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

FCC Form 399: Reimbursement Request

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

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

Facility ID:
25045
Service:
DTV
Call Sign:
WDVM-TV
Channel:
23 (UHF)
File Number:
0000028762
FRN:
0009961889
Date Submitted:
10/08/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Nexstar Media Inc.

Elizabeth Ryder

545 E. JOHN CARPENTER FREEWAY

SUITE 700

IRVING, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Elizabeth Ryder

General Counsel

Nexstar Media Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Replace main transmitter, main antenna and main transmission line. Acquire interim antenna and line for continued operation during construction and duration of the assigned phase. Map and analyze tower; design and implement modifications if required.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DCX Millennium 8 VSB
Year 2007
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 23 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9EVO-30
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 31 kW
Justification for New Transmitter The manufacturer of the existing IOT transmitter advises that the transmitter cannot be re-tuned to the assigned channel. A new Comark Paragon MSDC IOT transmitter is the basis for the cost reimbursement. We will purchase a SS "one step up" power level.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Back up Transmitter

Back up Transmitter to cover period while new transmitter is being installed

Additional Interior RF System

Interior RF System Existing Transmitter to Interim Transmission line

Transmitter Site Preparation

Transmitter Site Preparation

Concrete Pad, Ice Shield and Fence Installation

Concrete Pad for Transmitter Ancillary Equipment and Ice Shield

Rhode and Schwarz Electrical Services

Provide and install Panels and feeders, branch circuits, switches, cable tray, transfer switch, complete electrical demo.

Additional Transmitter Costs

Additional Transmitter Costs

Forklift Rental for Transmitter Installation

Lift and placing of new transmitter for Repack

Transmitter Surge Suppressor System

Rhode and Schwarz New Transmitter needs Surge Suppression

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model 102917.01-TRN-U-1000-FA
Transmitter Type Other Type
Other Transmitter Type UHF Air Cooled Broadband
Power capacity 1.4 kW
Justification for New Transmitter Main transmitter cannot be installed in time to meet phase 4 deadline. Interim transmitter is needed to avoid broadcast interruption.

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) 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
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? 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: 575.0 kW
Manufacturer
Model TFU-26JTH-R 4C130
Year 2008

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting 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: 800.0 kW
Manufacturer
Model TFU-25JTH/VP-R 4C130
Year 2018
Justification for New Antenna The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel.

Primary Antenna

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Other Antenna Costs

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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Additional Antenna Costs

Additional Antenna Costs

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 575.0 kW
Manufacturer
Model TFU-16WB-R C160
Year 2018
Justification for New Antenna An interim antenna is necessary to keep station on the air during primary antenna replacement and for the duration of the assigned phase. Station will attempt to rent if renting is available at time of acquisition.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? S
Feed Line Size 6 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 530 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 530 feet per run
Justification for New Transmission Line See attached 2008 Order Confirmation demonstrating that the WDVW, previously WHAG, facility had 19.5 ft sections of 6-1/8" line that cannot be repurposed for the assigned post-transition channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 5 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 360 feet per run
Justification for New Transmission Line An interim transmission line is necessary for the interim antenna to keep station on the air during primary antenna replacement and for the duration of the assigned phase.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Terrain Constrained
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? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1036848
Coordinates (NAD83) Latitude (NAD83) 39° 39' 45.0" N-
Longitude (NAD83) 077° 57' 53.0" W-
Overall Structure Height 459.97 feet
Support Structure Height 405.83 feet
Ground Elevation Above Mean Sea Level (AMSL) 1408.78 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner American Towers, LLC
Date Constructed 02/10/2006


Other Types of Users

Users
WDVM microwave
WCRH microwave

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
Helicopter Services Required Are helicopter services required? Yes

Primary Tower

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Other Tower Expenses Not Listed

Name Description

American Tower Rent and Misc. Costs

American Tower Corporation rent for interim antenna and line and ATC Project Management.

Weather Delays

Weather delay

Additional Antenna Rigging Costs

Due to remote site location additional rigging costs are incurred

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 750
Explanation Schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects. Internal accounting and Project management.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 No
Additional Field Engineering Service Yes
Number of Days 20
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Sales Tax

Sales and use tax on goods and services

Transmitter Road Repair

Repair of Transmitter Road

Equipment Rentals

Equipment Rentals

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,441,982.75 $1,316,837.75 N/A $1,092,072.13 N/A
Total for all systems $3,703,676.96 $3,225,950.55 N/A $2,264,558.04 N/A
Interim Transmitter 102917.01-TRN-U-1000-FA $34,750.00 $34,750.00 $34,750.00
UHF Air Cooled Broadband $34,750.00 $34,750.00 See Microwave Rental quote 190808-B; 50% of cost was submitted and approved under Backup Transmitter line $34,750.00 N/A
Primary Transmitter THU9EVO-30 $1,407,232.75 $1,282,087.75 $1,057,322.13
Transmitter Surge Suppressor System $17,953.00 $17,953.00 See Valentine Electric proposal 02019117 $17,953.00 N/A
Forklift Rental for Transmitter Installation $3,630.24 $3,630.24 Forklift Rental for Installation of new transmitter in building. N/A N/A
Additional Transmitter Costs $31,044.00 $31,044.00 See Rohde & Schwarz quotes 200966.1 and 275338.0 $31,044.00 N/A
Rhode and Schwarz Electrical Services $50,850.00 $50,850.00 See R&S proposal 192497.0 $50,850.00 N/A
Concrete Pad, Ice Shield and Fence Installation $72,181.96 $72,181.96 See quote from Z Construction ZE19049 $72,181.96 N/A
Transmitter Site Preparation $29,623.55 $29,623.55 See Rohde & Schwarz quote 235154.0 and Z Construction quote ZE18257 $26,488.17 N/A
Additional Interior RF System $140,000.00 $140,000.00 N/A N/A N/A
Back up Transmitter $34,750.00 $34,750.00 Vendor could not get primary transmitter installed in time to meet phase 4 deadline; back up transmitter was purchased to continue transmission until installation was complete; see quote from Microwave Rental LLC; remaining cost in interim TM line $34,750.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,850.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $37,150.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $824,055.00 See attached Comark Quote; cost revised from 702,370 to 824,055; see Rohde & Schwarz quote 126522.1 attached; upgrade cost from THU9evo-20 to THU9evo-30 will not be requested for reimbursement $824,055.00 N/A

Components

Actual Information Description File Name
UHF Air Cooled Broadband

Component Description:
Interim transmitter, installment #2
Amount:
$34,750.00
Transmitter Surge Suppressor System

Component Description:
Transmitter surge suppressor
Amount:
$17,953.00
Forklift Rental for Transmitter Installation Information not provided.
Additional Transmitter Costs

Component Description:
Additional transmitter costs
Amount:
$9,842.00

Component Description:
Additional transmitter costs
Amount:
$21,202.00

Component Description:
Additional transmitter costs
Amount:
$21,202.00
Rhode and Schwarz Electrical Services

Component Description:
Transmitter electrical service
Amount:
$50,850.00

Component Description:
Transmitter electrical service
Amount:
$50,850.00
Concrete Pad, Ice Shield and Fence Installation

Component Description:
Concrete pad and ice shield, installment #2
Amount:
$8,213.65

Component Description:
Concrete pad and ice shield, installment #3
Amount:
$10,263.64

Component Description:
Concrete pad and ice shield, installment #1
Amount:
$53,704.67
Transmitter Site Preparation

Component Description:
Transmitter site prep, installment #2
Amount:
$2,090.26

Component Description:
Transmitter site preparation
Amount:
$8,721.00

Component Description:
Transmitter site prep, installment #1
Amount:
$15,676.91
Additional Interior RF System Information not provided.
Back up Transmitter

Component Description:
Back up transmitter, installment #1
Amount:
$34,750.00

Component Description:
Reverse request - move to separate component line
Amount:
($34,750.00)

Component Description:
Backup transmitter, installment #2
Amount:
$34,750.00
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter system, installment #2 less upgrade cost
Amount:
$412,027.50

Component Description:
Transmitter system, installment #3 less upgrade cost
Amount:
$206,013.75

Component Description:
Transmitter system, installment #1 less upgrade cost
Amount:
$206,013.75

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $467,245.00 $351,711.00 N/A $323,865.60 N/A
Total for all systems $3,703,676.96 $3,225,950.55 N/A $2,264,558.04 N/A
Interim Antenna TFU-16WB-R C160 $149,365.00 $146,443.00 $118,623.00
UHF - High Power, Side Mount, basic slot antenna, 575 kW input, directional,, horizontally polarized $101,925.00 $101,925.00 See attached Dielectric Quote (Quote No. 700426CMZ-2) $101,925.00 N/A
Sweep test of existing antenna $6,730.00 $6,550.00 N/A $6,400.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,120.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,550.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $10,298.00 See attached Dielectric Quote (Quote No. 700426CMZ-2) $10,298.00 N/A
Primary Antenna TFU-25JTH/VP-R 4C130 $317,880.00 $205,268.00 $205,242.60
Additional Antenna Costs $9,350.00 $9,350.00 See Dielectric sales order confirmations 1929440, 1929456, 1930910 $9,324.60 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $10,298.00 See attached Dielectric Quote (Quote No. DMS130-3) $10,298.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $179,025.00 See attached Dielectric Quote (Quote No. DMS130-3), less cost of Vpol $20,265 which is not reimbursable $179,025.00 N/A
Sweep test of existing antenna $6,730.00 $6,595.00 See Greg Best invoice and Jeremy Ruck quote 190801-1 $6,595.00 N/A

Components

Actual Information Description File Name
UHF - High Power, Side Mount, basic slot antenna, 575 kW input, directional,, horizontally polarized

Component Description:
Aux antenna, installment #3, 10% balance due
Amount:
$10,192.50

Component Description:
Aux antenna, line 1 of invoice, installment #1
Amount:
$45,866.25

Component Description:
Aux antenna, installment #2, line 1 of invoice
Amount:
$45,866.25
Sweep test of existing antenna

Component Description:
Interim antenna sweep test
Amount:
$6,400.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow complex, installment #3, 10% balance due
Amount:
$1,029.80

Component Description:
Elbow complex, line 23 of invoice, installment #1
Amount:
$4,634.10

Component Description:
Elbow complex, installment #2, line 23 of invoice
Amount:
$4,634.10
Additional Antenna Costs

Component Description:
Additional antenna costs
Amount:
$1,900.00

Component Description:
Additional antenna component
Amount:
$684.60

Component Description:
Additional antenna costs
Amount:
$2,090.00

Component Description:
Additional antenna components
Amount:
$4,650.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow complex, balance due
Amount:
$1,029.80

Component Description:
Elbow complex, installment #2, line 3 of invoice
Amount:
$4,634.10

Component Description:
Elbow complex, line 3 of invoice, installment #1
Amount:
$4,634.10
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Main antenna, installment #3
Amount:
$8,634.30

Component Description:
Antenna, balance due
Amount:
$9,268.20

Component Description:
Main antenna, installment #2, line 1 of invoice
Amount:
$80,561.25

Component Description:
Primary antenna, line 1 of invoice, installment #1
Amount:
$80,561.25
Sweep test of existing antenna

Component Description:
Main antenna sweep test
Amount:
$6,400.00

Component Description:
Transmission line study
Amount:
$195.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $144,860.00 $108,127.59 N/A $108,127.59 N/A
Total for all systems $3,703,676.96 $3,225,950.55 N/A $2,264,558.04 N/A
Interim Transmission Line $37,800.00 $31,203.89 $31,203.89
Flexible Air Transmission Line - dielectric, 5" $37,800.00 $31,203.89 See attached Dielectric Quote (Quote No. 700426CMZ-2) $31,203.89 N/A
Primary Transmission Line $107,060.00 $76,923.70 $76,923.70
Rigid Transmission Line - copper, 6 1/8" $107,060.00 $76,923.70 See attached Dielectric Quote (Quote No. DMS130-3) $76,923.70 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 5"

Component Description:
Flexible transmission line, installment #3, 10% balance due
Amount:
$3,120.39

Component Description:
Flexible transmission line, installment #2, line 3 of invoice
Amount:
$14,041.75

Component Description:
Flexible transmission line, line 3 of invoice, installment #1
Amount:
$14,041.75
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Transmission line, installment #3
Amount:
$7,692.36

Component Description:
Rigid transmission line, line 4 of invoice, installment #1
Amount:
$34,615.67

Component Description:
Transmission line, installment #2, line 4 of invoice
Amount:
$34,615.67

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $942,080.00 $743,730.00 N/A $319,945.00 N/A
Total for all systems $3,703,676.96 $3,225,950.55 N/A $2,264,558.04 N/A
Primary Tower TOWER $942,080.00 $743,730.00 $319,945.00
Weather Delays $4,000.00 $4,000.00 See quote S3-20-0102-01 and related invoice $4,000.00 N/A
Major tower reinforcement/modifications $421,000.00 $409,500.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $31,075.00 See ATC PO requests $31,075.00 N/A
Additional Antenna Rigging Costs $9,000.00 $9,000.00 N/A $2,615.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $229,375.00 See United States Tower quote 110718RO-01 $184,575 for interim/main installation, Northeast Towers quote S3-20-0102-01 $44,800 for interim removal $229,375.00 N/A
Tower Helicopter Lift $0.00 $0.00 See Helicopter cost in US Tower Services quote N/A N/A
American Tower Rent and Misc. Costs $60,780.00 $60,780.00 See attached American Tower Corporation Quote $52,880.00 N/A

Components

Actual Information Description File Name
Weather Delays

Component Description:
Auxiliary antenna removal weather day
Amount:
$4,000.00
Major tower reinforcement/modifications Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Tower mapping
Amount:
$20,600.00

Component Description:
Structural analysis
Amount:
$10,475.00
Additional Antenna Rigging Costs

Component Description:
Additional rigging costs
Amount:
$2,615.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Aux antenna removal
Amount:
$44,800.00

Component Description:
Antenna installation, installment #3
Amount:
$58,702.35

Component Description:
Antenna installation, installment #1
Amount:
$63,484.67

Component Description:
Antenna installation, installment #2
Amount:
$62,387.98
Tower Helicopter Lift Information not provided.
American Tower Rent and Misc. Costs

Component Description:
Interim antenna temporary rent
Amount:
$38,400.00

Component Description:
Tower coordination costs
Amount:
$5,000.00

Component Description:
American Tower Fee
Amount:
$9,480.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $261,420.00 $260,005.00 N/A $55,080.48 N/A
Total for all systems $3,703,676.96 $3,225,950.55 N/A $2,264,558.04 N/A
Outside Professional Services $261,420.00 $260,005.00 $55,080.48
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,050.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,585.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,305.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,120.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $4,500.00 See related invoices $4,500.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,535.00 N/A $625.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,070.00 N/A $3,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,170.00 N/A $7,000.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,560.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,560.00 N/A $2,500.00 N/A
Project management of the transition $118,500.00 $115,500.00 N/A $37,455.48 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,050.00 N/A N/A N/A
Additional Field Engineering Service, 20 Days $108,000.00 $108,000.00 N/A N/A N/A

Components

Actual Information Description File Name
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Prepare request for STA, item 2 from invoice summary
Amount:
$1,500.00

Component Description:
Prepare request for STA, Item 3 from invoice summary
Amount:
$1,500.00

Component Description:
Prepare request for STA
Amount:
$1,500.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare License to Cover Application
Amount:
$625.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare engineering section of Form FCC Construction Permit Application for Main Facility
Amount:
$3,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Kessler & Gehman subcontractor invoice line 2; perform engineering study for new channel assignment and antenna development
Amount:
$7,000.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Kessler & Gehman subcontractor invoice line 1; Prepare FCC Form 399
Amount:
$2,500.00
Project management of the transition

Component Description:
Project management services May 2020
Amount:
$10.00

Component Description:
Project management services Aug 2019
Amount:
$300.00

Component Description:
Project management services Jul 2019
Amount:
$130.00

Component Description:
Project management services Nov 2019
Amount:
$240.00

Component Description:
Project management services
Amount:
$100.00

Component Description:
Project management services, items 1 and 5 from invoice summary
Amount:
$940.00

Component Description:
Project management services Aug 2019
Amount:
$650.00

Component Description:
Project management services 7.28.18 through 9.28.18
Amount:
$2,775.00

Component Description:
Project management services Jun 2019
Amount:
$110.00

Component Description:
Project management services Apr 2020
Amount:
$25.00

Component Description:
Project management services Feb 2020
Amount:
$125.00

Component Description:
Project management services May 2019
Amount:
$50.00

Component Description:
Project management services 4.27.19 through 5.31.19
Amount:
$2,550.00

Component Description:
Project management services
Amount:
$4,791.54

Component Description:
Project management services
Amount:
$5,681.50

Component Description:
Project management services Mar 2020
Amount:
$55.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from January 1, 2018 through January 26, 2018.
Amount:
$975.00

Component Description:
Project management services
Amount:
$2,400.00

Component Description:
Project management services Apr 2019
Amount:
$78.00

Component Description:
Project management services
Amount:
$229.00

Component Description:
Project management services May 27, 2017 through June 30, 2017.
Amount:
$1,000.00

Component Description:
Project management services 2.1.19 through 3.1.19
Amount:
$600.00

Component Description:
Project management services Jun 2019
Amount:
$97.50

Component Description:
Project management Services July 1, 2017 through September 29, 2017
Amount:
$3,217.27

Component Description:
Project management services 6.30.18 through 7.27.18
Amount:
$900.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from October 27, 2017 through December 31, 2017.
Amount:
$300.00

Component Description:
Project management services March 2019
Amount:
$260.00

Component Description:
Project management services 5.26.18 through 6.29.18
Amount:
$1,050.00

Component Description:
Project management services 9.29.18 through 10.26.18
Amount:
$300.00

Component Description:
Project management services 3.2.19 through 3.29.19
Amount:
$450.00

Component Description:
Project management services 10.27.18 through 11.30.18
Amount:
$900.00

Component Description:
Project management services Jul 2020
Amount:
$65.00

Component Description:
Project management services Aug 2018
Amount:
$125.00

Component Description:
Project management services Dec 2018
Amount:
$240.00

Component Description:
Professional management services 12.1.18 through 12.31.18
Amount:
$150.00

Component Description:
Project management services as described in invoice
Amount:
$1,575.67

Component Description:
Project management services Jul 2019
Amount:
$100.00

Component Description:
Project management services Dec 2019
Amount:
$130.00

Component Description:
Project management services Oct 2018
Amount:
$275.00

Component Description:
Project management services 6.1.19 through 6.28.19
Amount:
$2,325.00

Component Description:
Project management services
Amount:
$50.00

Component Description:
Project management services April 2019
Amount:
$78.00

Component Description:
Project management services 3.30.19 through 4.26.19
Amount:
$900.00

Component Description:
Project management services Sep 2019
Amount:
$230.00
ASR modification (prepare FCC Form 854) Information not provided.
Additional Field Engineering Service, 20 Days Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $446,089.21 $445,539.21 N/A $365,467.24 N/A
Total for all systems $3,703,676.96 $3,225,950.55 N/A $2,264,558.04 N/A
Other Expenses $446,089.21 $445,539.21 $365,467.24
Equipment Rentals $35,000.00 $35,000.00 See Rohde & Schwarz quote 236725.0 and related invoices for forklift, pallet jack and dumptruck rentals $32,377.16 N/A
Transmitter Road Repair $140,000.00 $140,000.00 See East Coast Landscaping Estimate 1008 $140,000.00 N/A
Sales Tax $96,000.00 $96,000.00 See related invoices/tax returns $94,462.42 N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A N/A N/A
Equipment Storage $25,000.00 $25,000.00 N/A $12,740.00 N/A
Equipment Delivery and Handling Charges $80,039.21 $80,039.21 See R&S proposals 220605.0 and 169910, and related Dielectric and R&S invoices $75,879.71 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A $5,888.75 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $4,119.20 N/A
Non-zoning permits $25,000.00 $25,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $6,500.00 $6,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Equipment Rentals

Component Description:
Pallet truck rental 8/20/19 thru 8/29/19
Amount:
$65.03

Component Description:
Pallet truck rental 7/23/19 thru 8/20/19
Amount:
$201.60

Component Description:
Forklift rental 8/21/19 thru 9/18/19
Amount:
$3,448.50

Component Description:
Dump truck rental
Amount:
$801.25

Component Description:
Forklift rental 7/24/19 thru 8/21/19
Amount:
$3,448.50

Component Description:
Forklift rental 2/17/20 thru 2/25/20
Amount:
$1,783.94

Component Description:
Forklift rental 5/29/19 thru 6/26/19
Amount:
$3,543.50

Component Description:
Forklift rental 6/26/19 thru 7/24/19
Amount:
$3,448.50

Component Description:
Forklift rental 9/18/19 thru 10/1/19
Amount:
$1,770.34

Component Description:
Equipment rentals
Amount:
$13,866.00
Transmitter Road Repair

Component Description:
Transmitter road repair, installment #1
Amount:
$50,000.00

Component Description:
Transmitter road repair, installment #3
Amount:
$35,000.00

Component Description:
Transmitter road repair, installment #2
Amount:
$50,000.00

Component Description:
Transmitter road repair, installment #4
Amount:
$5,000.00

Component Description:
Access road repair
Amount:
$8,800.00

Component Description:
Access road repair
Amount:
$8,800.00

Component Description:
Access road repair
Amount:
$8,500.00

Component Description:
Access road repair
Amount:
$8,800.00

Component Description:
Access road repair
Amount:
$2,650.00

Component Description:
Access road repair
Amount:
$5,000.00

Component Description:
Access road repair
Amount:
$18,550.00

Component Description:
Access road repair
Amount:
$7,700.00

Component Description:
Access road repair
Amount:
$8,740.00

Component Description:
Access road repair
Amount:
$3,200.00

Component Description:
Access road repair
Amount:
$12,850.00

Component Description:
Access road repair
Amount:
$5,300.00

Component Description:
Access road repair
Amount:
$9,270.00

Component Description:
Access road repair
Amount:
$12,800.00

Component Description:
Access road repair
Amount:
$50,000.00

Component Description:
Access road repair
Amount:
$10,155.00

Component Description:
Access road repair
Amount:
$11,450.00

Component Description:
Access road repair
Amount:
$8,850.00

Component Description:
Access road repair
Amount:
$35,000.00

Component Description:
Access road repair
Amount:
$5,080.00

Component Description:
Access road repair
Amount:
$9,390.00

Component Description:
Access road repair
Amount:
$50,000.00

Component Description:
Access road repair
Amount:
$8,050.00

Component Description:
Access road repair
Amount:
$5,850.00

Component Description:
Access road repair
Amount:
$8,050.00

Component Description:
Access road repair
Amount:
$8,230.00

Component Description:
Transmitter road repair, installment #3
Amount:
$35,000.00

Component Description:
Access road repair
Amount:
$15,040.00

Component Description:
Access road repair
Amount:
$3,240.00

Component Description:
Access road repair
Amount:
$13,100.00

Component Description:
Access road repair
Amount:
$7,900.00

Component Description:
Access road repair
Amount:
$7,800.00

Component Description:
Access road repair
Amount:
$3,720.00

Component Description:
Access road repair
Amount:
$7,040.00

Component Description:
Access road repair
Amount:
$2,450.00

Component Description:
Access road repair
Amount:
$10,750.00
Sales Tax

Component Description:
Tax on transmission line
Amount:
$4,615.42

Component Description:
Tax due on transmitter electrical service
Amount:
$3,051.00

Component Description:
Tax on transmitter consolidation services
Amount:
$1,215.90

Component Description:
Tax on forklift rental
Amount:
$181.50

Component Description:
Tax on dump truck rental
Amount:
$58.50

Component Description:
Tax on antenna components
Amount:
$279.00

Component Description:
Tax on transmitter site preparation
Amount:
$523.26

Component Description:
Tax on antenna component
Amount:
$41.08

Component Description:
Tax on main antenna component
Amount:
$617.88

Component Description:
Tax on forklift rental
Amount:
$84.17

Component Description:
Tax due on transmitter, less upgrade
Amount:
$45,760.93

Component Description:
Tax on forklift rental
Amount:
$181.50

Component Description:
Tax on forklift rental
Amount:
$181.50

Component Description:
Tax on additional transmitter components
Amount:
$1,272.12

Component Description:
Tax on antenna component
Amount:
$125.40

Component Description:
Tax due on transmitter electrical services
Amount:
$3,051.00

Component Description:
Tax on antenna freight and storage
Amount:
$224.10

Component Description:
Tax on equipment rentals
Amount:
$831.96

Component Description:
Tax on forklift rental
Amount:
$181.50

Component Description:
Tax on main antenna
Amount:
$10,741.50

Component Description:
Tax on antenna installation, installment #3
Amount:
$3,522.15

Component Description:
Tax on pallet truck rental
Amount:
$3.48

Component Description:
Tax on pallet truck rental
Amount:
$10.80

Component Description:
Tax on forklift rental
Amount:
$88.72

Component Description:
Tax on antenna installation, installment #1
Amount:
$3,809.08

Component Description:
Tax on transmitter consolidation services
Amount:
$1,215.90

Component Description:
Tax on antenna installation, installment #2
Amount:
$3,743.27

Component Description:
Tax on antenna component
Amount:
$114.00

Component Description:
WDVM Maryland Sales and Use Tax
Amount:
$8,605.00

Component Description:
Tax due on transmitter transportation
Amount:
$2,730.00

Component Description:
Tax on additional transmitter materials
Amount:
$590.52

Component Description:
Tax on surge suppressor
Amount:
$1,077.18

Component Description:
Tax on additional transmitter costs
Amount:
$1,272.12
MVPD Notification of Channel Change Information not provided.
Equipment Storage

Component Description:
Transmitter storage
Amount:
$6,500.00

Component Description:
Main antenna storage
Amount:
$1,170.00

Component Description:
Auxiliary antenna storage
Amount:
$1,170.00

Component Description:
Main antenna storage cost
Amount:
$3,900.00
Equipment Delivery and Handling Charges

Component Description:
Transmitter consolidation services
Amount:
$13,765.00

Component Description:
Main antenna freight cost
Amount:
$2,565.00

Component Description:
Auxiliary antenna freight cost
Amount:
$3,408.00

Component Description:
Main antenna freight cost
Amount:
$3,569.40

Component Description:
Antenna component shipping
Amount:
$1,181.90

Component Description:
Transmitter transportation; see also sales tax
Amount:
$45,500.00

Component Description:
Freight cost for additional transmitter materials
Amount:
$2,710.00

Component Description:
Transmitter consolidation services
Amount:
$20,265.00

Component Description:
Antenna components shipping cost
Amount:
$1,158.60

Component Description:
Shipping cost for antenna component
Amount:
$1,439.75

Component Description:
Shipping for additional antenna components
Amount:
$582.06
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal costs Aug 2019
Amount:
$411.75

Component Description:
Disposal costs Jul 2019
Amount:
$90.00

Component Description:
Disposal costs Oct 2019
Amount:
$297.00

Component Description:
Disposal costs Sep 2019
Amount:
$90.00

Component Description:
Transmitter disposal cost
Amount:
$5,000.00
DTV Medical Facility Notification

Component Description:
Notification of medical facilities
Amount:
$4,119.20
Non-zoning permits Information not provided.
Develop and air announcement of upcoming channel change Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,703,676.96 $3,225,950.55 $2,264,558.04

Reimbursement Status

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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

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Elizabeth Ryder

General Counsel


10/08/2021

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

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

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

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

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

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

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

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

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

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

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

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

Elizabeth Ryder

General Counsel


10/08/2021

Certification

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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.

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  3. 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.

  4. 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.

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

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

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

Elizabeth Ryder

General Counsel


10/08/2021

Attachments

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