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:
36607
Service:
DTV
Call Sign:
KJZZ-TV
Channel:
19 (UHF)
File Number:
0000028798
FRN:
0025502048
Date Submitted:
12/08/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KJZZ Licensee, LLC

Doing Business As: KJZZ Licensee, LLC

Harvey Arnold

10706 Beaver Dam Road

Cockeysville, MD 21030

United States

+1 (410) 568-1500 FCCContacts@sbgtv.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Paul A Cicelski

Lerman Senter PLLC

Paul Cicelski

2001 L Street, NW

Suite 400

Washington, DC 20036

United States

+1 (202) 429-8970 pcicelski@lermansenter.com

Broadcaster Information and Transition Plan

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

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 DHD45P2
Year 2001
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 10.5 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-16
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25.5 kW
Justification for New Transmitter Per the manufacturer, the current transmitter cannot be retuned. See Exhibit B.

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 2 inches
Length 800.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 50 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

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Other Transmitter Cost Not Listed

Name Description

Installation

Installation

Replacement Services

Replacement Services

Additional parts

Additional parts

Large Parallel Remote Interface

Large Parallel Remote Interface

Dummy Load and Switches

Dummy Load and Switches

Band 5 Harmonic Filter

Band 5 Harmonic Filter

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model ULXTE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12 kW
Justification for New Transmitter This interim transmitter cost will be shared by the eight stations that are collocated on this tower, and will aid all of the stations in transitioning to their new channels considering the terrain and phase time constraints.

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 800.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 50 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
Inside RF System Is an additional interior RF system required to support this interim transmitter? Yes

Interim Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 8
Number of Panels 48
Design power capacity in use 77.0 %
Lower Limit 773.00 MHz
Upper Limit 928.00 MHz
Other Antenna Type N/A
ERP: 200.0 kW
Manufacturer
Model 773 928
Year 1999

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

Facility ID Call Sign
69396 KUED
69582 KUEN
1136 KUCW
35823 KUTV
6359 KSL-TV
6823 KBYU-TV
68889 KTVX

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? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Bottom
Polarization Circular
Type Broadband Panel
Number of Stations Supported 8
Number of Panels/Bays 48
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 90.0 %
Other Antenna Type N/A
ERP: 114.0 kW
Manufacturer
Model 759 25063
Year 2017
Justification for New Antenna FROM MANUFACTURER. These panel antennas are finely tuned to a specific band, but the new repacked channels are not within the specific band, so the current antenna cannot be used for the new repack 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? Yes
Type New
Number of channels supported 8
Frequencies of channels supported Upper and lower frequency
Frequency 470.0 MHz - 608.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? Yes
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
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

Antenna Installation

Antenna Installation Cost

Other Costs

Other Costs

Transmission Line

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

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 Owned
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) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1062408
Coordinates (NAD83) Latitude (NAD83) 40° 39' 33.0" N-
Longitude (NAD83) 112° 12' 10.0" W-
Overall Structure Height 308.40 feet
Support Structure Height 308.40 feet
Ground Elevation Above Mean Sea Level (AMSL) 9035.32 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner DTV UTAH, LC
Date Constructed 10/28/1999

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

Facility ID Call Sign Service
1136 KUCW DTV
69582 KUEN DTV
6823 KBYU-TV DTV
68889 KTVX DTV
69396 KUED DTV
35823 KUTV DTV
6359 KSL-TV DTV

Other Types of Users

Users
Go Go Air
KPNZ - Telev

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 800
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution. See Exhibit K.
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 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility 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 2
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

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Other Professional Services Expenses Not Listed

Name Description

Sinclair Internal Costs

Internal Employee Time Costs

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 Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

DTV Utah Operating Agreement Equity Equalization

Per Operating Agreement signed July 1998. See Exhibit M.

Garbage Disposal

Remove general garbage from mountaintop site (does not include equipment removal). Billed as used.

KSTU Mask Filter

Needed for KSTU (channel 28) to protect KUED (channel 27). See Exhibit N.

Road Maintenance

Snow plowing, grading, and repairs to existing road to remote mountaintop site. See Exhibit R.

Tax

Tax

Temporary Sanitation

For onsite workers. See Exhibit S.

Temporary Storage

For tools and equipment onsite and staging area off-site. See Exhibit P.

Transportation Services

Snow cat and helicopter to move equipment and personnel to remote mountaintop site during winter season. See Exhibit R.

True-up

True-up

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $2,476,527.04 $1,477,860.78 N/A $465,099.32 N/A
Total for all systems $4,540,515.91 $2,825,607.61 N/A $1,248,223.13 N/A
Interim Transmitter ULXTE-20 $1,003,800.00 $262,847.91 $161,538.33
UHF inside RF system including switching $147,500.00 $17,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $5,502.26 N/A
50 Ton system $266,000.00 $96,392.50 Updated cost estimate per FCC guidelines. Check quote for CCI and Quote for WHW. 1/6 share of the entire quotes added including added scope. $53,707.98 N/A
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $2,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $0.00 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $4,375.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $4,537.50 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $3,645.79 N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $137,542.91 This cost is shared with all DTV Utah stations and represents 1/6 of the cost of this item. $98,682.30 N/A
Primary Transmitter THU9evo-16 $1,472,727.04 $1,215,012.87 $303,560.99
Band 5 Harmonic Filter $6,230.30 $6,230.30 N/A $6,230.30 N/A
Dummy Load and Switches $49,879.14 $49,879.14 N/A $49,879.14 N/A
Large Parallel Remote Interface $934.94 $934.94 N/A $934.94 N/A
Additional parts $190.05 $190.05 N/A $190.05 N/A
Replacement Services $79,212.42 $79,212.42 N/A $79,212.42 The need more information can be removed.
50 Ton system $266,000.00 $37,785.83 This cost is shared with eight stations, six of which are repacked, and we estimate $180,000 total for the cost of this HVAC service. $37,785.83 The need more information can be removed.
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $20,000.00 N/A $0.00 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $0.00 N/A
Installation $27,480.19 $27,480.19 N/A $27,480.19 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $922,000.00 N/A $101,848.12 N/A

Components

Actual Information Description File Name
UHF inside RF system including switching

Component Description:
Transmitter related cost. #233001
Amount:
$557.63

Component Description:
1/6 share for 25% of Transmitter related cost. #GTIA-1010
Amount:
$201.09

Component Description:
1/6 share of interim transmitter related cost. #GTIA-1024
Amount:
$308.50

Component Description:
1/6 share of interim transmitter related cost. #266916
Amount:
$1,236.39

Component Description:
1/6 share of interim transmitter related cost. #267999
Amount:
$2,589.33

Component Description:
1/6 share of interim transmitter related cost. #268011
Amount:
$6.06

Component Description:
1/6 share of interim transmitter cost. #GTIA-1018
Amount:
$603.26
50 Ton system

Component Description:
Interim Transmitter related cost, progress payment 4. #147696
Amount:
$8,627.50

Component Description:
Updated 1/6 share of transmitter related cost. #171552
Amount:
$933.33

Component Description:
1/6 share of cost for transmitter HVAC project. #171552
Amount:
$933.33

Component Description:
1/6 cost of HVAC project payment 1. #141941
Amount:
$16,416.66

Component Description:
1/6 share of cost for HVAC work. #145734
Amount:
$14,166.66

Component Description:
1/6 share of the cost of the transmitter HVAC project. Payment 2. #170702
Amount:
$266.66

Component Description:
1/6 share of cost for HVAC project, payment 2. #143250
Amount:
$11,163.83

Component Description:
Interim transmitter related cost, progress payment 1. #141941
Amount:
$16,416.66

Component Description:
Interim Transmitter related cost, progress payment 2. #143250
Amount:
$11,163.83

Component Description:
1/6 share of costs for HVAC project, payment 4. #147696
Amount:
$8,627.50

Component Description:
1/6 share of transmitter related cost. #170701
Amount:
$2,400.00

Component Description:
1/6 cost of HVAC project. #171551
Amount:
$7,466.66

Component Description:
1/6 share of the cost of transmitter HVAC project. #170701
Amount:
$2,400.00

Component Description:
Interim Transmitter related cost, progress payment 5. #10833x-718
Amount:
$10,255.33
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp

Component Description:
1/6 share of transmitter switchgear related cost. #17051
Amount:
$496.60

Component Description:
1/6 share of switchgear related cost for transmitter. #17470
Amount:
$3,149.19
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
Transmitter related cost. #9514
Amount:
$660.43

Component Description:
1/6 share of cost for interim transmitter. #JW30003982-BS
Amount:
$27,365.14

Component Description:
Install station specific transmitter electrical equipment. #717-100
Amount:
$15,222.00

Component Description:
1/6 share of cost for interim transmitter. #US0310264
Amount:
$21,682.94

Component Description:
Transmitter related cost. #9511
Amount:
$459.77

Component Description:
1/6 share of costs for interim transmitter. #US0311663
Amount:
$5,412.88

Component Description:
1/6 share of cost for interim transmitter. #JW30003982-DP
Amount:
$27,365.14

Component Description:
Transmitter downpayment. #9500074989
Amount:
$40,494.81

Component Description:
Transmitter related cost. #9510
Amount:
$514.00
Band 5 Harmonic Filter

Component Description:
Transmitter related cost. #9500077414
Amount:
$1,538.64

Component Description:
Transmitter related cost. #75049
Amount:
$4,691.66
Dummy Load and Switches

Component Description:
Transmitter related cost. #9500083984
Amount:
$11,753.50

Component Description:
Transmitter related cost. #002073
Amount:
$12,695.34

Component Description:
Transmitter related cost. #9500085346
Amount:
$25,430.30
Large Parallel Remote Interface

Component Description:
Transmitter related cost. #9500084006
Amount:
$934.94
Additional parts

Component Description:
Transmitter related cost. #129
Amount:
$190.05
Replacement Services

Component Description:
Transmitter related cost. #6894
Amount:
$79,212.42

Component Description:
Transmitter related cost. #6894
Amount:
$79,212.42
50 Ton system

Component Description:
Transmitter related cost. #148929
Amount:
$3,990.34

Component Description:
Transmitter related cost. #147347
Amount:
$2,118.15

Component Description:
Transmitter related cost. #171553
Amount:
$933.33

Component Description:
Transmitter related cost. #SLC0116329
Amount:
$153.79

Component Description:
1/6 share of costs for HVAC system. #141941
Amount:
$16,416.66

Component Description:
Credit memo. #150265
Amount:
($1,047.50)

Component Description:
Transmitter related cost. #170702
Amount:
$266.66

Component Description:
Transmitter related cost. #149290
Amount:
$11,160.91

Component Description:
Credit memo. #CM151596
Amount:
($2,083.71)

Component Description:
Transmitter related cost. #171551
Amount:
$6,200.00

Component Description:
Transmitter related cost. #002073
Amount:
N/A

Component Description:
Transmitter related cost. #156557
Amount:
$626.10

Component Description:
Transmitter related cost. #147344
Amount:
$4,194.93

Component Description:
Transmitter related cost. #10833x-718
Amount:
$10,255.33

Component Description:
Transmitter related cost. #10833x-718
Amount:
$10,225.33
2" 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.
Installation

Component Description:
Transmitter related cost. #717-103
Amount:
$25,668.00

Component Description:
Transmitter related cost. #717-105
Amount:
$995.35

Component Description:
Transmitter related cost. #717-108
Amount:
$816.84
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter cost. #9500074989
Amount:
$101,848.12

Component Description:
Transmitter related cost. #6894
Amount:
N/A

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $554,566.67 $681,836.92 N/A $566,622.52 N/A
Total for all systems $4,540,515.91 $2,825,607.61 N/A $1,248,223.13 N/A
Primary Antenna 759 25063 $554,566.67 $681,836.92 $566,622.52
Other Costs $50,873.70 $50,873.70 ***System Notice: Estimate adjusted and locked because line has been superseded.***Updated estimated amount per FCC's requirement. $36,765.06 N/A
Antenna Installation $23,062.97 $23,062.97 N/A $23,062.97 N/A
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $120,000.00 The station now has an invoice with this cost separated as a line item, and is entering it in the 399 as such. $33,264.48 The need more information for KSL and Burk can be removed.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $8,014.01 N/A $8,014.01 N/A
UHF - High Power Top Mount Eight Station broadband panel antenna elliptically or circularly polarized $250,000.00 $250,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit D. $238,471.92 N/A
Sweep test of existing antenna $6,730.00 $6,000.00 N/A $3,157.24 N/A
New combiner, cost per channel (without antenna) $84,200.00 $223,886.24 As per the request of the FCC $223,886.84 The share of the cost is greater than expected because the FCC requested to use 1/6 share as opposed to 1/8 share of the cost. Please delete the old entries as the new ones are updated.

Components

Actual Information Description File Name
Other Costs

Component Description:
Antenna related cost. #261013
Amount:
$191.95

Component Description:
1/6 share of antenna installation. #GTIA-1021
Amount:
$798.45

Component Description:
1/6 share of remainder antenna installation cost. #GTIA-1055
Amount:
$11,754.09

Component Description:
1/6 share of antenna installation cost. #GTIA-1011
Amount:
$1,748.05

Component Description:
1/6 share of cost for antenna installation. #GTIA-1012
Amount:
$1,310.83

Component Description:
1/6 share of antenna installation. #GTIA-1004
Amount:
$11,754.09

Component Description:
1/6 share of cost for antenna installation. #GTIA-1036
Amount:
$23,508.19
Antenna Installation

Component Description:
Antenna related cost. #GTIA-1011
Amount:
$1,748.05

Component Description:
Antenna related cost. #GTIA-1021
Amount:
$798.45

Component Description:
Antenna related cost. #GTIA-1108
Amount:
$4,445.72

Component Description:
Antenna installation related cost 1/6 of 25% down payment. #GTIA-1011
Amount:
$1,748.05

Component Description:
Antenna related cost. #273029
Amount:
$4,316.66

Component Description:
Antenna related cost. #GTIA-1055
Amount:
$11,754.09
Combiner output splitting/switching for dual feed lines, if applicable

Component Description:
Antenna related cost. #235015
Amount:
$1,401.51

Component Description:
Antenna related cost. #242051
Amount:
$406.25

Component Description:
Antenna related cost. #0000000407
Amount:
$213.19

Component Description:
Antenna related cost. #US0311888
Amount:
$3,320.18

Component Description:
Antenna related cost. #273003
Amount:
$22,679.29

Component Description:
Antenna related cost. #0000000507
Amount:
$246.05

Component Description:
Antenna related cost. #414
Amount:
$216.88

Component Description:
Antenna related cost. #717-107
Amount:
$106.33

Component Description:
Credit memo. #CM-2021-12-06-KJZZ
Amount:
($2,561.53)

Component Description:
Combiner related cost. #0000000318
Amount:
$61.85

Component Description:
Antenna related cost. #403
Amount:
$277.43

Component Description:
Antenna related cost. #0000000404
Amount:
$196.25

Component Description:
Combiner cost. #00068513-3
Amount:
$2,561.53

Component Description:
Antenna related cost. #6898
Amount:
$2,321.33

Component Description:
Antenna related cost. #236006
Amount:
$406.25

Component Description:
Antenna related cost. #69115
Amount:
$3,906.86

Component Description:
Antenna related cost. #0000000406
Amount:
$4.51

Component Description:
Antenna related cost. #318
Amount:
$61.85

Component Description:
Antenna related cost. #00068513-3
Amount:
$2,561.53
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Antenna related cost. #230017
Amount:
$917.06

Component Description:
Antenna related cost. #75050
Amount:
$992.51

Component Description:
1/6 share of cost for antenna installation related cost. #GTIA-1050
Amount:
$4,794.94

Component Description:
Antenna related cost. #90003
Amount:
$1,309.50
UHF - High Power Top Mount Eight Station broadband panel antenna elliptically or circularly polarized

Component Description:
1/6 share for second incremental invoice (25% of total) of High Power antenna installation. #GTIA-1035
Amount:
$47,876.97

Component Description:
Antenna related cost. #GTIA-1111
Amount:
$3,333.33

Component Description:
1/6 share of progress payment for high power antenna cost. #GTIA-1048
Amount:
$86,178.56

Component Description:
1/6 share for 25% of antenna related cost. #GTIA-1005
Amount:
$47,876.97

Component Description:
1/6 share of final 25% invoiced for antenna related cost. #GTIA-1056
Amount:
$7,710.92

Component Description:
1/6 share of high power antenna cost. #STS87757-1
Amount:
$4,160.41

Component Description:
1/6 share of cost for antenna installation. #GTIA-1057
Amount:
$4,794.94

Component Description:
1/6 share of final invoice for antenna related cost. #GTIA-1054
Amount:
$9,575.39

Component Description:
1/6 share of progress payment for high power antenna related cost. #GTIA-1049
Amount:
$6,400.09

Component Description:
1/6 share of cost for antenna installation. #GTIA-1002
Amount:
$5,142.50

Component Description:
1/6 share for 25% down payment for Antenna related costs. #GTIA-1003
Amount:
$7,710.92

Component Description:
1/6 share of antenna cost. #GTIA-1037
Amount:
$7,710.92
Sweep test of existing antenna

Component Description:
1/6 share of cost for antenna sweep test. #GTIA-1000
Amount:
$2,828.08

Component Description:
1/6 share of cost for antenna sweep test. #GTIA-1001
Amount:
$329.16
New combiner, cost per channel (without antenna)

Component Description:
1/6 share of cost for the construction for a new combiner and monitor system. #00068513
Amount:
$5,123.06

Component Description:
1/6 share of the second payment that is due for the associated new combiner cost. #00068513-2
Amount:
$5,123.06

Component Description:
1/6 share of cost for the construction of a new combiner and monitor system. #00068513
Amount:
$5,123.06

Component Description:
Updated 1/6 share of antenna related cost. #GTIA-1086
Amount:
$6,727.52

Component Description:
1/6 share of antenna related reduced cost. #23001
Amount:
$90,717.50

Component Description:
1/6 of antenna related reduced cost. #CLE 068 RevD-DP
Amount:
$22,679.35

Component Description:
Antenna related cost. #00068513-3
Amount:
$2,561.53

Component Description:
Antenna related cost #0000000461
Amount:
$237.33

Component Description:
1/6 share of new combiner cost last balance due. #00068513-3
Amount:
$2,561.53

Component Description:
Updated 1/6 share of antenna related cost.
Amount:
$113,396.87

Component Description:
1/6 share of antenna related reduced cost. #25008
Amount:
$90,717.49

Component Description:
1/6 share of new combiner cost. #GTIA-1086
Amount:
$6,727.52

Component Description:
1/6 share of costs for interim transmitter. #US0311888
Amount:
$3,320.18

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $854,600.00 $101,500.00 N/A $2,413.47 N/A
Total for all systems $4,540,515.91 $2,825,607.61 N/A $1,248,223.13 N/A
Primary Tower TOWER $854,600.00 $101,500.00 $2,413.47
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $50,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit L for partial cost. $0.00 N/A
Major tower reinforcement/modifications $421,000.00 $50,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $1,515.15 N/A
Structural engineering tower load study for well documented tower $12,600.00 $1,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $898.32 N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Major tower reinforcement/modifications

Component Description:
1/6 share of tower related cost. #GTIA-1087
Amount:
$1,515.15
Structural engineering tower load study for well documented tower

Component Description:
1/6 Share of cost for tower engineering study. #GTIA-1025
Amount:
$671.66

Component Description:
1/6 share of cost for one month of structural engineering & design services. #8895
Amount:
$226.66

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 $276,919.10 $187,586.81 N/A $162,623.49 N/A
Total for all systems $4,540,515.91 $2,825,607.61 N/A $1,248,223.13 N/A
Outside Professional Services $276,919.10 $187,586.81 $162,623.49
Sinclair Internal Costs $409.10 $409.10 N/A $409.10 .
RF Exposure Measurements $21,050.00 $18,296.87 This cost is shared with all DTV Utah stations and represents 1/6 of the cost of this item. $18,296.87 .
Comprehensive coverage verification via field study, if needed $84,200.00 $10,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $3,468.50 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 $0.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $3,043.64 N/A $3,043.64 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $0.00 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $221.92 N/A $221.92 .
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $2,565.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $659.45 N/A $659.45 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $5,785.83 See Carl T. Jones invoices $5,785.83 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $10,170.00 See Carl T. Jones invoices $10,170.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,360.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $375.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,418.10 N/A
Project management of the transition $126,400.00 $120,000.00 N/A $108,850.08 N/A

Components

Actual Information Description File Name
Sinclair Internal Costs

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$16.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$23.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$25.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$6.09

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations.
Amount:
$1.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.39

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$26.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$15.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 35 stations.
Amount:
$5.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations.
Amount:
$24.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$8.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 60 stations.
Amount:
$4.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations.
Amount:
$23.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$5.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$17.02

Component Description:
Portion of general repack matter internal time card attributable to this station - divided by 100.
Amount:
$66.55

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 35 stations.
Amount:
$30.43

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$33.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$1.69

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$9.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 60 stations.
Amount:
$23.77
RF Exposure Measurements

Component Description:
RF related cost. #202023
Amount:
$4,000.00

Component Description:
1/6 share of the outside professional service. #7251
Amount:
$14,296.87
Comprehensive coverage verification via field study, if needed

Component Description:
Coverage cost. #17174
Amount:
$3,468.50
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
1/6 share of legal service cost. #843151
Amount:
$1,960.50

Component Description:
1/6 share of legal cost. #856027
Amount:
$415.83

Component Description:
1/6 share of legal service cost. #857095
Amount:
$68.00

Component Description:
1/6 share of legal service cost. #842108
Amount:
$165.91

Component Description:
1/6 share of legal service cost. #854957
Amount:
$357.00

Component Description:
1/6 share of legal service cost. #844167
Amount:
$501.40
ASR modification (prepare FCC Form 854) 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

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$99.92

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$122.00
Prepare request for Special Temporary Authorization

Component Description:
Outside professional service cost. #878-74-0004
Amount:
$2,565.00

Component Description:
Outside professional service cost. #878-74-0004
Amount:
$2,565.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Updated 1/6 share of special temporary authorization cost. #18-032A
Amount:
$659.45

Component Description:
1/6 share of professional legal service cost. #18-032A
Amount:
$659.45
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Outside professional service cost. #878-74-0006
Amount:
$4,567.50

Component Description:
Outside professional service cost. #09282018
Amount:
$933.33

Component Description:
Outside professional service cost. #878-74-0007
Amount:
$285.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Outside professional service cost. #878-74-0005
Amount:
$5,797.50

Component Description:
Outside professional service cost. #878-74-0002
Amount:
$1,987.50

Component Description:
Consulting engineering cost. #878-74-0001
Amount:
$2,385.00

Component Description:
Outside professional service cost. #878-74-0002
Amount:
$1,987.50
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting engineering services. #878-74-0001
Amount:
$2,655.00

Component Description:
Consulting engineering cost. #858-64-0001
Amount:
$3,705.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Legal services cost.
Amount:
$375.00
Prepare and or review reimbursement form

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$152.01

Component Description:
Legal services cost. #461804
Amount:
$85.31

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$869.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$1,311.48
Project management of the transition

Component Description:
$26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for Invoice 461759 (correct reimbursement amount is $709.74). #CM-11-21-2019-461759
Amount:
($289.46)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093
Amount:
$265.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173
Amount:
$311.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 33 stations. #486788
Amount:
$583.82

Component Description:
Outside professional service cost. #18-00057
Amount:
$288.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1105
Amount:
$216.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #1086
Amount:
$275.35

Component Description:
Outside professional service cost. #18-00005
Amount:
$742.45

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #132
Amount:
$589.44

Component Description:
Legal Service Cost. #476372
Amount:
$102.50

Component Description:
1/6 outside professional service cost. #17-0049
Amount:
$703.95

Component Description:
Legal Service Cost. #469584
Amount:
$963.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations. #485240
Amount:
$541.57

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #480175
Amount:
$377.96

Component Description:
Legal Service Cost. #473544
Amount:
$1,548.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #464321
Amount:
$683.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474405
Amount:
$490.56

Component Description:
Outside professional service cost. #18-119
Amount:
$14.58

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475283
Amount:
$384.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475744
Amount:
$305.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1079
Amount:
$177.14

Component Description:
Legal services cost. #487612
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473885
Amount:
$318.62

Component Description:
Legal services cost. #460941
Amount:
$765.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476367
Amount:
$364.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #107
Amount:
$602.28

Component Description:
Legal services cost. #453970
Amount:
$172.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470923
Amount:
$406.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #118
Amount:
$468.97

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1090
Amount:
$176.70

Component Description:
Outside professional service cost. #18-00038
Amount:
$256.94

Component Description:
Legal Service Cost. #472178
Amount:
$956.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1130
Amount:
$281.49

Component Description:
Legal Service Cost. #475289
Amount:
$757.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1145
Amount:
$369.98

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 33 stations. #288
Amount:
$1,726.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479285
Amount:
$372.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #471524
Amount:
$322.83

Component Description:
Legal Service Cost. #470875
Amount:
$51.25

Component Description:
Legal Service Cost. #473891
Amount:
$1,168.75

Component Description:
Outside professional service cost. #17-0021
Amount:
$1,102.36

Component Description:
Legal Service Cost. #470915
Amount:
$212.50

Component Description:
Legal Service Cost. #471530
Amount:
$893.75

Component Description:
1/6 outside professional service cost. #17-0036
Amount:
$916.62

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1133
Amount:
$307.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479829
Amount:
$458.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476885
Amount:
$403.34

Component Description:
Outside professional service cost. #19-0087
Amount:
$1,112.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470237
Amount:
$436.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467861
Amount:
$470.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1098
Amount:
$238.07

Component Description:
Outside professional service cost. #859300
Amount:
$362.91

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478288
Amount:
$194.86

Component Description:
Legal Service Cost. #472589
Amount:
$1,921.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1117
Amount:
$282.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 59 stations. #295
Amount:
$997.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #468718
Amount:
$349.51

Component Description:
Legal Service Cost. #471525
Amount:
$780.70

Component Description:
Legal Service Cost. #473966
Amount:
$57.50

Component Description:
Legal Service Cost. #469697
Amount:
$62.50

Component Description:
Legal services cost. #474912
Amount:
$313.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463567
Amount:
$566.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 43 stations. #306
Amount:
$1,691.34

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1143
Amount:
$436.90

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453972
Amount:
$716.28

Component Description:
Outside professional service cost. #854957
Amount:
$357.00

Component Description:
Legal Service Cost. #475750
Amount:
$861.25

Component Description:
Legal Service Cost. #464259
Amount:
$575.00

Component Description:
Outside professional service cost. #857095
Amount:
$68.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$91.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #469573
Amount:
$377.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473506
Amount:
$421.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457331
Amount:
$836.44

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457851
Amount:
$818.59

Component Description:
Outside Consulting Cost. #1080
Amount:
$4,032.00

Component Description:
Legal Service Cost. #472993
Amount:
$2,656.90

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478780
Amount:
$271.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1114
Amount:
$242.25

Component Description:
Outside professional service cost. #858220
Amount:
$640.66

Component Description:
updated 1/6 share of outside consulting cost. #17-000137
Amount:
$699.66

Component Description:
Legal services cost. #487020
Amount:
$58.75

Component Description:
Legal services cost. #477825
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1063
Amount:
$262.29

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465001
Amount:
$596.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1012
Amount:
$20.65

Component Description:
Legal services cost. #487957
Amount:
$57.50

Component Description:
1/6 share of outside consulting cost. #18-00031
Amount:
$521.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1141
Amount:
$406.17

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1156
Amount:
$399.52

Component Description:
Outside professional service cost. #0000002214
Amount:
$876.75

Component Description:
1/6 share of outside consulting cost. #18-00008
Amount:
$545.14

Component Description:
1/6 share of outside consulting cost. #18-00005
Amount:
$742.45

Component Description:
1/6 share of outside consulting cost. #18-00037
Amount:
$837.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1167
Amount:
$313.41

Component Description:
1/6 share of outside consulting services. #18-00056
Amount:
$1,046.00

Component Description:
Legal Service Cost. #465184
Amount:
$4,462.50

Component Description:
Legal services cost. #464698
Amount:
$240.00

Component Description:
Legal services cost. #463575
Amount:
$250.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$29.98

Component Description:
Legal Service Cost. #468722
Amount:
$57.50

Component Description:
Legal Service Cost. #470280
Amount:
$523.75

Component Description:
Outside professional service cost. #18-00044
Amount:
$591.28

Component Description:
Updated 1/6 share of outside consulting cost. #18-00056
Amount:
$1,046.00

Component Description:
1/6 share of outside consulting cost. #18-00017
Amount:
$359.67

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809
Amount:
$395.77

Component Description:
1/6 share of costs for engineering consulting cost. #GTIA-1038
Amount:
$1,750.00

Component Description:
1/6 share of outside consulting cost. #191
Amount:
$1,200.00

Component Description:
Legal services cost. #474816
Amount:
$562.50

Component Description:
1/6 share of outside consulting cost. #18-00039
Amount:
$17.82

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1058
Amount:
$187.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1032
Amount:
$43.72

Component Description:
Legal Service Cost. #467387
Amount:
$209.07

Component Description:
Legal services cost. #464356
Amount:
$1,250.00

Component Description:
1/6 outside professional service cost. #17-0026
Amount:
$916.41

Component Description:
Legal Service Cost. #466699
Amount:
$1,760.95

Component Description:
Outside professional service cost. #18-00039
Amount:
$17.82

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1111
Amount:
$159.58

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1151
Amount:
$388.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1022
Amount:
$32.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1051
Amount:
$105.97

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations. #247
Amount:
$1,105.31

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1055
Amount:
$243.38

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1039
Amount:
$30.47

Component Description:
1/6 share of cost for engineering consulting costs. #GTIA-1007
Amount:
$2,763.54

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1078
Amount:
$215.68

Component Description:
Legal services cost. #485259
Amount:
$100.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477305
Amount:
$393.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #487892
Amount:
$103.07

Component Description:
1/6 share of outside consulting service cost. #17-0042
Amount:
$891.87

Component Description:
updated 1/6 share of outside consulting services. #17-0036
Amount:
$916.62

Component Description:
Updated outside consulting services. #1080
Amount:
$4,032.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 43 stations. #487620
Amount:
$337.32

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1010
Amount:
$86.88

Component Description:
1/6 share of outside consulting cost. #18-00023
Amount:
$358.38

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477820
Amount:
$320.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1045
Amount:
$185.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1123
Amount:
$342.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453686
Amount:
$943.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465173
Amount:
$654.26

Component Description:
1/6 share of outside consulting services. #GTIA-1007
Amount:
$2,763.54

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1029
Amount:
$20.91

Component Description:
1/6 share of consulting cost. #18-00027
Amount:
$525.66

Component Description:
Outside professional service cost. #18-00069
Amount:
$1,057.25

Component Description:
Outside professional service cost. #18-00074
Amount:
$754.52

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 60 stations. #487016
Amount:
$267.75

Component Description:
Legal services cost. #478786
Amount:
$1,417.70

Component Description:
Outside professional service cost. #18-045
Amount:
$202.70

Component Description:
1/6 share of outside consulting service cost. #17-0053
Amount:
$445.45

Component Description:
1/6 share of outside consulting service cost. #17-0021
Amount:
$1,102.36

Component Description:
Consulting cost. #1800032
Amount:
$101.15

Component Description:
Legal services cost. #463022
Amount:
$5,586.40

Component Description:
Legal Service Cost. #478786
Amount:
$1,417.70

Component Description:
1/6 outside professional service cost. #17-0053
Amount:
$445.45

Component Description:
Legal services cost. #464259
Amount:
$575.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472583
Amount:
$279.89

Component Description:
Legal Service Cost. #467895
Amount:
$318.75

Component Description:
Legal Service Cost. #467841
Amount:
$1,988.40

Component Description:
Legal service cost. #457856
Amount:
$3,745.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #450412
Amount:
$999.04

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1072
Amount:
$237.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #466690
Amount:
$446.87

Component Description:
Outside professional service cost. #19-0002
Amount:
$182.02

Component Description:
1/6 share of outside consulting service cost. #17-0026
Amount:
$916.41

Component Description:
Legal Service Cost. #467497
Amount:
$564.20

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #309
Amount:
$1,299.46

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1069
Amount:
$246.68

Component Description:
1/6 share of outside consulting service cost. #17-0049
Amount:
$703.95

Component Description:
Outside professional service cost. #18-069
Amount:
$29.16

Component Description:
Legal Service Cost. #471619
Amount:
$1,773.75

Component Description:
1/6 share of outside consulting services. #18-00065
Amount:
$1,497.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1099
Amount:
$266.93

Component Description:
Legal Service Cost. #467387
Amount:
$209.07

Component Description:
1/6 share of outside consulting services. #18-00043
Amount:
$1,215.74

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467378
Amount:
$576.96

Component Description:
1/6 share of outside consulting service cost. #17-00137
Amount:
$699.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1161
Amount:
$267.48

Component Description:
1/6 share of outside consulting cost. #18-00061
Amount:
$2,803.83

Component Description:
1/6 share of outside consulting cost. #17-0036
Amount:
$916.62

Component Description:
1/6 share of outside consulting cost. #17-0059
Amount:
$696.62

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985
Amount:
$282.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026
Amount:
$801.57

Component Description:
Legal Service Cost. #468747
Amount:
$2,552.90

Component Description:
Outside professional service cost. #18-00039
Amount:
$19.32

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 $377,903.10 $376,823.10 N/A $51,464.33 N/A
Total for all systems $4,540,515.91 $2,825,607.61 N/A $1,248,223.13 N/A
Other Expenses $377,903.10 $376,823.10 $51,464.33
Temporary Sanitation $3,000.00 $3,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit S. Estimate is based on past experience at this site. $0.00 N/A
Tax $26,305.23 $26,305.23 N/A $26,305.23 x
KSTU Mask Filter $6,756.25 $6,756.25 Mask filter to remedy adjacent channel problem with KSTU. This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit N. $0.00 N/A
Garbage Disposal $1,500.00 $1,500.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. Billed as used, but the estimate is based on past experience at this site. $1,212.50 N/A
DTV Utah Operating Agreement Equity Equalization $223,083.00 $223,083.00 See Exhibit M. $0.00 N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A $0.00 N/A
Develop and air announcement of upcoming channel change $28,050.00 $28,050.00 See Exhibit T. $0.00 N/A
Equipment Storage $4,000.00 $4,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit Q. $3,710.49 N/A
Equipment Delivery and Handling Charges $18,687.62 $18,687.62 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit P. $18,645.12 N/A
True-up $0.00 $0.00 N/A ($7,005.49) N/A
Transportation Services $5,000.00 $5,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. To be used during inclement weather. $1,871.65 N/A
Temporary Storage $4,000.00 $4,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit P. $1,927.50 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $4,549.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $0.00 N/A $0.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $0.00 N/A $0.00 N/A
Non-zoning permits $1,875.00 $1,875.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. $0.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $28,566.00 $28,566.00 See Exhibit U. $248.33 N/A
Road Maintenance $10,000.00 $10,000.00 This cost is shared with all DTV Utah stations and represents 1/8 of the cost of this item. See Exhibit R. $0.00 N/A

Components

Actual Information Description File Name
Temporary Sanitation Information not provided.
Tax

Component Description:
Use Tax cost. #2018-Q3 UseTax
Amount:
$24,781.56

Component Description:
Use tax cost. #2018-Q2 UseTax
Amount:
$91.81

Component Description:
Use tax cost. #2018-Q4 UseTax
Amount:
$1,075.62

Component Description:
Use Tax cost. #2018-Q1 UseTaxCorrected
Amount:
$17.81

Component Description:
Use tax cost. #2018-Q1 UseTax
Amount:
$53.45

Component Description:
Use tax cost. #2017-Q4 UseTax
Amount:
$284.98
KSTU Mask Filter Information not provided.
Garbage Disposal

Component Description:
1/6 share of garbage disposal cost. #10581
Amount:
$300.00

Component Description:
1/6 share of garbage disposal cost. #10660
Amount:
$225.00

Component Description:
Garbage disposal. #10184
Amount:
$312.50

Component Description:
1/6 share of garbage disposal cost. #10786
Amount:
$150.00

Component Description:
1/6 share of garbage disposal cost. #10723
Amount:
$225.00
DTV Utah Operating Agreement Equity Equalization Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
1/6 share of equipment storage cost. #0029104-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029067-In
Amount:
$187.50

Component Description:
Equipment storage cost. #1-47568
Amount:
$33.33

Component Description:
1/6 share of cost for equipment storage. #0029058-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029169-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029086
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029220-IN
Amount:
$308.33

Component Description:
1/6 share of equipment storage cost. #0029122-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029188-IN
Amount:
$187.50

Component Description:
1/6 share of cost for equipment storage. #002901-IN
Amount:
$120.83

Component Description:
1/6 share of cost for equipment storage. #0029207-IN
Amount:
$308.33

Component Description:
1/6 share of equipment storage cost. #9568587381
Amount:
$139.68

Component Description:
1/6 share of equipment storage cost. #0029246-IN
Amount:
$308.33

Component Description:
1/6 share of equipment storage cost. #0029141-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. 0029156-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029104-IN
Amount:
$187.50

Component Description:
1/6 share of equipment storage cost. #0029262-IN
Amount:
$308.33

Component Description:
1/6 share of equipment storage cost. #0029234-IN
Amount:
$308.33
Equipment Delivery and Handling Charges

Component Description:
1/6 share of cost for equipment rental and delivery. #179518
Amount:
$503.82

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029150-IN
Amount:
$14.16

Component Description:
Equipment delivery and handling cost. #250008
Amount:
$2,325.91

Component Description:
Equipment delivery and handling cost. #0000002268
Amount:
$955.98

Component Description:
1/6 share of cost for equipment handling and transportation service. #0029079-IN
Amount:
$70.83

Component Description:
Equipment delivery and handling cost. #241416A
Amount:
$562.50

Component Description:
Equipment delivery and handling cost. #0029299-IN
Amount:
$113.34

Component Description:
Equipment delivery and handling cost. #1862
Amount:
$216.66

Component Description:
Equipment delivery and handling cost. #0029311-IN
Amount:
$28.33

Component Description:
Equipment delivery and handling cost. #240916A
Amount:
$637.50

Component Description:
Equipment delivery and handling. #0029274-IN
Amount:
$99.16

Component Description:
Updated 1/6 share of cost for equipment delivery and handling.
Amount:
$264.97

Component Description:
Equipment delivery and handling reduced by 8.40%. #279013
Amount:
$885.52

Component Description:
Equipment delivery and handling cost. #0029199-IN
Amount:
$42.50

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029115-IN
Amount:
$55.66

Component Description:
Equipment delivery and handling cost. #240679A
Amount:
$600.00

Component Description:
Equipment delivery and handling cost. #1916
Amount:
$241.66

Component Description:
1/6 share of equipment delivery/handling cost. #244363A
Amount:
$62.50

Component Description:
Equipment delivery and handling cost. #19-022
Amount:
$727.51

Component Description:
1/6 share of cost for equipment and delivery. #189068-2
Amount:
$385.58

Component Description:
1/6 share of equipment delivery and handling cost. #100
Amount:
$40.83

Component Description:
1/6 share of equipment delivery and handling cost. #0029166-AD
Amount:
$14.16

Component Description:
Freight cost. #239058A
Amount:
$450.00

Component Description:
1/6 share of cost for equipment handling and transportation service. #0029097-IN
Amount:
$77.91

Component Description:
Equipment delivery and handling cost. #237008
Amount:
$443.17

Component Description:
1/6 share of equipment delivery and handling cost. #239940A
Amount:
$100.00

Component Description:
1/6 share of equipment delivery and handling cost. #9450
Amount:
$1,553.69

Component Description:
1/6 share of equipment delivery and handling cost. #189065
Amount:
$265.99

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029132-IN
Amount:
$42.50

Component Description:
Equipment delivery and handling cost. #717-102
Amount:
$3,652.40

Component Description:
1/6 share of equipment delivery and handling cost. #189068
Amount:
$1,020.24

Component Description:
1/6 share of equipment delivery and handling cost. #239583A
Amount:
$68.75

Component Description:
Equipment delivery and handling cost. #0029281-IN
Amount:
$308.33

Component Description:
1/6 share of cost for equipment handling and transportation services. #0029199-IN
Amount:
$28.33

Component Description:
Equipment delivery and handling cost. #0029244-IN
Amount:
$28.33

Component Description:
1/6 share of equipment delivery and handling cost. #228748A
Amount:
$100.00

Component Description:
Equipment delivery and handling cost. #0029217-AD
Amount:
$255.00

Component Description:
Equipment delivery and handling cost. #1838
Amount:
$108.33

Component Description:
1/6 share of equipment delivery and handling cost. #239584A
Amount:
$68.75

Component Description:
Equipment delivery and handling cost. #0029231-IN
Amount:
$1,112.08

Component Description:
1/6 share of equipment delivery and handling. #189067
Amount:
$176.98

Component Description:
Equipment delivery and handling cost. #243092A
Amount:
$243.75
True-up

Component Description:
Dielectric Credit Memo. #CM-2021-10-01-KJZZ
Amount:
($7,005.49)
Transportation Services

Component Description:
1/6 share of costs for transportation service. #900
Amount:
$507.50

Component Description:
1/6 Share of cost for transportation service. #932
Amount:
$362.50

Component Description:
1/6 share of cost for transportation service. #932
Amount:
$362.50

Component Description:
1/6 share of transportation service cost. #1783
Amount:
$108.33

Component Description:
Transportation cost. #1838-1
Amount:
$216.66

Component Description:
1/6 share of cost for transportation service. #905
Amount:
$676.66
Temporary Storage

Component Description:
Storage cost. #1
Amount:
$1,927.50

Component Description:
Updated 1/6 share of temporary storage cost. #5-1-2017
Amount:
$1,927.50

Component Description:
Temporary storage unit cost. #5-1-2017
Amount:
$1,927.50
DTV Medical Facility Notification

Component Description:
1/6 share of DTV Notification Service cost. #INV-001775
Amount:
$2,385.00

Component Description:
1/6 share of DTV Medical Facility Notification. #INV-001827
Amount:
$2,164.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Non-zoning permits Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal related cost. #85285
Amount:
$173.33

Component Description:
Equipment disposal cost. #10848
Amount:
$75.00
Road Maintenance Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,540,515.91 $2,825,607.61 $1,248,223.13

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. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Lucy Rutishauser

CFO


12/08/2021

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.

Lucy Rutishauser

CFO


12/08/2021

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.

Lucy Rutishauser

CFO


12/08/2021

Attachments

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