TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

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

Applicant

Address

Phone

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

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

Applicant

Address

Phone

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

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	Replace transmitter, antenna, and transmission line. Acquire interim antenna system during construction and duration of the assigned phase. Map and analyze tower; design and implement modifications if required. See attached.

Transmitters

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

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	CTT-U-DCX-1
	Year	2007
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	25.3 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	THU9evo-24
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	37 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 a replacement as suggested by the FCC. See attachment.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	150 kVA
	Rigid Conduit and Wiring	Yes
	Size	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

Other Transmitter Cost Not Listed

Name	Description
Additional Transmitter Costs	Additional Transmitter Costs
Transmitter Installation Services	Transmitter Installation, drawings, and Electrical Installation. Please see Land Communications Estimate # 1096 attached.
Additional Interior RF System	Interior RF System Existing Transmitter to Interim Transmission line
Burk SNMP LIcense	License for Burk remote for new Rhode & Schwarz Transmitter Please see Heartland Video Systems Quote # WISQ65253 attached.
Transmitter Electrical Services	Transmitter Electrical Services; disconnect wiring to old transmitter

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	900.0 kW
	Manufacturer
	Model	TFU-25JSC-R P210SP
	Year	2007

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	910.0 kW
	Manufacturer
	Model	TFU-25JSC/VP-R P210
	Year	2018
	Justification for New Antenna	The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel.

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	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?	Yes
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	Yes
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Additional Antenna Costs	Additional Antenna Costs
Radome Color Change	Due to placement of new RePack Antenna, color of radome needed to be changed from orange to white. Please see Addendum #2 of Precision Communications Proposal #20302-5 attached.

Interim Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	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:	900.0 kW
	Manufacturer
	Model	TBD
	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

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

Other Antenna Cost Not Listed

Name	Description
Elbow Reinf Uneq Leg	Elbow Reinf Uneq Leg

Transmission Line

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

Primary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	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

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	The existing primary transmission line is rigid with section lengths that cannot accommodate the assigned channel.

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Type	Flexible Air
	Diameter	5 inches
	Segment Length	N/A
	Other Segment Length
	Number of parallel runs	1
	Length	390 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. Station will attempt to rent if renting is available at time of acquisition.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Transmission Line 6-50	Transmission Line 6-50

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?	Located on Building
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	Yes
	Others Types of Users	No
	Is tower documented for structural analysis?	No
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1035539
Coordinates (NAD83)	Latitude (NAD83)	42° 17' 14.0" N-
	Longitude (NAD83)	089° 10' 15.0" W-
	Overall Structure Height	708.65 feet
	Support Structure Height	649.60 feet
	Ground Elevation Above Mean Sea Level (AMSL)	790.67 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Mission Broadcasting, Inc.
	Date Constructed	01/01/1953

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
72945	WTVO	DTV

Primary Tower

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

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	Located on Building
Helicopter Services Required	Are helicopter services required?	No

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Additional Tower Work, and Weather Delays	Unexpected Work outside the original quote, & Weather Delays. Please see addendum to Proposal 20302-5 Attached.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	295
	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	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	Yes
	Number of Days	14
	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

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Facility Expenses	Name	N/A
	Other Distributed Transmission System Expenses Not listed	N/A
	Name	N/A
	Is Notification of a Medical Facility required as a result of DTV broadcasting?	Yes
Permit and Filing Costs	Local Zoning	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

Other Expenses Not Listed

Name	Description
Sales Tax	Sales and use tax on goods and services

Cost Information

Transmitters

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,849,522.38	$1,090,289.38	N/A	$884,789.38	N/A
Total for all systems	$3,672,062.05	$2,722,080.20	N/A	$2,364,249.88	N/A
Primary Transmitter THU9evo-24	$1,849,522.38	$1,090,289.38		$884,789.38
Transmitter Electrical Services	$1,935.00	$1,935.00	See Wilson Electric quote	$1,935.00	N/A
Burk SNMP LIcense	$506.38	$506.38	License for Burk remote for new Rhode & Schwarz Transmitter Please see Heartland Video Systems Quote # WISQ65253 attached.	$506.38	N/A
Additional Interior RF System	$140,000.00	$140,000.00	N/A	N/A	N/A
Additional Transmitter Costs	$56,969.00	$56,969.00	See Rohde & Schwarz quote 301980.0	$56,969.00	N/A
3" Rigid Conduit and Wiring (Cost per foot)	$5,200.00	$4,900.00	N/A	N/A	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$24,300.00	N/A	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	$1,473,000.00	$717,217.00	See Rohde & Schwarz quote 230148.0 less upgrade cost	$717,217.00	N/A
Transmitter Installation Services	$108,162.00	$108,162.00	Transmitter Installation, drawings, and Electrical Installation. Please see Land Communications Estimate # 1096 attached.	$108,162.00	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Transmitter Electrical Services	Component Description: Transmitter electrical disconnect Amount: $1,935.00
Burk SNMP LIcense	Component Description: SNMP Plus Amount: $506.38
Additional Interior RF System	Information not provided.
Additional Transmitter Costs	Component Description: Additional transmitter costs Amount: $56,969.00
3" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Transformer 3 phase/480v - 150 KVA	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	Component Description: Transmitter, installment #1, less upgrade cost Amount: $179,304.25 Component Description: Transmitter, installment #2, less upgrade cost Amount: $537,912.75
Transmitter Installation Services	Component Description: Transmitter installation Amount: $108,162.00
Switchgear - industrial 800 amp	Information not provided.

Cost Information

Antennas

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$328,110.00	$312,813.00	N/A	$289,499.00	N/A
Total for all systems	$3,672,062.05	$2,722,080.20	N/A	$2,364,249.88	N/A
Interim Antenna TBD	$54,469.00	$42,752.00		$26,051.00
Elbow Reinf Uneq Leg	$7,028.00	$7,028.00	See Dielectric quote 700443CMZ-4.	$7,028.00	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$12,623.00	See Dielectric quote 700443CMZ-4	$12,623.00	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$11,700.00	N/A	N/A	N/A
UHF - High Power, Side Mount, basic slot antenna, 900 kW input, directional,, horizontally polarized	$1.00	$1.00	WQRF will reuse TUA-P4-4/10H-1-SM antenna from KASN	N/A	N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$5,000.00	N/A	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
Primary Antenna TFU-25JSC/VP-R P210	$273,641.00	$270,061.00		$263,448.00
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$21,750.00	See Dielectric quote DMS160-2	$21,750.00	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$10,710.00	See Dielectric quote DMS160-2	$10,710.00	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
UHF - High Power, Side Mount, basic slot antenna, 910 kW input, directional,, elliptically or circularly polarized	$156,201.00	$156,201.00	See Dielectric quote DMS160-2; total cost $176,826 less vpol ($20,625)	$156,201.00	N/A
Additional Antenna Costs	$55,000.00	$55,000.00	See Dielectric sales order 1931036 and change orders on sales order 1698162	$53,387.00	a
Radome Color Change	$15,000.00	$15,000.00	Due to placement of new RePack Antenna, color of radome needed to be changed from orange to white. Please see Addendum #2 of Precision Communications Proposal #20302-5 attached.	$15,000.00	N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$5,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Elbow Reinf Uneq Leg	Component Description: Elbow, balance due Amount: $702.80 Component Description: Elbow, installment #2, line 2 of invoice Amount: $3,162.60 Component Description: Elbow, installment #1, line 2 of invoice Amount: $3,162.60
Side mount brackets for high power antennas (if not included in antenna base cost)	Component Description: Mounting brackets, installment #1, line 1 of invoice Amount: $5,680.35 Component Description: Mounting brackets, balance due Amount: $1,262.30 Component Description: Mounting brackets, installment #2, line 1 of invoice Amount: $5,680.35
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 900 kW input, directional,, horizontally polarized	Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
Sweep test of existing antenna	Component Description: Sweep test Amount: $6,400.00
Side mount brackets for high power antennas (if not included in antenna base cost)	Component Description: Side Mount Brackets, installment #1, line 3 of invoice Amount: $9,787.50 Component Description: Side mount brackets, installment #2, line 2 of invoice Amount: $9,787.50 Component Description: Side mount brackets, balance due Amount: $2,175.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: Elbow complex, installment #1, line 4 of invoice Amount: $4,819.50 Component Description: Elbow complex, balance due Amount: $1,071.00 Component Description: Elbow complex, installment #2, line 3 of invoice Amount: $4,819.50
Sweep test of existing antenna	Component Description: Sweep Test Amount: $6,400.00
UHF - High Power, Side Mount, basic slot antenna, 910 kW input, directional,, elliptically or circularly polarized	Component Description: Antenna, balance due Amount: $10,047.02 Component Description: Antenna, installment #3 Amount: $5,573.08 Component Description: Antenna, installment #1, line 1 of invoice Amount: $70,290.45 Component Description: Antenna, installment #2, line 1 of invoice Amount: $70,290.45
Additional Antenna Costs	Component Description: Additional antenna costs Amount: $2,604.00 Component Description: Additional antenna costs Amount: $924.00 Component Description: Additional antenna costs Amount: $1,239.60 Component Description: Additional antenna costs Amount: $1,075.00 Component Description: Additional antenna costs Amount: $4,750.00 Component Description: Additional antenna costs Amount: $3,902.00 Component Description: Additional antenna costs Amount: $4,379.00 Component Description: Additional antenna costs Amount: $2,730.00 Component Description: Additional antenna costs Amount: $1,875.00 Component Description: Additional antenna costs Amount: $9,240.00 Component Description: Additional antenna costs Amount: $6,856.00 Component Description: Additional antenna costs Amount: $12,902.40 Component Description: Additional antenna costs Amount: $910.00
Radome Color Change	Component Description: Radome replacement required to match tower color band Amount: $15,000.00 Component Description: Radome replacement Amount: $15,000.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.

Cost Information

Transmission Line

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$150,712.00	$119,762.15	N/A	$117,060.15	N/A
Total for all systems	$3,672,062.05	$2,722,080.20	N/A	$2,364,249.88	N/A
Interim Transmission Line	$43,652.00	$35,192.35		$32,490.35
Transmission Line 6-50	$2,702.00	$2,702.00	See Dielectric quote 700443CMZ-4.	$2,702.00	N/A
Flexible Air Transmission Line - dielectric, 5"	$40,950.00	$32,490.35	See Dielectric quote 700443CMZ-4.	$29,788.35	N/A
Primary Transmission Line	$107,060.00	$84,569.80		$84,569.80
Rigid Transmission Line - copper, 6 1/8"	$107,060.00	$84,569.80	See Dielectric quote DMS160-2	$84,569.80	N/A

Components

Actual Information Description	File Name
Transmission Line 6-50	Component Description: Transmission line 6-50, balance due Amount: $270.20 Component Description: Transmission Line 6-50, installment #1, line 3 of invoice Amount: $1,215.90 Component Description: Transmission Line 6-50, installment #2, line 3 of invoice Amount: $1,215.90
Flexible Air Transmission Line - dielectric, 5"	Component Description: Transmission line, installment #3 Amount: $547.03 Component Description: Transmission line, installment #1, line 4 of invoice Amount: $14,620.66 Component Description: Transmission line, installment #2, line 4 of invoice Amount: $14,620.66
Rigid Transmission Line - copper, 6 1/8"	Component Description: Transmission line, balance due Amount: $8,456.98 Component Description: Transmission line, installment #1, line 5 of invoice Amount: $38,056.41 Component Description: Transmission line, installment #2, line 4 of invoice Amount: $38,056.41

Cost Information

Tower Equipment and Rigging Costs

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,013,597.67	$873,965.67	N/A	$854,465.67	N/A
Total for all systems	$3,672,062.05	$2,722,080.20	N/A	$2,364,249.88	N/A
Primary Tower TOWER	$1,013,597.67	$873,965.67		$854,465.67
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$276,450.00	Interim antenna installation $96,750 see PCI quote 20301-5; main antenna installation $179,700 see PCI quote 20302-5	$276,450.00	N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$25,000.00	N/A	$5,500.00	N/A
Major tower reinforcement/modifications	$421,000.00	$427,218.00	$70818 Tower Modification Materials - see FDH quotes P18_T01311 and P18_T013112; $356,400 see PCI quote 20300-5	$427,218.00	N/A
Additional Tower Work, and Weather Delays	$145,297.67	$145,297.67	Unexpected Work outside the original quote, & Weather Delays. Please see addendum to Proposal 20302-5 Attached.	$145,297.67	N/A

Components

Actual Information Description	File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: Main antenna installation, installment #2 Amount: $59,900.00 Component Description: Interim antenna installation, installment #2 Amount: $32,250.00 Component Description: Interim antenna installation, installment #1 Amount: $64,500.00 Component Description: Main antenna installation, installment #1 Amount: $119,800.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: Structural analysis Amount: $2,750.00 Component Description: Structural analysis, balance due on completion Amount: $2,750.00
Major tower reinforcement/modifications	Component Description: Tower modification materials, installment #1 Amount: $19,713.50 Component Description: Tower Modifications, installment #2 Amount: $118,800.00 Component Description: Tower Modifications, installment #1 Amount: $237,600.00 Component Description: Tower modification materials, installment #2 Amount: $19,713.50 Component Description: Tower modification materials, installment #1 Amount: $15,695.50 Component Description: Tower modification materials, installment #2 Amount: $15,695.50
Additional Tower Work, and Weather Delays	Component Description: Weather delays and additional work Amount: $145,297.67

Cost Information

Outside Professional Services

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$105,320.00	$101,000.00	N/A	$40,714.00	N/A
Total for all systems	$3,672,062.05	$2,722,080.20	N/A	$2,364,249.88	N/A
Outside Professional Services	$105,320.00	$101,000.00		$40,714.00
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,500.00	N/A	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	N/A	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$1,500.00	N/A	$1,500.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$625.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$3,000.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$7,000.00	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	N/A	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$2,500.00	N/A
Project management of the transition	$46,610.00	$44,250.00	N/A	$26,089.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$0.00	N/A
Additional Field Engineering Service, 14 Days	$28,000.00	$28,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization	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 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 FCC Form 2100, item 4 from invoice summary Amount: $3,000.00
Perform engineering study for new channel assignment and antenna development	Component Description: Perform engineering study for new channel assignment, item 3 from invoice summary. 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: Prepare reimbursement form, item 2 from invoice summary Amount: $2,500.00
Project management of the transition	Component Description: Project management services 3.2.19 through 3.29.19 Amount: $225.00 Component Description: Project management services Amount: $790.00 Component Description: Project management services 6/30/18 through 7/27/18 Amount: $1,500.00 Component Description: Vendor has issued a revised invoice; see 29370R Amount: $525.00 Component Description: Project management services Amount: $703.00 Component Description: Prepare FCC Schedule 387, item 6 from invoice summary Amount: $150.00 Component Description: Project management services 9.29.18 through 10.26.18 Amount: $2,100.00 Component Description: Project management services Amount: $1,805.00 Component Description: Vendor has issued a revised invoice; see 29370R Amount: ($13,500.00) Component Description: Project management services 7.28.18 through 9.28.18 Amount: $2,700.00 Component Description: Project management services, various Amount: $653.00 Component Description: Project management services 4.27.19 through 5.31.19 Amount: $1,200.00 Component Description: Project management services Mar 2020 Amount: $395.00 Component Description: Project management services Amount: $2,025.50 Component Description: Project management services 3.30.19 through 4.26.19 Amount: $300.00 Component Description: Project management services Amount: $308.00 Component Description: Project management services 6.26.19 through 7.26.19 Amount: $150.00 Component Description: Project management services 6.1.19 through 6.28.19 Amount: $375.00 Component Description: Vendor has issued a revised invoice; see 29370R Amount: ($525.00) Component Description: Project management services Amount: $714.50 Component Description: Project management services Jun 2020 Amount: $55.00 Component Description: Project management services March 2019 Amount: $143.00 Component Description: Project management services April 2019 Amount: $123.50 Component Description: Project management services 10.27.18 through 11.30.18 Amount: $1,600.00 Component Description: Prepare FCC Schedule 387, item 7 from invoice summary Amount: $150.00 Component Description: Project management services 10.2018 Amount: $75.00 Component Description: Prepare FCC Schedule 387, item 5 from invoice summary Amount: $300.00 Component Description: Vendor has issued a revised invoice; see 29370R Amount: $13,500.00 Component Description: Project management services May 2020 Amount: $70.00 Component Description: Project management services 2.1.19 through 3.1.19 Amount: $825.00 Component Description: Project management services February 2019 Amount: $123.50 Component Description: Project management services Feb 2020 Amount: $310.00 Component Description: Project management services 12.1.18 through 1.31.19 Amount: $1,050.00 Component Description: Project management services June 2019 Amount: $325.00 Component Description: Project management services, item 1 from invoice summary Amount: $3,825.00 Component Description: Project management services 5/26/18 through 6/29/18 Amount: $1,020.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Prepare License to Cover Application Amount: N/A
Additional Field Engineering Service, 14 Days	Information not provided.

Cost Information

Other Expenses

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$224,800.00	$224,250.00	N/A	$177,721.68	N/A
Total for all systems	$3,672,062.05	$2,722,080.20	N/A	$2,364,249.88	N/A
Other Expenses	$224,800.00	$224,250.00		$177,721.68
MVPD Notification of Channel Change	$2,000.00	$2,000.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$1,500.00	$1,500.00	N/A	N/A	N/A
Equipment Storage	$20,000.00	$20,000.00	N/A	$11,238.00	N/A
Non-zoning permits	$25,000.00	$25,000.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$2,384.00	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$25,500.00	$25,500.00	Per quote from USA Commercial EST-13 attached and related invoices	$25,449.20	N/A
Sales Tax	$77,000.00	$77,000.00	Sales and use tax due on purchases; see related invoices	$76,832.51	N/A
Equipment Delivery and Handling Charges	$62,250.00	$62,250.00	See freight and shipping invoices	$61,817.97	N/A

Components

Actual Information Description	File Name
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: Transmitter storage Amount: $3,898.00 Component Description: Main antenna storage Amount: $5,320.00 Component Description: Interim antenna components storage Amount: $2,020.00
Non-zoning permits	Information not provided.
DTV Medical Facility Notification	Component Description: Notification of medical facilities Amount: $2,384.00
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Removal of transmitters and components Amount: $25,000.00 Component Description: Disposal costs Amount: $449.20
Sales Tax	Component Description: Tax due on transmitter, less upgrade cost Amount: $44,826.00 Component Description: Illinois Use Tax Due Amount: $26,190.00 Component Description: Tax due on antenna components Amount: $117.19 Component Description: Tax due on antenna components Amount: $296.88 Component Description: Tax on additional transmitter components Amount: $3,560.57 Component Description: Tax due on antenna components Amount: $806.40 Component Description: Tax due on antenna components Amount: $428.50 Component Description: Tax due on antenna components Amount: $273.69 Component Description: Tax due on antenna components Amount: $243.88 Component Description: Tax on SNMP Plus Amount: $31.65 Component Description: Tax due on antenna components Amount: $57.75
Equipment Delivery and Handling Charges	Component Description: Transmitter warehousing and shipping Amount: $13,963.00 Component Description: Shipping costs for interim antenna components Amount: $6,682.50 Component Description: Shipping costs for additional antenna components Amount: $864.78 Component Description: Shipping costs for additional antenna components Amount: $4,022.49 Component Description: Shipping costs for additional antenna components Amount: $3,982.32 Component Description: Shipping costs for additional antenna components Amount: $1,352.18 Component Description: Shipping costs for additional antenna components Amount: $3,057.26 Component Description: Shipping costs for additional antenna components Amount: $154.76 Component Description: Shipping costs for additional antenna components Amount: $1,064.34 Component Description: SNMP Plus shipping Amount: $10.00 Component Description: Shipping costs for additional antenna components Amount: $3,053.08 Component Description: Shipping costs for additional antenna components Amount: $653.06 Component Description: Main antenna freight costs Amount: $9,326.15 Component Description: Shipping costs for additional antenna components Amount: $980.83 Component Description: Shipping costs for additional antenna components Amount: $6,537.00 Component Description: Shipping costs for additional antenna components Amount: $4,534.22 Component Description: Shipping costs for tower modification materials Amount: $1,580.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$3,672,062.05	$2,722,080.20	$2,364,249.88

Reimbursement Status

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

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Elizabeth Ryder General Counsel 03/10/2022

Section

Question

Response

Submission of Estimated Expenses Statements

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

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

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

Elizabeth Ryder

General Counsel

03/10/2022

Certification

Section	Question	Response
Submission of Actual Cost Documentation Statements	WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) . The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Elizabeth Ryder General Counsel 03/10/2022

Section

Question

Response

Submission of Actual Cost Documentation Statements

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

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

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

Elizabeth Ryder

General Counsel

03/10/2022

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Elizabeth Ryder General Counsel 03/10/2022

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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

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

Elizabeth Ryder

General Counsel

03/10/2022

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

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

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

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components