TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
WILDERNESS COMMUNICATIONS, LLC Doing Business As: WILDERNESS COMMUNICATIONS, LLC	3501 NORTHWEST EVANGELINE THRUWAY CARENCRO, LA 70520 United States	+1 (337) 896-1600	eddie@delta-network.com	Limited Liability Company

Applicant

Address

Phone

Applicant Type

WILDERNESS COMMUNICATIONS, LLC

Doing Business As: WILDERNESS COMMUNICATIONS, LLC

3501 NORTHWEST EVANGELINE THRUWAY

CARENCRO, LA 70520

United States

+1 (337) 896-1600

eddie@delta-network.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
Arthur Lee Clardy , III . Director of Engineering Delta Media Corporation	Lee Clardy PO Box 159 Carencro, LA 70520 United States	+1 (337) 896-1600	lclardy@deltamediacorp.com

Applicant

Address

Phone

Arthur Lee Clardy , III .

Director of Engineering

Delta Media Corporation

Lee Clardy

PO Box 159

Carencro, LA 70520

United States

+1 (337) 896-1600

lclardy@deltamediacorp.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	Existing CH 41 RF system is not capable of re-tuning to new channel. Existing transmitter no longer supported by manufacturer. Need to purchase new antenna, RF filters and transmitter.

Transmitters

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

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	CST II
	Year	2002
	Type	Inductive Output Tube
	IOT Power Type	Two
	Power Capacity	60 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	Parallax U13
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	21 kW
	Justification for New Transmitter	Advanced Broadcast Systems is no longer providing support for their transmitter products. Please see attached response to transmitter power question.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	150 kVA
	Rigid Conduit and Wiring	Yes
	Size	1.5 inches
	Length	100.0 feet
	Other Electrical Service	Yes
	Description	Rigid Conduit and Wiring 2.0 inches 40 feet
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Cooling Only
	Size	10 tons
	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
Power Conditoner Regulator	Hitachi Comark requires a power conditioner with the installation of the transmitter
Louisiana State and Local Sales Taxes	Louisiana State and Local Sales
Skid Steer Rental	Skid Steer Rental to offload Staco Energy Power Conditioner Regulator at time of delivery to transmitter site

Interim Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Interim
	Description of Use	N/A
	Change Type	Purchase
	Manufacturer
	Model	EC703HP-BB
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	2.5 kW
	Justification for New Transmitter	KBCA needs interim transmission system in order to maintain over the air broadcasts while the main transmitter and antenna are being changed out.

Interim 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	Yes
	Size	0.75 inches
	Length	80.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A
Inside RF System	Is an additional interior RF system required to support this interim transmitter?	Yes

Interim Transmitter

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	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:	1000.0 kW
	Manufacturer
	Model	ATW30H3-HTC4-41H
	Year	2004

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	1000.0 kW
	Manufacturer
	Model	TFU-22ETT/VP-R 2C255 (SP)
	Year	2018
	Justification for New Antenna	The existing channel 41 antenna is not capable of being re-tuned or re-manufactured for use on channel 26.

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	No
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	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?	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
Louisiana State and Local Sales Taxes	Louisiana State and Local Sales Tax rate at 10%
Shipping And Offloading	Shipping and handling costs for antenna
50 to 75 OHM Transformer	50 to 75 OHM Transformer for connection from existing line to antenna

Interim Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Slot
	Number of Stations Supported	1
	Number of Panels/Bays	8
	Lower Limit	470.00 MHz
	Upper Limit	698.00 MHz
	Design power capacity in use	12.5 %
	Other Antenna Type	N/A
	ERP:	14.2 kW
	Manufacturer
	Model	TFU-8WB
	Year	2019
	Justification for New Antenna	Need to use an interim antenna to maintain over the air programming while the main antenna is being replaced.

Interim Antenna

Other Antenna Costs

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

Interim Antenna

Other Antenna Cost Not Listed

Name	Description
Louisiana State Sales Tax	Louisiana State sales tax on freight and shipping
Freight and shipping	Freight and shipping charges for interim antenna from Raymond, Maine.

Transmission Line

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

Primary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Utilize Existing
	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	Electronics Research
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 3/4 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1020 feet per run

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Dehydrator System	Dehydrator system to pressurize interim transmission line.
RF Scout Plus	RF power metering system and directional coupler line section for RF channel 26
Sweep Test Existing Transmission Line	Sweep test Existing transmission line to determine suitability for RF channel 26
Indoor Transmission Line Sections	Custom cut indoor transmission line sections, gas barrier, elbows and line hangers to connect transmitter to antenna transmission line.

Interim Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Type	Flexible Air
	Diameter	1 5/8 inches
	Segment Length	N/A
	Other Segment Length
	Number of parallel runs	1
	Length	900 feet per run
	Justification for New Transmission Line	Need transmission line to use with interim antenna.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?	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?	Unknown
	Is tower compliant with Rev G?	Unknown
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1231316
Coordinates (NAD83)	Latitude (NAD83)	30° 54' 17.4" N-
	Longitude (NAD83)	092° 37' 28.9" W-
	Overall Structure Height	999.99 feet
	Support Structure Height	996.71 feet
	Ground Elevation Above Mean Sea Level (AMSL)	142.06 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Delta Media Corp.
	Date Constructed	04/28/2005

Other Types of Users

Users
Cellular

Primary Tower

Tower Modification Costs

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

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Crane and Crane Operator	Will require the rental of a crane to lift the new antenna off the truck transportation at the site. Then place the antenna in position for rigging and hoisting.
Staging Area Preparation	Staging area has to be prepared for tower rigging to hoist old antenna down and new antenna up.
Excavator Rental	Excavator rental needed to assist with the removal of the old antenna and installation of the new antenna
Road Preparation	Half-mile ingress and egress must be made capable of handling heavy truck transportation into and out of the tower site.
Skid-Steer Rental	Skid-steer rental needed for assisting with moving, loading and un-loading heavy equipment

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	200
	Explanation	Wilderness Communications engineering staff also works for 16 stations licensed to different licensees and significant project management assistance will be 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	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	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	1
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	Yes
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	Yes
	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
Attorney Fees related to repack	Additional attorney fees related to repack issues
General Contractor	A Louisiana licensed and insured commercial general contractor will be retained to provide project management as well as general construction services for this project.
Outside Accounting Services	An independent accounting firm to provide oversight and assistance with compliance and reporting as required for this project.

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	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

Other Expenses Not Listed

Name	Description
Additional Hired Workers	Additional workers hired to assist with removal of old transmitter system
RF Consulting Engineer	RF consulting engineer to provide services related to KBCA repack
AOL Beacon Cable	New antenna does not come with a cable for the AOL beacon - it is purchased and installed separately

Cost Information

Transmitters

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,457,684.78	$1,177,143.11	N/A	$931,225.22	N/A
Total for all systems	$2,803,071.76	$2,428,609.09	N/A	$1,647,703.23	N/A
Interim Transmitter EC703HP-BB	$275,000.00	$271,508.33		$126,508.33
UHF inside RF system including switching	$147,500.00	$143,500.00	N/A	$0.00	N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	$126,000.00	$126,508.33	Cost of interim transmitter including shipping handling and Louisiana state and local sales taxes	$126,508.33	N/A
0.75" Rigid Conduit and Wiring	$1,500.00	$1,500.00	N/A	N/A	N/A
Primary Transmitter Parallax U13	$1,182,684.78	$905,634.78		$804,716.89
Other Electrical Service: Rigid Conduit and Wiring 2.0 inches 40 feet	$3,963.60	$3,963.60	N/A	$3,963.60	Not
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	$13,324.18	N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$675,000.00	N/A	$675,000.00	N/A
Skid Steer Rental	$399.49	$399.49	N/A	$399.49	N/A
Louisiana State and Local Sales Taxes	$77,510.00	$77,510.00	N/A	$62,356.49	N/A
Power Conditoner Regulator	$48,661.69	$48,661.69	Revised quotation from Stacy Energy Products to include maintenance bypass breaker	$48,661.69	N/A
10 Ton system	$38,900.00	$37,000.00	N/A	N/A	N/A
1.5" Rigid Conduit and Wiring	$2,500.00	$2,500.00	N/A	$1,011.44	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$24,300.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
UHF inside RF system including switching	Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	Component Description: Comark invoice S10422-1 for the purchase of interim transmitter for KBCA Amount: $126,508.33
0.75" Rigid Conduit and Wiring	Information not provided.
Other Electrical Service: Rigid Conduit and Wiring 2.0 inches 40 feet	Component Description: Delta Media Corporation - Invoice 290 for purchase of 1/0 AWG electrical compression lugs from Grainger for the installation of the electrical service to the STACO Energy Automatic Voltage Regulator Amount: $485.91 Component Description: Elliott Electric Supply Invoice #59-84311-02 to Delta Media Corporation for remaining 300A 600V fuse for electrical disconnect for the STACO Energy Automatic Voltage Regulator Amount: $371.72 Component Description: Elliott Electric Supply Invoice #59-84799-01 to Delta Media Corporation for set of 3 f300A 600v fuses for the electrical disconnect for the STACO Energy Automatic Voltage Regulator Amount: $743.45 Component Description: Elliott Electric Supply Invoice #59-84311-01 to Delta Media Corporation for 2" Electrical Conduit and Wiring for the STACO Energy Automatic Voltage Regulator Amount: $2,362.52
Switchgear - industrial 800 amp	Component Description: Delta Centre invoice #505 for electrical switchgear components that were needed to convert the main 480 VAC distribution panel to feed power connections to the Comark transmitter Amount: $3,940.53 Component Description: Delta Invoice #508 - Credit for return of electrical components that were ordered by mistake for the KBCA main tranmitter. Amount: ($1,238.54) Component Description: Delta Invoice #507 - For purchase of 70 Amp 480VAC fuses needed for power distribution to Comark main transmitter cabinets Amount: $583.66 Component Description: 480 VAC Electrical Panelboard needed for Comark transmitter installation Amount: $60.61 Component Description: 480 VAC Electrical branch panelboard, breakers and fuses needed for Comark transmitter installation Amount: $9,977.92
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: 60% of total contract price for transmitter equipment due to manufacturer Amount: $405,000.00 Component Description: Invoice for 30% payment due to transmitter manufacturer, includes installation, check out and proof Amount: $202,500.00 Component Description: Invoice for 10% payment due to transmitter manufacturer, includes installation, check out and proof Amount: $67,500.00
Skid Steer Rental	Component Description: Skid Steer Rental to offload Staco Energy Power Conditioner Regulator at time of delivery to transmitter site Amount: $399.49
Louisiana State and Local Sales Taxes	Component Description: 10% Louisiana State and Local sales taxes due on this invoice Amount: $39,591.42 Component Description: State and local sales taxes due on this invoice Amount: $2,969.36 Component Description: 10% State and local sales taxes due on this invoice Amount: $19,795.71
Power Conditoner Regulator	Component Description: Staco Energy invoice 127503-00 for purchase of powerline regulator and maintenance bypass switch Amount: $48,661.69
10 Ton system	Information not provided.
1.5" Rigid Conduit and Wiring	Component Description: Delta Centre invoice #503 for electrical wire for Comark transmitter power connections Amount: $650.27 Component Description: Delta Centre invoice #499 for 1-1/2" Electrical Conduit for Comark transmitter power connections Amount: $92.72 Component Description: Delta Centre invoice #501 for 1-1/2" Electrical Conduit components for Comark transmitter power connections Amount: $241.05 Component Description: Delta Centre invoice #475 for conduit adapters for transmitter pump units Amount: $27.40
Transformer 3 phase/480v - 150 KVA	Information not provided.

Cost Information

Antennas

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$455,965.00	$348,839.00	N/A	$250,317.00	N/A
Total for all systems	$2,803,071.76	$2,428,609.09	N/A	$1,647,703.23	N/A
Interim Antenna TFU-8WB	$93,833.00	$92,353.00		$48,878.00
Freight and shipping	$3,645.00	$3,645.00	N/A	$3,645.00	N/A
Louisiana State Sales Tax	$308.00	$308.00	N/A	$308.00	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$22,000.00	N/A	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	N/A	N/A
UHF - High Power, Side Mount, basic slot antenna, 8 bay,, 14 kW input, directional,, horizontally polarized	$60,000.00	$60,000.00	N/A	$44,925.00	N/A
Primary Antenna TFU-22ETT/VP-R 2C255 (SP)	$362,132.00	$256,486.00		$201,439.00
50 to 75 OHM Transformer	$4,212.00	$4,212.00	N/A	$4,212.00	N/A
Shipping And Offloading	$25,000.00	$25,000.00	N/A	$5,043.00	N/A
Louisiana State and Local Sales Taxes	$24,390.00	$24,390.00	N/A	N/A	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$10,984.00	N/A	$10,984.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$185,500.00	Wilderness elected to purchase an upgraded antenna per paragraph 624 of the Broadcast Incentive Auction Report and Order. The attachment provided is a quotation for a horizontally polarized antenna plus a line item for the vertical component.	$174,800.00	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
Freight and shipping	Component Description: Dielectric invoice 507005 - Freight and shipping charges for interim antenna Amount: $3,645.00
Louisiana State Sales Tax	Component Description: Dielectric Invoice ST507005 - Louisiana state sales tax for freight and shipping for interim antenna Amount: $308.00
Side mount brackets for high power antennas (if not included in antenna base cost)	Information not provided.
Sweep test of existing antenna	Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 8 bay,, 14 kW input, directional,, horizontally polarized	Component Description: Invoice for TFU-8WB-R interim antenna for low power STA operations of KBCA on RF channel 26 while main antenna is being changed out. Amount: $44,925.00
50 to 75 OHM Transformer	Component Description: Dielectric Invoice 462008 - Balance due for Sales Order 1379003 - Line item 2 XFMR 6-50 / 6-75 of $4,212.00 - $421.20 applied to 50 to 75 ohm transformer entry, remainder of $3,790.80 to be applied to main antenna entry Amount: $421.20 Component Description: 45% Installment Payment prior to shipping per payment terms Amount: $1,895.40 Component Description: 45% Installment Payment Amount: $1,895.40
Shipping And Offloading	Component Description: Dielectric Invoice 573038 - Freight and Shipping charges for KBCA main antenna - The remaining amount of $3,300.00 is submitted under the storage costs Amount: $5,043.00
Louisiana State and Local Sales Taxes	Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: Dielectric Invoice 462008 - Balance due for Sales Order 1379003 - Line item 1 Elbow Complex of $10,984.00 - $1,098.40 applied to elbow complex, remainder of $9,885.60 to be applied to main antenna entry Amount: $1,098.40 Component Description: 45% Installment Payment Amount: $4,942.80 Component Description: 45% Installment Payment prior to shipping per payment terms Amount: $4,942.80
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: This invoice reflects balance of antenna sweeps costs applied to main antenna budget Amount: $5,760.00 Component Description: Dielectric invoice 462008 - This invoice reflects balance of elbow complex costs applied to main antenna budget Amount: $9,885.60 Component Description: Dielectric invoice 462008 - This invoice reflects balance of 50 to 75 ohm transformer costs applied to main antenna budget Amount: $3,790.80 Component Description: Dielectric Invoice 445004 - Balance due for Sales Order 1379003 - Main Antenna less Item 2 - VPOL Components to be paid by Wilderness Communications LLC Amount: $21,803.60 Component Description: 45% Installment Payment prior to shipping per payment terms Amount: $66,780.00 Component Description: 45% Installment Payment Amount: $66,780.00
Sweep test of existing antenna	Component Description: Dielectric Invoice 530007 - Balance due for Sales Order 1379003 - Main antenna sweep - 10% Balance due remainder to be applied to antenna costs Amount: $640.00 Component Description: 45% Installment Payment prior to shipping per payment terms Amount: $2,880.00 Component Description: 45% Installment Payment Amount: $2,880.00

Cost Information

Transmission Line

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$58,821.25	$49,121.25	N/A	$24,217.19	N/A
Total for all systems	$2,803,071.76	$2,428,609.09	N/A	$1,647,703.23	N/A
Interim Transmission Line	$29,700.00	$20,000.00		$0.00
Flexible Air Transmission Line - dielectric, 1 5/8"	$29,700.00	$20,000.00	N/A	N/A	N/A
Primary Transmission Line	$29,121.25	$29,121.25		$24,217.19
Indoor Transmission Line Sections	$15,480.00	$15,480.00	N/A	$10,942.90	N/A
Sweep Test Existing Transmission Line	$2,500.00	$2,500.00	N/A	$2,133.04	N/A
RF Scout Plus	$6,053.14	$6,053.14	N/A	$6,053.14	N/A
Dehydrator System	$5,088.11	$5,088.11	Quotation from Dielectric exceeded the initial predetermined cost estimate by $ 88.11.	$5,088.11	N/A

Components

Actual Information Description	File Name
Flexible Air Transmission Line - dielectric, 1 5/8"	Information not provided.
Indoor Transmission Line Sections	Component Description: Dielectric Invoice ST521010 - LA state sales taxes for invoice 521010 Amount: $822.76 Component Description: Invoice placed in wrong category - Please disregard. Amount: N/A Component Description: Dielectric invoice 521010 - for indoor custom cut sections, elbows, gas barrier and hangers for connection of output of mask filter to input of transmission line to antenna. Amount: $9,736.80 Component Description: Dielectric invoice 523014 - Freight and shipping charges for indoor custom cut transmission line Amount: $4,536.58 Component Description: Dielectric Invoice ST523014 - Louisiana Sales Tax associated with Invoice 523014 Amount: $383.34
Sweep Test Existing Transmission Line	Component Description: Engineering Services to perform a line sweep of existing transmission line for evaluation for service on repack channel 26 Amount: $2,133.04
RF Scout Plus	Component Description: Dielectric Invoice 517001 - For RF Scout Plus - RF power monitoring system Amount: $5,581.50 Component Description: Dielectric Invoice ST517001 - Louisiana state sales tax associated with Dielectric invoice 517001 Amount: $471.64
Dehydrator System	Component Description: Invoice for dehydrator system Amount: $5,088.11

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	$513,044.75	$540,944.75	N/A	$352,647.82	N/A
Total for all systems	$2,803,071.76	$2,428,609.09	N/A	$1,647,703.23	N/A
Primary Tower TOWER	$513,044.75	$540,944.75		$352,647.82
Skid-Steer Rental	$2,736.25	$2,736.25	N/A	$2,736.25	N/A
Crane and Crane Operator	$15,000.00	$15,000.00	N/A	N/A	N/A
Staging Area Preparation	$58,991.00	$58,991.00	Please see attached contractor's quotation.	$55,000.00	N/A
Tall Tower (greater than 500')	$210,500.00	$247,000.00	New quotation for tower crew and rigging exceeds predetermined cost estimate. AND additional cost for tower crew to install interim antenna for KBCA to operate on post-auction channel during construction of main antenna and transmitter facilities.	$247,000.00	N/A
Minor tower reinforcement/modifications	$158,000.00	$150,000.00	N/A	N/A	N/A
Structural engineering tower load study for well documented tower	$12,600.00	$12,000.00	N/A	$1,500.00	N/A
Road Preparation	$30,217.50	$30,217.50	Please see attached contractor's quotation.	$21,820.00	N/A
Excavator Rental	$25,000.00	$25,000.00	N/A	$24,591.57	N/A

Components

Actual Information Description	File Name
Skid-Steer Rental	Component Description: Far Horizon Invoice 10039 - For Skid-Steer Rental May 1-31, 2019 Needed to unload, load and move heavy equipment around transmitter site. Amount: $2,736.25
Crane and Crane Operator	Information not provided.
Staging Area Preparation	Component Description: Invoice to prepare staging area at transmitter site Amount: $55,000.00
Tall Tower (greater than 500')	Component Description: Bell Tower invoice for first 25% due payable with signing of order or prior to crew mobilization per terms of proposal. Amount: $56,875.00 Component Description: Tower services rendered to install interim antenna on KBCA tower for KBCA to begin operations on post-auction channel 26 while the main antenna and transmitter facilities are being constructed Amount: $19,500.00 Component Description: Bell Tower Invoice 273 -Third 25% payment due when tower crew sets new top antenna per proposal agreement Amount: $56,875.00 Component Description: Bell tower Invoice 271 - Second 25% due when crew arrives with equipment as per terms of proposal Amount: $56,875.00 Component Description: Bell Tower Invoice 276 -Fourth 25% payment due upon completion of tower services per proposal agreement Amount: $56,875.00
Minor tower reinforcement/modifications	Information not provided.
Structural engineering tower load study for well documented tower	Component Description: Engineering Study for 940' Tower in Glenmora LA - KBCA - Due Date is Net 30 Amount: $1,500.00
Road Preparation	Component Description: Invoice for expenses to prepare KBCA tower site road for heavy traffic, such as antenna and transmitter deliveries and tower construction equipment Amount: $21,820.00
Excavator Rental	Component Description: Delta Centre Invoice #526 for expenses incurred for continuation of excavator rental at KBCA tower site Amount: $7,882.19 Component Description: Delta Centre Invoice #527 for expenses incurred for continuation and return of excavator rental at KBCA tower site Amount: $8,257.19 Component Description: Excavator rental period from 5/24/2019 to 6/21/2019 at KBCA transmitter site Amount: $8,452.19

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	$251,375.00	$246,935.00	N/A	$50,183.75	N/A
Total for all systems	$2,803,071.76	$2,428,609.09	N/A	$1,647,703.23	N/A
Outside Professional Services	$251,375.00	$246,935.00		$50,183.75
Attorney Fees related to repack	$25,000.00	$25,000.00	N/A	$11,678.75	N/A
Outside Accounting Services	$7,500.00	$7,500.00	N/A	$555.00	N/A
General Contractor	$35,000.00	$35,000.00	Please see attachment with copy State of Louisiana Contractors License including statement that a contractor is required by state law.	$35,000.00	N/A
RF Exposure Measurements	$21,050.00	$20,000.00	N/A	N/A	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$80,000.00	N/A	N/A	N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,000.00	N/A	N/A	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,000.00	N/A	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$7,000.00	N/A	N/A	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$3,000.00	N/A	$0.00	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	N/A	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	N/A	N/A
Project management of the transition	$31,600.00	$30,000.00	N/A	N/A	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$4,000.00	N/A	N/A	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	N/A	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$4,100.00	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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	$1,580.00	$1,535.00	N/A	$0.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$250.00	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	$2,105.00	$2,050.00	N/A	$375.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$1,500.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$825.00	N/A

Components

Actual Information Description	File Name
Attorney Fees related to repack	Component Description: Attorney services rendered related to channel repack Amount: $1,250.00 Component Description: Attorney services rendered related to channel repack - Corrected invoice Amount: $125.00 Component Description: Attorney services rendered related to channel repack Amount: $250.00 Component Description: Attorney services rendered related to channel repack Amount: $875.00 Component Description: Attorney services rendered related to channel repack Amount: $62.50 Component Description: Attorney services rendered related to channel repack Amount: $2,025.00 Component Description: Attorney services rendered related to channel repack Amount: $875.00 Component Description: Attorney services rendered related to channel repack Amount: $132.50 Component Description: Attorney services rendered related to channel repack Amount: $1,943.75 Component Description: Attorney services rendered related to channel repack Amount: $2,275.00 Component Description: Attorney services rendered related to channel repack Amount: $190.00 Component Description: Attorney services rendered related to channel repack Amount: $62.50 Component Description: Attorney services rendered related to channel repack Amount: $425.00 Component Description: Attorney services rendered related to channel repack - Line item service dated 5/13/19 to be split 50/50 between KBCA and KLWB $125.00 divided by half equals $62.50. Amount: $62.50 Component Description: Attorney services rendered related to channel repack Amount: $250.00 Component Description: Attorney services rendered related to channel repack Amount: $875.00
Outside Accounting Services	Component Description: Accounting services split between 2 facilities Amount: $555.00 Component Description: CPA Accounting services through August 31, 2017 - Revised and re-submitted Amount: $555.00
General Contractor	Component Description: Contractor quotation, invoice and license required by State of Louisiana for road construction and staging area preparation at KBCA tower site Amount: $35,000.00 Component Description: Please reject this invoice. It is being replaced with Delta Centre invoice #490 Amount: N/A
RF Exposure Measurements	Information not provided.
Comprehensive coverage verification via field study, if needed	Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Information not provided.
ASR modification (prepare FCC Form 854)	Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization	Information not provided.
Prepare request for Special Temporary Authorization	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	Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - 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.
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	Component Description: RF Consulting Engineer Fees to preparation of engineering portions of FCC application for KBCA license to cover. Amount: $250.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Component Description: Chesapeake RF Consultants - invoice 5001 - RF engineering fees related to engineering and filing for construction permit for KBCA STA channel 26 Interim antenna. Amount: $375.00 Component Description: RF engineering services related to STA interim facilities for KBCA channel 26 Amount: $375.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: RF Consulting Engineer fee to prepare engineer section FCC Form 2100, Construction Permit App Amount: $1,500.00
Perform engineering study for new channel assignment and antenna development	Component Description: Please disregard this invoice as it was submitted in error Amount: N/A Component Description: RF Consulting Engineer study for new channel assignment Amount: $825.00

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	$66,180.98	$65,625.98	N/A	$39,112.25	N/A
Total for all systems	$2,803,071.76	$2,428,609.09	N/A	$1,647,703.23	N/A
Other Expenses	$66,180.98	$65,625.98		$39,112.25
AOL Beacon Cable	$400.00	$400.00	N/A	$326.27	N/A
RF Consulting Engineer	$2,000.00	$2,000.00	N/A	$350.00	N/A
Additional Hired Workers	$5,000.00	$5,000.00	N/A	$1,000.00	N/A
MVPD Notification of Channel Change	$2,500.00	$2,500.00	N/A	$1,200.00	N/A
Develop and air announcement of upcoming channel change	$2,500.00	$2,500.00	N/A	$600.00	N/A
Equipment Storage	$5,000.00	$5,000.00	N/A	$3,300.00	N/A
Equipment Delivery and Handling Charges	$26,822.58	$26,822.58	N/A	$26,822.58	hold
Non-zoning permits	$5,000.00	$5,000.00	N/A	N/A	N/A
Local Zoning	$1,500.00	$1,500.00	N/A	N/A	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$190.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$335.00	N/A	$335.00	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$3,378.40	$3,378.40	N/A	$3,378.40	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$1,800.00	N/A

Components

Actual Information Description	File Name
AOL Beacon Cable	Component Description: Delta Centre Invoice #528 for the purchase of AOL beacon cable that is not supplied with the Dielectric antenna. Amount: $326.27
RF Consulting Engineer	Component Description: RF engineer review prospective interim antenna for initial implementation of repack Ch-26 Amount: $350.00
Additional Hired Workers	Component Description: Invoice for services of 5 man crew to assist with the disassembly and removal of the old KBCA transmitter Amount: $1,000.00
MVPD Notification of Channel Change	Component Description: Delta Media Corporation - Invoice 6833 - For expenses incurred for MVPD notifications Amount: $1,200.00
Develop and air announcement of upcoming channel change	Component Description: Delta Media Invoice #1079 for production charges for :30 spot for general public notification of KBCA post-auction channel change Amount: $200.00 Component Description: Delta Media Invoice #1075 for production charges for :30 spot for general public notification of KBCA post-auction channel change Amount: $200.00 Component Description: Delta Media Invoice #1078 for production charges for :30 spot for general public notification of KBCA post-auction channel change Amount: $200.00
Equipment Storage	Component Description: Dielectric Invoice 573038 - Storage charges for KBCA main antenna - The remaining amount of $5,043.00 is submitted under the freight and shipping costs Amount: $3,300.00
Equipment Delivery and Handling Charges	Component Description: 10% of total shipping, offloading and placement of equipment costs due to transmitter manufacturer Amount: $2,228.60 Component Description: 30% of total shipping, offloading and placement of equipment costs due to transmitter manufacturer Amount: $6,685.80 Component Description: Dielectric invoice 523014 - Freight charges for indoor custom cut line sections - re-submission 2-6-2020 Amount: $4,536.58 Component Description: 60% of total shipping, offloading and placement of equipment costs due to transmitter manufacturer Amount: $13,371.60
Non-zoning permits	Information not provided.
Local Zoning	Information not provided.
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Component Description: FCC- License to cover application fee Amount: $335.00
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: EDI Invoice 7927 - Removal and disposal of HV Beam Supplies from decommissioned KLWB channel 50 transmitter Amount: $618.00 Component Description: EDI Invoice 7596 for removal and disposal of non-hazardous waste fluid and mineral oil used in decommissioned channel 41 transmitter Amount: $2,760.40
DTV Medical Facility Notification	Component Description: Delta Media Corporation - Invoice 6831 - For expenses incurred for medical facility notifications Amount: $1,800.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,803,071.76	$2,428,609.09	$1,647,703.23

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.	No

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Arthur Lee Clardy , III . Director of Engineering 10/07/2021

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.

Arthur Lee Clardy , III .

Director of Engineering

10/07/2021

Certification

Section	Question	Response
Submission of Actual Cost Documentation Statements	WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) . The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Arthur Lee Clardy , III . Director of Engineering 10/07/2021

Section

Question

Response

Submission of Actual Cost Documentation Statements

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

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

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

Arthur Lee Clardy , III .

Director of Engineering

10/07/2021

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.	Arthur Lee Clardy , III . Director of Engineering 10/07/2021

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.

Arthur Lee Clardy , III .

Director of Engineering

10/07/2021

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

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Interim Transmitter

New Transmitter Costs

Interim Transmitter

Other Transmitter Costs

Interim Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

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

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components