TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
SCRIPPS BROADCASTING HOLDINGS LLC Doing Business As: SCRIPPS BROADCASTING HOLDINGS LLC	David Giles 312 WALNUT STREET 28TH FLOOR CINCINNATI, OH 45202 United States	+1 (513) 898-4050	DAVE.GILES@SCRIPPS.COM	Limited Liability Company

Applicant

Address

Phone

Applicant Type

SCRIPPS BROADCASTING HOLDINGS LLC

Doing Business As: SCRIPPS BROADCASTING HOLDINGS LLC

David Giles

312 WALNUT STREET

28TH FLOOR

CINCINNATI, OH 45202

United States

+1 (513) 898-4050

DAVE.GILES@SCRIPPS.COM

Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Ray Thurber Vice President Engineering SCRIPPS BROADCASTING HOLDINGS LLC	Ray Thurber 312 Walnut St. Cincinnati, OH 45202 United States	+1 (248) 827-9202	ray.thurber@scripps.com

Applicant

Address

Phone

Ray Thurber

Vice President Engineering

SCRIPPS BROADCASTING HOLDINGS LLC

Ray Thurber

312 Walnut St.

Cincinnati, OH 45202

United States

+1 (248) 827-9202

ray.thurber@scripps.com

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	No
Briefly describe transition plan	WLWK must replace retune its main transmitter and replace its antenna to be able to move to its new channel. See attached narrative for a more detailed explanation.

Transmitters

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

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Retune Existing
	Use	Primary (Main)
	Ownership	Owned
	Owner	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	GatesAir
	Model	UAX-500AT
	Year	2015
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	0.65 kW

Primary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	1.5 kW
	Other Power	N/A
New Exciter	Is a new exciter needed?	No

Primary Transmitter

Other Transmitter Costs

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

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Wisconsin Sales Tax	Wisconsin Sales Tax on Transmitter Expenses

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Class A
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	4.3 kW
	Manufacturer
	Model	SWRLP80I
	Year	2000

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Class A
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	4.1 kW
	Manufacturer
	Model	TLP-8B(SP)
	Year	2019
	Justification for New Antenna	Existing main antenna is a coaxial slot antenna that is channel specific and cannot be reused on the new channel.

Primary Antenna

Other Antenna Costs

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

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Wisconsin Sales Tax	Wisconsin Sales Tax on Antenna Expenses.

Transmission Line

Section	Question	Response
Transmission Line Related Expenses	Do you have transmission line related expenses?	No

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Leased
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	No
	Others Types of Users	Yes
	Is tower documented for structural analysis?	Yes
	Is tower compliant with Rev G?	Yes
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1045893
Coordinates (NAD83)	Latitude (NAD83)	44° 54' 13.7" N-
	Longitude (NAD83)	087° 22' 08.2" W-
	Overall Structure Height	483.26 feet
	Support Structure Height	463.25 feet
	Ground Elevation Above Mean Sea Level (AMSL)	836.93 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	MADDAM AERIALS CORP
	Date Constructed	01/01/1992

Other Types of Users

Users
Cellular
Land Mobile

Primary Tower

Tower Modification Costs

Section	Question	Response
Engineering Study	Please what type of engineering study is required, if any:	Study needed for documented tower
Tower Reinforcements	Please select whether tower reinforcements are needed:	No reinforcements needed

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Wisconsin Sales Tax	Wisconsin Sales Tax on Tower Expenses

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	595
	Explanation	reimbursement filing, expense tracking, vendor coordination, progress reporting, budget creation, budget review, budget tracking, daisy-chain monitoring and all other activities necessary
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	No
	Quantity	N/A
	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	No
	Quantity	N/A
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	Yes
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Site Survey	GatesAir performed a site survey to access changes to facility as necessary to transition to new channel including, power and HVAC requirements, available transmitter room space and existing antenna and transmission line RF characteristics at new channel.
Wisconsin Sales Tax	Wisconsin Sales Tax on Professional Services

Other Expenses

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

Other Expenses

Other Expenses Not Listed

Name	Description
Wisconsin Sales Tax	Wisconsin Sales Tax on Other Expenses
Employee Time	Time needed by Scripps corporate and WLWK employees to work on the transition to a new channel.

Cost Information

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$113,370.00	$108,464.80	N/A	$13,619.91	N/A
Total for all systems	$488,884.34	$480,374.14	N/A	$117,919.64	N/A
Primary Transmitter UAX-500AT	$113,370.00	$108,464.80		$13,619.91
Wisconsin Sales Tax	$5,140.00	$5,140.00	N/A	$0.00	N/A
1.5 kW mask filter	$3,030.00	$3,324.80	see Estimated Cost Justification WLWK-CD-110-1st Primary Transmitter - 1.5 kW Mask Filter v0	$3,324.80	N/A
UHF and VHF - minor banding issues	$105,200.00	$100,000.00	N/A	$10,295.11	N/A

Components

Actual Information Description	File Name
Wisconsin Sales Tax	Information not provided.
1.5 kW mask filter	Component Description: Channel Change Quote Q-57373 Amount: $3,324.80
UHF and VHF - minor banding issues	Component Description: WLWK-CD-110-1st Primary Transmitter - Retune Existing, Minor Banding Issues Amount: $10,295.11

Cost Information

Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$34,600.00	$32,970.00	N/A	$22,737.00	N/A
Total for all systems	$488,884.34	$480,374.14	N/A	$117,919.64	N/A
Primary Antenna TLP-8B(SP)	$34,600.00	$32,970.00		$22,737.00
Wisconsin Sales Tax	$1,570.00	$1,570.00	N/A	N/A	N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic	$26,300.00	$25,000.00	N/A	$16,337.00	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A

Components

Actual Information Description	File Name
Wisconsin Sales Tax	Information not provided.
UHF - Lower Power Side Mount, Class A One Station antenna -- basic	Component Description: UHF- Low Power Side Mount Amount: $13,792.00 Component Description: FREIGHT, SHIPPING, AND HANDLING Amount: $2,545.00
Sweep test of existing antenna	Component Description: INCLUDES ONE FIELD ENGINEER ON-SITE FOR ONE DAY Amount: $6,400.00

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$101,400.00	$96,600.00	N/A	$3,155.85	N/A
Total for all systems	$488,884.34	$480,374.14	N/A	$117,919.64	N/A
Primary Tower GTOWER	$101,400.00	$96,600.00		$3,155.85
Short Tower (less than 500')	$84,200.00	$80,000.00	N/A	$2,605.85	N/A
Structural engineering tower load study for well documented tower	$12,600.00	$12,000.00	N/A	$550.00	N/A
Wisconsin Sales Tax	$4,600.00	$4,600.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Short Tower (less than 500')	Component Description: Mobilze crew. Amount: $2,605.85
Structural engineering tower load study for well documented tower	Component Description: Professional Services Amount: $550.00
Wisconsin Sales Tax	Information not provided.

Cost Information

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$161,724.20	$165,109.20	N/A	$73,519.88	N/A
Total for all systems	$488,884.34	$480,374.14	N/A	$117,919.64	N/A
Outside Professional Services	$161,724.20	$165,109.20		$73,519.88
Wisconsin Sales Tax	$3,116.00	$3,116.00	N/A	N/A	N/A
Site Survey	$18,568.20	$18,568.20	see Estimated Cost Justification WLWK-CD-590-Transmitter Site Survey v0	$18,568.20	N/A
RF Exposure Measurements	$21,050.00	$20,000.00	N/A	$550.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$575.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$4,128.78	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	N/A	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$240.00	N/A
Project management of the transition	$94,010.00	$99,675.00	Widelity Strategic Quote	$49,457.90	N/A

Components

Actual Information Description	File Name
Wisconsin Sales Tax	Information not provided.
Site Survey	Component Description: Field Service Amount: $18,568.20
RF Exposure Measurements	Component Description: Call with David Amount: $550.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: WLWK-CD-530-RF Eng - Construction Permit Application (Main) Amount: $75.00 Component Description: Engineering Services Amount: $500.00
Perform engineering study for new channel assignment and antenna development	Component Description: WLWK-CD-530-RF Eng - Engineering Study for New Channel Assignment Amount: $15.00 Component Description: Prep GM Exhibit and TVStudy Analysis Amount: $315.00 Component Description: Professional Engineering Services Amount: $2,048.78 Component Description: Professional Engineering Services Amount: $1,375.00 Component Description: WACY - Calls w/ Repack Team, Info Gathering on Station, Coverage Maps Amount: $330.00 Component Description: WMAR Repack Conference Call/Status Discussion Amount: $30.00 Component Description: Repack Conference Calls/Status Discussions Amount: $15.00
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare and or review reimbursement form	Component Description: Required Revisions Amount: $75.00 Component Description: WLWK-CD-590-Prepare and/or Review Reimbursement Form Amount: $165.00
Project management of the transition	Component Description: Project management Amount: $3,086.80 Component Description: FOR SERVICES RENDERED THROUGH: 10/1/18-10/31/18 Amount: $75.00 Component Description: FCC Repack Amount: $150.00 Component Description: Project Management Amount: $2,909.95 Component Description: Project Management Amount: $787.85 Component Description: Project Management Amount: $1,745.30 Component Description: Project management Amount: $2,967.80 Component Description: Project Management Amount: $619.55 Component Description: Project Management Amount: $2,852.90 Component Description: Project Management Amount: $2,945.80 Component Description: Project Management Amount: $2,986.40 Component Description: Project Management Amount: $3,180.95 Component Description: FOR SERVICES RENDERED Amount: $75.00 Component Description: Project Management Amount: $2,890.95 Component Description: Project Management Amount: $1,660.20 Component Description: Project Management Amount: $489.80 Component Description: Project Management Amount: $2,064.30 Component Description: FOR SERVICES RENDERED Amount: $75.00 Component Description: Project Management Amount: $93.55 Component Description: Project Management Amount: $1,216.10 Component Description: Project Management Amount: $1,953.30 Component Description: FCC Repack Amount: $150.00 Component Description: Project Management Amount: $293.30 Component Description: Project management Amount: $738.10 Component Description: Project Management Amount: $64.95 Component Description: Project Management Amount: $2,986.20 Component Description: Project management Amount: $927.75 Component Description: 387 Amount: $75.00 Component Description: Project Management Amount: $2,602.20 Component Description: Project Management Amount: $2,561.40 Component Description: Project Management Amount: $1,899.50 Component Description: Project Management Amount: $182.80 Component Description: Project Management Amount: $2,150.20

Cost Information

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$77,790.14	$77,230.14	N/A	$4,887.00	N/A
Total for all systems	$488,884.34	$480,374.14	N/A	$117,919.64	N/A
Other Expenses	$77,790.14	$77,230.14		$4,887.00
Employee Time	$42,604.14	$42,604.14	N/A	N/A	N/A
Wisconsin Sales Tax	$801.00	$801.00	N/A	N/A	N/A
MVPD Notification of Channel Change	$2,500.00	$2,500.00	N/A	$1,801.60	N/A
Develop and air announcement of upcoming channel change	$5,000.00	$5,000.00	N/A	$702.00	N/A
Equipment Delivery and Handling Charges	$4,500.00	$4,500.00	N/A	N/A	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$500.00	$500.00	N/A	N/A	N/A
Non-zoning permits	$5,000.00	$5,000.00	N/A	N/A	N/A
Local Zoning	$5,000.00	$5,000.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$2,383.40	N/A

Components

Actual Information Description	File Name
Employee Time	Information not provided.
Wisconsin Sales Tax	Information not provided.
MVPD Notification of Channel Change	Component Description: MVPD Notification Services Amount: $1,801.60
Develop and air announcement of upcoming channel change	Component Description: Door Cty Advocate Wlwk Repack Amount: $702.00
Equipment Delivery and Handling Charges	Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
Non-zoning permits	Information not provided.
Local Zoning	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
DTV Medical Facility Notification	Component Description: DTV Notification Service Amount: $2,383.40

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$488,884.34	$480,374.14	$117,919.64

Reimbursement Status

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

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Sravan V Reddy Senior Director, General Accounting 08/30/2021

Section

Question

Response

Submission of Estimated Expenses Statements

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

The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

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

Sravan V Reddy

Senior Director, General Accounting

08/30/2021

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Sravan V Reddy Senior Director, General Accounting 08/30/2021

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

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

Sravan V Reddy

Senior Director, General Accounting

08/30/2021

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

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

Retuning Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

Other Types of Users

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification

Attachments