antenna Installation
Amount:
$50,000.00

Component Description:
Progress Payment for the Repack Antenna Installation
Amount:
$50,000.00
Structural engineering tower load study for well documented tower

Component Description:
STNLSA STNL Structural Analysis
Amount:
$5,084.50

Component Description:
STNLSA STNL Structural Analysis
Amount:
$2,875.00

Component Description:
Inspection and mapping services
Amount:
$6,651.90

Component Description:
STNLSA STNL Structural Analysis
Amount:
$2,875.00

Component Description:
engineering - structural analysis
Amount:
$2,750.00

Component Description:
STNLSA STNL Structural Analysis
Amount:
$9,452.00

Component Description:
Engineering - structural analysis
Amount:
$2,750.00
Minor tower reinforcement/modifications

Component Description:
Modification Material Transmission line support material
Amount:
$9,452.00

Component Description:
STNLSA STNL Material Only
Amount:
$3,024.50

Component Description:
Temporary Frame
Amount:
$3,024.50

Component Description:
Engineering - material only
Amount:
$18,754.00

Component Description:
Engineering - material only
Amount:
$18,754.00

Component Description:
Modification materials to upgrade the existing tower
Amount:
$3,250.00
Tall Tower (greater than 500')

Component Description:
WDBD-450-Existing Auxiliary Tower - Tower Rigging, Tall Tower ( 500')
Amount:
$50,000.00

Component Description:
WDBD-450-Existing Auxiliary Tower - Tower Rigging, Tall Tower (500')
Amount:
$50,000.00

Component Description:
WDBD-450-Existing Auxiliary Tower - Tower Rigging, Tall Tower (500')
Amount:
$50,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
WDBD-450-Existing Auxiliary Tower - Tower Mapping Undocumented/Poorly Documented Tower
Amount:
$4,500.00
Minor tower reinforcement/modifications

Component Description:
Materials - C-clamps, center gussets, sub-horizontals with spacers
Amount:
$5,084.50
Removal of dormant equip

Component Description:
De-installation of equipment making room for new repack transmitter
Amount:
$14,550.00

Component Description:
Service Call - hardline & microwave
Amount:
$33,420.00

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 $160,945.57 $251,943.44 N/A $137,971.72 N/A
Total for all systems $5,255,158.34 $4,710,318.17 N/A $4,057,021.65 N/A
Outside Professional Services $160,945.57 $251,943.44 $137,971.72
Attorney - Other Matters $1,265.57 $1,265.57 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $1,265.57 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $1,563.80 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $144.78 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,285.46 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $8,250.00 du Treil, Lundin & Rackley, Inc. invoice 240646 $2,299.88 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $127.87 Please see WDBD Transition Timing and Coordination Budget Revision Justification Letter.pdf $127.87 N/A
Project management of the transition $47,400.00 $144,675.00 Widelity Strategic Support Quote $127,342.17 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $567.19 N/A
Prepare request for Special Temporary Authorization $2,050.00 $2,375.00 Per invoices received $2,375.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Attorney - Other Matters

Component Description:
For Professional Services Rendered
Amount:
$108.26

Component Description:
Professional Services
Amount:
$106.56

Component Description:
Professional Services Rendered
Amount:
$167.07

Component Description:
For Professional Services Rendered
Amount:
$144.57

Component Description:
Professional Services Rendered
Amount:
$34.63

Component Description:
For Professional Services Rendered
Amount:
$245.57

Component Description:
Professional Services
Amount:
$27.84

Component Description:
ASM Attorneys Fees - Draft 10 Week Form 387 Report for WDBD
Amount:
$303.20

Component Description:
Professional services rendered through Feb. 28, 2018
Amount:
$127.87
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
For professional services
Amount:
$860.07

Component Description:
WDBD-550-Attorney - Special Temporary Authorization
Amount:
$703.73
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
WDBD-550-Attorney - License to Cover Application (Main)
Amount:
$61.25

Component Description:
WDBD-550-Attorney - License to Cover Application (Main)
Amount:
$83.53
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of engineering section of FCC Form 2100
Amount:
$2,000.00

Component Description:
Professional legal services
Amount:
$285.46
Perform engineering study for new channel assignment and antenna development

Component Description:
Transmitter building field measurements for new install floorplan.
Amount:
$187.48

Component Description:
WDBD Transmitter installation field measurements and electrical drawing field notes.
Amount:
$737.40

Component Description:
RF Consulting Engineering to determine correct mask filter to avoid interference
Amount:
$5,000.00

Component Description:
Engineering study work for new channel assignment and antenna development
Amount:
$125.00

Component Description:
Engineering study work for new channel assignment and antenna development
Amount:
$1,250.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Professional Services Rendered
Amount:
$127.87
Project management of the transition

Component Description:
Project Management
Amount:
$2,117.85

Component Description:
Project Management
Amount:
$1,989.20

Component Description:
Project Management
Amount:
$751.75

Component Description:
Project Management
Amount:
$1,224.50

Component Description:
Project management
Amount:
$5,110.40

Component Description:
Project Management
Amount:
$2,375.45

Component Description:
Project Management
Amount:
$914.07

Component Description:
Project management
Amount:
$5,015.05

Component Description:
Project Management
Amount:
$2,903.45

Component Description:
Project management
Amount:
$1,896.60

Component Description:
Project Management
Amount:
$2,157.55

Component Description:
Project Management
Amount:
$3,937.45

Component Description:
Project Management
Amount:
$3,528.60

Component Description:
Project Management
Amount:
$130.90

Component Description:
Project Management
Amount:
$5,358.30

Component Description:
Project Management
Amount:
$3,568.15

Component Description:
Project Management
Amount:
$609.50

Component Description:
Project Management
Amount:
$4,199.45

Component Description:
Project Management
Amount:
$5,947.80

Component Description:
Project Management
Amount:
$5,404.25

Component Description:
Project Management
Amount:
$3,514.15

Component Description:
Project Management
Amount:
$1,782.20

Component Description:
Project Management
Amount:
$688.20

Component Description:
Project Management
Amount:
$5,143.15

Component Description:
Project Management
Amount:
$3,542.85

Component Description:
Project Management
Amount:
$3,292.45

Component Description:
Project Management
Amount:
$5,494.15

Component Description:
Project Management
Amount:
$2,636.35

Component Description:
Project Management
Amount:
$585.20

Component Description:
Project management
Amount:
$5,190.30

Component Description:
Project Management
Amount:
$315.60

Component Description:
Project Management
Amount:
$4,654.10

Component Description:
Project Management
Amount:
$2,543.35

Component Description:
Project Management
Amount:
$3,419.95

Component Description:
Project Management
Amount:
$6,912.35

Component Description:
Project Management
Amount:
$38.50

Component Description:
Project Management
Amount:
$1,477.30

Component Description:
Project Management
Amount:
$3,000.90

Component Description:
Project Management
Amount:
$1,781.95

Component Description:
Project Management
Amount:
$200.20

Component Description:
Project Management
Amount:
$3,387.80

Component Description:
Project Management
Amount:
$8,600.90
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Professional Services Rendered
Amount:
$567.19
Prepare request for Special Temporary Authorization

Component Description:
WDBD STA/Interim Application
Amount:
$1,375.00

Component Description:
STA modification/interim application
Amount:
$1,000.00
Prepare engineering section of 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 $82,920.91 $73,970.91 N/A $42,414.95 N/A
Total for all systems $5,255,158.34 $4,710,318.17 N/A $4,057,021.65 N/A
Other Expenses $82,920.91 $73,970.91 $42,414.95
Security service $12,852.00 $12,852.00 Increase from Bullock Investigations and Security invoice #5WLBT Armed security provided by vendor to the equipment shelter site $12,852.00 per invoices recieved
Equipment Shelter Repairs $6,500.00 $6,500.00 Kain Masonery Contractors - Equipment shelter wall repairs $6,500.00 N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 estimate $0.00 N/A
Develop and air announcement of upcoming channel change $2,850.00 $2,850.00 estimate for on air rescan announcement production Quote attached N/A N/A
Equipment Storage $30,500.00 $30,500.00 Estimate for Dielectric on site antenna storage Dielectric letter attached $3,799.04 N/A
Equipment Delivery and Handling Charges $16,473.91 $16,473.91 Please see Estimated Cost Justification WDBD-610-Equipment Delivery and Handling v2 $16,473.91 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $195.00 fixed FCC filing fee $190.00 N/A
DTV Medical Facility Notification $11,550.00 $2,600.00 Group quote attached $2,600.00 N/A

Components

Actual Information Description File Name
Security service

Component Description:
1 Armed Guard
Amount:
$4,860.00

Component Description:
Security
Amount:
$1,512.00

Component Description:
Security
Amount:
$6,480.00
Equipment Shelter Repairs

Component Description:
Equipment Shelter Repairs
Amount:
$6,500.00
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
WDBD-610-Equipment Storage
Amount:
$2,700.00

Component Description:
40' Standard Tri Cam Container
Amount:
$708.79

Component Description:
Rental 174424 PO#2238 THIGP Unit 300071
Amount:
$48.00

Component Description:
40' Standard Tri Cam Container
Amount:
$165.23

Component Description:
Equipment Storage
Amount:
$165.23

Component Description:
40' Standard tri cam container, Personal property expenses, Loss limitation waiver
Amount:
$11.79
Equipment Delivery and Handling Charges

Component Description:
5000# Reach lift
Amount:
$207.60

Component Description:
WDBD-610-Equipment Delivery and Handling
Amount:
$5,520.00

Component Description:
5000# Reach Lift
Amount:
$2,713.37

Component Description:
10000# Reach Lift
Amount:
$2,010.00

Component Description:
Diesel fuel and Pick up Charge
Amount:
$192.60

Component Description:
5000# Reach Lift
Amount:
$2,045.44

Component Description:
OTHER
Amount:
$1,636.86

Component Description:
5000# Reach Lift
Amount:
$2,148.04
FCC Filing Fees - Special Temporary Authorization request

Component Description:
WDBD-610-FCC Filing Fee - Special Temporary Authorization
Amount:
$190.00
DTV Medical Facility Notification

Component Description:
Medical Notification mailing complete per FCC Repack
Amount:
$2,600.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $5,255,158.34 $4,710,318.17 $4,057,021.65

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.

Paul M Eriksen

Controller


07/06/2021

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.

Paul M Eriksen

Controller


07/06/2021

Attachments

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