TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
KTKA Television, LLC	Thomas J. Vaughan 3121 Rivershore Lane Port Charlotte, FL 33953 United States	+1 (941) 764-6867	glenn.richards@pillsburylaw.com	Limited Liability Company

Applicant

Address

Phone

Applicant Type

KTKA Television, LLC

Thomas J. Vaughan

3121 Rivershore Lane

Port Charlotte, FL 33953

United States

+1 (941) 764-6867

glenn.richards@pillsburylaw.com

Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Jessica Nyman , Esq . FCC Counsel Pillsbury Winthrop Shaw Pittman LLP	Jessica Nyman 1200 Seventeenth Street Washington, DC 20036 United States	+1 (202) 663-8810	jessica.nyman@pillsburylaw.com

Applicant

Address

Phone

Jessica Nyman , Esq .

FCC Counsel

Pillsbury Winthrop Shaw Pittman LLP

Jessica Nyman

1200 Seventeenth Street

Washington, DC 20036

United States

+1 (202) 663-8810

jessica.nyman@pillsburylaw.com

Broadcaster Information and Transition Plan

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

Transmitters

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

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Auxiliary
	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	Affinity
	Year	2002
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	1 kW

Auxiliary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Auxiliary (Backup)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Manufacturer
	Model	TMU9evo/3
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	1.15 kW
	Justification for New Transmitter	The manufacturer of the existing transmitter advises that the transmitter cannot be re-tuned to the assigned channel. See attachment.

Auxiliary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	Yes
	Description	De-install existing and install new
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

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Additional Transmitter Costs	Additional Transmitter Costs
Additional Interior RF System	Interior RF System Existing Transmitter to Interim Transmission line
Transmitter Electrical and Installation	Transmitter Electrical and Installation

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	Diamond
	Year	2006
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	1.8 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?	No
	Manufacturer
	Model	TMU9evo/6
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	2.3 kW
	Justification for New Transmitter	The manufacturer of the existing transmitter advises that the transmitter cannot be re-tuned to the assigned channel. 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	2 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 Interior RF System	Interior RF System Existing Transmitter to Interim Transmission line
RF Combiner Components	RF 42" Riser, Elbow, and 3' Heliax Connector to Complete installation of Combiner. Please see Electronics Research Inc. Proposal # 20200619-864 Attached.
Transmitter Building Drilling	Transmitter Building Drilling to provide access for feed lines and conduit

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Other
	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	Travelling Wave
	ERP:	89.1 kW
	Manufacturer
	Model	ATW25H3-HTPXU-49H
	Year	2001

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	51.0 kW
	Manufacturer
	Model	ATW17H3-HTP230-16L
	Year	2019
	Justification for New Antenna	The existing primary top-mount 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?
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

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:	89.1 kW
	Manufacturer
	Model	TLP-24J
	Year	2019
	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.

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	4 1/16 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
Additional Antenna Costs	Additional Antenna Costs
Combiner and installation	Purchase of combiner and installation required to meet transition deadline

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	Waveguide
	Diameter	N/A
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1485 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	19 3/4 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1518 feet per run
	Justification for New Transmission Line	The existing primary transmission line is frequency-specific circular waveguide with a diameter that cannot accommodate the assigned channel.

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Additional Transmission Line Components	Additional Transmission Line Components

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	Rigid
	Diameter	3 1/8 inches
	Segment Length	19 ¾ '
	Other Segment Length
	Number of parallel runs	1
	Length	1370 feet per run
	Justification for New Transmission Line	An interim transmission line is necessary for the interim antenna to keep station on the air during primary antenna replacement and for the duration of the assigned phase.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Transmission Line Test	Testing of Transmission Line to determine use as temporary and Auxiliary line for antennas. Please see Jeremy Ruck & Associates Quotation # 200501-1 Attached.
Additional Transmission Line Components	Additional Transmission Line Components

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	Construct New
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	Yes
	Others Types of Users	Yes
	Is tower documented for structural analysis?	No
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1031887
Coordinates (NAD83)	Latitude (NAD83)	39° 01' 34.0" N-
	Longitude (NAD83)	095° 55' 02.0" W-
	Overall Structure Height	1439.29 feet
	Support Structure Height	1381.22 feet
	Ground Elevation Above Mean Sea Level (AMSL)	1109.89 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Nexstar Broadcasting, Inc.
	Date Constructed	01/01/1984

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
67334	KTPK	FM
18055	KSAJ-FM	FM

Other Types of Users

Users
4 mwave ant
1 RPU antenna

Primary Tower

Tower Construction Costs

Section	Question	Response
Construct New Tower	Use	Primary (Main)
	Description of Use	N/A
	Is this a request for upgraded equipment?	No
	Height	1387.00 feet
	Justification for New Tower	See attached engineering technical statement, ERI structural analysis and ERI letter of recommendation to construct a new tower

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Tower Fence, Gate and Caging	Tower Fence, Gate and Caging needed to secure tower area; see Kansas Fencing quotes
Weather Delays	Weather delays
Combiner and Antenna installation	Install combiner and interim antenna on old tower to meet transition deadline
ENG Dish Removal and Re-Installation	ENG dish removal from old tower and installation on new tower. Please see Electronics Research Proposal # 20200710-996
Crane Pad for Tower Installation	200 Ton Crane Pad needed to erect new tower at the site. Please see Meiert Industries LLC Estimate # 35 Attached
Electrical Service for Tower Lighting	120V & 208V Electrical Service for LED Tower Lighting. Please see McElroy Electric Inc. Proposal # 200810-0007 attached.
Additional Tower Work	Additional Tower Work
Ice Bridge	20' of Additional Ice Bridge to new tower and re-use of 30' from old tower., Please see Attached ERI Change Order # 35662P
Structural Analysis	Structural analysis
Tower Disposal Costs	Tower Disposal Costs

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	1000
	Explanation	It will be necessary to 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.
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	Yes
	Environmental Assessment	Yes
	ASR Modification	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	Yes
	Number of Days	20
	Justification	It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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	Yes
	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
Land Survey for New Tower Construction	Tower Site Land Survey and Site Plan Development for ERI New Tower Build and installation
Pack and Secure Material for Shipping	Secure Packing and shipment of 6 and one eigth Feedline TFU24WB Antenna and associated Hardware to PCI in Grove OK. Please see Deep South Communications quote of April 30 2020 attached.
Sales and Use Tax Due	Sales and Use Tax Due
Waste Management and Toilet Rental Expenses	Rental Expenses during Tower Work for RePack.
Tower Road Access Preparation	Tower Road Access Preparation - Gravel required to prepare road for tower equipment

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	$452,164.01	$329,814.01	N/A	$183,428.00	N/A
Total for all systems	$6,397,323.56	$5,397,358.19	N/A	$4,996,060.69	N/A
Primary Transmitter TMU9evo/6	$264,586.01	$219,786.01		$83,400.00
Transmitter Building Drilling	$500.00	$500.00	See related invoice	$500.00	N/A
RF Combiner Components	$1,736.01	$1,736.01	RF 42" Riser, Elbow, and 3' Heliax Connector to Complete installation of Combiner. Please see Electronics Research Inc. Proposal # 20200619-864 Attached.	N/A	N/A
Additional Interior RF System	$70,000.00	$70,000.00	N/A	N/A	N/A
Switchgear - industrial 800 amp	$38,200.00	$37,150.00	N/A	N/A	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$24,900.00	N/A	N/A	N/A
2" Rigid Conduit and Wiring (Cost per foot)	$2,600.00	$2,600.00	N/A	N/A	N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	$126,000.00	$82,900.00	See Rohde & Schwarz quote 230143.0	$82,900.00	N/A
Auxiliary Transmitter TMU9evo/3	$187,578.00	$110,028.00		$100,028.00
Transmitter Electrical and Installation	$30,977.00	$30,977.00	See Land Communications Estimate 1111	$30,977.00	N/A
Additional Interior RF System	$0.00	$0.00	See Transmitter Electrical and Installation	N/A	N/A
Other Electrical Service: De-install existing and install new	$10,000.00	$10,000.00	N/A	N/A	N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	$126,000.00	$48,450.00	See Rohde & Schwarz quote 235153.0	$48,450.00	N/A
Additional Transmitter Costs	$20,601.00	$20,601.00	See Rohde & Schwarz quote 304846.1	$20,601.00	N/A

Components

Actual Information Description	File Name
Transmitter Building Drilling	Component Description: Drill holes in wall to accommodate feed lines and conduit Amount: $500.00
RF Combiner Components	Information not provided.
Additional Interior RF System	Information not provided.
Switchgear - industrial 800 amp	Information not provided.
Transformer 3 phase/480v - 150 KVA	Information not provided.
2" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	Component Description: Transmitter, installment #1 Amount: $20,725.00 Component Description: Transmitter, installment #2 Amount: $62,175.00
Transmitter Electrical and Installation	Component Description: Auxiliary transmitter electrical and installation Amount: $30,977.00
Additional Interior RF System	Information not provided.
Other Electrical Service: De-install existing and install new	Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	Component Description: Aux transmitter, installment #1 Amount: $12,112.50 Component Description: Aux transmitter, installment #2 Amount: $36,337.50
Additional Transmitter Costs	Component Description: Additional transmitter components Amount: $20,601.00

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	$414,215.00	$215,800.75	N/A	$155,438.33	N/A
Total for all systems	$6,397,323.56	$5,397,358.19	N/A	$4,996,060.69	N/A
Interim Antenna TLP-24J	$148,185.00	$69,202.75		$19,288.33
Combiner and installation	$12,000.00	$12,000.00	Combiner required to connect with single interim antenna for both KTKA and KTMJ to meet transition deadline; 50% shared cost with KTMJ	$10,815.00	N/A
Additional Antenna Costs	$2,075.00	$2,075.00	See related invoices	$2,073.33	a
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$5,120.00	N/A	N/A	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$4,788.00	See Dielectric Quote Number 700438CMZ	N/A	N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	$9,570.00	$9,320.00	N/A	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	See Dielectric Quote Number 700438CMZ	$6,400.00	N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	$89,400.00	$29,499.75	See Dielectric Quote Number 700438CMZ	N/A	N/A
Primary Antenna ATW17H3-HTP230-16L	$266,030.00	$146,598.00		$136,150.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$10,298.00	See Dielectric Quote Number DMS153-4	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	See Dielectric Quote Number DMS153-4	$6,250.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	$247,000.00	$129,900.00	See Electronics Research quote 20181228-237 Rev C	$129,900.00	N/A

Components

Actual Information Description	File Name
Combiner and installation	Component Description: Combiner, installment #2, 50% shared cost with KTMJ Amount: $5,407.50 Component Description: Combiner, installment #1, 50% shared cost with KTMJ Amount: $5,407.50
Additional Antenna Costs	Component Description: Hanger kit, 50% shared cost with KTMJ Amount: $462.82 Component Description: Additional antenna components, 50% shared cost with KTMJ Amount: $742.50 Component Description: Additional antenna components, 50% shared cost with KTMJ Amount: $868.01
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)	Information not provided.
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	Information not provided.
Sweep test of existing antenna	Component Description: Interim antenna sweep test Amount: $6,400.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Information not provided.
Sweep test of existing antenna	Component Description: Sweep test, installment #1 Amount: $1,875.00 Component Description: Sweep test, installment #2 Amount: $1,875.00 Component Description: Sweep test, balance due Amount: $625.00 Component Description: Sweep test, installment #3 Amount: $1,875.00
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	Component Description: Antenna, balance due Amount: $12,990.00 Component Description: Main antenna, installment #2 Amount: $38,970.00 Component Description: Antenna, installment #2 Amount: $38,970.00 Component Description: Antenna, installment #1 Amount: $38,970.00 Component Description: Main antenna, installment #1 Amount: $38,970.00 Component Description: Antenna, installment #3 Amount: $38,970.00

Cost Information

Transmission Line

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$464,516.00	$282,298.88	N/A	$276,768.79	N/A
Total for all systems	$6,397,323.56	$5,397,358.19	N/A	$4,996,060.69	N/A
Interim Transmission Line	$156,880.00	$94,298.88		$92,877.66
Additional Transmission Line Components	$8,000.00	$8,000.00	See related invoices	$7,858.24	N/A
Transmission Line Test	$6,400.00	$6,400.00	Testing of Transmission Line to determine use as temporary and Auxiliary line for antennas. Please see Jeremy Ruck & Associates Quotation # 200501-5 Attached.	$6,400.00	N/A
Rigid Transmission Line - copper, 3 1/8"	$142,480.00	$79,898.88	See ERI proposal 20200917-489	$78,619.42	N/A
Primary Transmission Line	$307,636.00	$188,000.00		$183,891.13
Additional Transmission Line Components	$1,000.00	$1,000.00	See related invoice	$690.00	N/A
Rigid Transmission Line - copper, 6 1/8"	$306,636.00	$187,000.00	See Electronic Research quote 20181228-237 Rev C	$183,201.13	N/A

Components

Actual Information Description	File Name
Additional Transmission Line Components	Component Description: Aux transmission line dehydrator, installment #2 Amount: $3,929.12 Component Description: Aux transmission line dehydrator, installment #1 Amount: $3,929.12
Transmission Line Test	Component Description: Sweep test Amount: $6,400.00
Rigid Transmission Line - copper, 3 1/8"	Component Description: Aux transmission line, installment #2 Amount: $38,669.98 Component Description: Aux transmission line, installment #1 Amount: $39,949.44
Additional Transmission Line Components	Component Description: Additional transmission line components Amount: $690.00
Rigid Transmission Line - copper, 6 1/8"	Component Description: Transmission line, balance due Amount: $18,700.00 Component Description: Return unused transmission line Amount: ($3,798.87) Component Description: Transmission line, installment #2 Amount: $56,100.00 Component Description: Transmission line, installment #1 Amount: $56,100.00 Component Description: Transmission line, installment #1 Amount: $56,100.00 Component Description: Transmission line, installment #2 Amount: $56,100.00 Component Description: Transmission line, installment #3 Amount: $56,100.00

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	$4,286,400.35	$3,915,591.35	N/A	$3,914,906.92	N/A
Total for all systems	$6,397,323.56	$5,397,358.19	N/A	$4,996,060.69	N/A
Primary Tower TOWER	$0.00	$0.00		$0.00
Primary Tower	$4,286,400.35	$3,915,591.35		$3,914,906.92
Electrical Service for Tower Lighting	$3,326.35	$3,326.35	120V & 208V Electrical Service for LED Tower Lighting. Please see McElroy Electric Inc. Proposal # 200810-0007 attached.	$3,089.96	N/A
Structural Analysis	$43,850.00	$43,850.00	Structural analysis and mapping required to determine tower requirements; see proposals from ERI $14320; $3750 and $25530, and Bartlett & West $8700	$43,850.00	N/A
Weather Delays	$25,350.00	$25,350.00	See related invoices	$25,350.00	N/A
New tower between 1000' and 1500' without elevator, presumptive soil conditions	$3,647,810.00	$3,382,144.00	See attached ERI Proposal Number 20181210-098 REV C	$3,382,144.00	N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$315,857.00	See Electronics Research Proposal 20190410-188 Rev A and 20200917-489	$315,857.00	N/A
Crane Pad for Tower Installation	$8,800.00	$8,800.00	200 Ton Crane Pad needed to erect new tower at the site. Please see Meier Industries LLC Estimate # 35 Attached	$8,716.58	N/A
Additional Tower Work	$3,600.00	$3,600.00	See ERI Change orders and related invoices	$3,600.00	N/A
Ice Bridge	$26,100.00	$26,100.00	Additional 20" of Ice Bridge to meet 30" of Existing Bridge. Please See ERI Change Order #35662P and Change Order 35662D-1	$26,100.00	N/A
Tower Disposal Costs	$36,000.00	$36,000.00	See ERI change order and related invoice	$36,000.00	N/A
Tower Fence, Gate and Caging	$31,500.00	$31,500.00	See Kansas Fencing quotes	$31,136.34	N/A
ENG Dish Removal and Re-Installation	$36,504.00	$36,504.00	ENG dish removal from old tower and installation on new tower. Please see Electronics Research Proposal # 20200710-996 and 20190912-732 Rev B and related invoices	$36,503.04	N/A
Combiner and Antenna installation	$2,560.00	$2,560.00	Install combiner and temporary antenna on old tower to meet transition deadline; 50% shared cost with KTMJ	$2,560.00	N/A

Components

Actual Information Description	File Name
Electrical Service for Tower Lighting	Component Description: Electrical services for tower light power Amount: $3,089.96
Structural Analysis	Component Description: Structural analysis Amount: $3,750.00 Component Description: Reinforcement and foundation mapping, installment #1 Amount: $12,765.00 Component Description: Structural analysis, installment #2 Amount: $7,160.00 Component Description: Structural analysis, installment #1 Amount: $7,160.00 Component Description: Reinforcement and foundation mapping, installment #2 Amount: $6,490.00 Component Description: Structural analysis Amount: $6,525.00
Weather Delays	Component Description: Tower installation weather delays Amount: $15,600.00 Component Description: Tower installation weather delays Amount: $9,750.00
New tower between 1000' and 1500' without elevator, presumptive soil conditions	Component Description: Guyed Tower, installment #3 Amount: $191,029.80 Component Description: Guyed Tower, installment #2 Amount: $1,500,042.20 Component Description: Guyed Tower, installment #1 Amount: $1,691,072.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: Aux transmission line installation, installment #2 Amount: $33,360.50 Component Description: Antenna installation, installment #2 Amount: $74,740.80 Component Description: Antenna installation, installment #3 Amount: $74,740.80 Component Description: Antenna installation, installment #1 Amount: $74,740.80 Component Description: Aux transmission line installation, installment #1 Amount: $33,360.50 Component Description: Antenna installation, balance due Amount: $24,913.60
Crane Pad for Tower Installation	Component Description: Crane pad for antenna erection Amount: $8,716.58
Additional Tower Work	Component Description: Labor and materials to remove anchors Amount: $3,600.00
Ice Bridge	Component Description: Transmission line bridge Amount: $20,500.00 Component Description: Transmission line bridge Amount: $5,600.00
Tower Disposal Costs	Component Description: Tower disposal costs Amount: $36,000.00
Tower Fence, Gate and Caging	Component Description: Cages for guy cables, installment #2 Amount: $10,259.89 Component Description: Tower fence and gate, installment #2 Amount: $2,376.45 Component Description: Tower fence and gate, installment #1 Amount: $4,500.00 Component Description: Cages for guy cables, installment #1 Amount: $14,000.00
ENG Dish Removal and Re-Installation	Component Description: Dish mount assembly Amount: $450.00 Component Description: Dish removal and re-installation, installment #1 Amount: $9,056.52 Component Description: Dish removal and reinstallation Amount: $17,940.00 Component Description: Dish removal and re-installation, installment #2 Amount: $9,056.52
Combiner and Antenna installation	Component Description: Combiner and temporary antenna installation, installment #2, 50% shared cost with KTMJ Amount: $1,280.00 Component Description: Combiner and and temporary antenna installation, installment #1, 50% shared cost with KTMJ Amount: $1,280.00

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	$317,750.00	$191,875.00	N/A	$50,105.50	N/A
Total for all systems	$6,397,323.56	$5,397,358.19	N/A	$4,996,060.69	N/A
Outside Professional Services	$317,750.00	$191,875.00		$50,105.50
Project management of the transition	$158,000.00	$32,500.00	See related invoice	$32,305.50	N/A
Additional Field Engineering Service, 20 Days	$108,000.00	$108,000.00	N/A	N/A	N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,050.00	N/A	$275.00	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,050.00	N/A	$1,375.00	N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet	$10,520.00	$10,240.00	N/A	N/A	N/A
NEPA Section 106 environmental review, if needed	$6,310.00	$6,140.00	N/A	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,585.00	N/A	N/A	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,305.00	N/A	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,120.00	N/A	N/A	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$1,535.00	N/A	$1,500.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,535.00	N/A	$625.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$4,525.00	See related invoices	$4,525.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,170.00	N/A	$7,000.00	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,560.00	N/A	N/A	N/A
Prepare and or review reimbursement form	$2,630.00	$2,560.00	N/A	$2,500.00	N/A

Components

Actual Information Description	File Name
Project management of the transition	Component Description: Project management services, item 1 from invoice summary Amount: $2,625.00 Component Description: Prepare FCC Schedule 387, item 5 from invoice summary Amount: $300.00 Component Description: Prepare FCC Schedule 387, item 7 from invoice summary Amount: $150.00 Component Description: Prepare FCC Schedule 387, item 6 from invoice summary Amount: $150.00 Component Description: Various project management services, item 8 from invoice summary Amount: $2,862.00 Component Description: Project management services Amount: $553.00 Component Description: Project management services April 2019 Amount: $123.50 Component Description: Project management services 12.1.18 through 12.31.18 Amount: $150.00 Component Description: Project management services 2.1.19 through 3.1.19 Amount: $450.00 Component Description: Project management services January 2019 Amount: $65.00 Component Description: Project management services May 2019 Amount: $150.00 Component Description: Project management services Jun 2019 Amount: $162.50 Component Description: Project management services 10.26.19 through 11.29.19 Amount: $158.00 Component Description: Project management services 1.1.19 through 1.31.19 Amount: $750.00 Component Description: Project management services Amount: $150.00 Component Description: Project management services 6.1.19 through 6.28.19 Amount: $450.00 Component Description: Project management services Amount: $158.00 Component Description: Project management services March 2019 Amount: $143.00 Component Description: Project management services August 2018 Amount: $50.00 Component Description: Project management services February 2019 Amount: $60.00 Component Description: Prepare Q2 2020 Form 387 Amount: $250.00 Component Description: Project management services 3.2.19 through 3.29.19 Amount: $825.00 Component Description: Project management services 10.27.18 through 11.30.18 Amount: $500.00 Component Description: Project management services 5.26.18 through 6.29.18 Amount: $600.00 Component Description: Project management services 3.30.19 through 4.26.19 Amount: $375.00 Component Description: Project management services, items 1, 3-8 from invoice summary Amount: $1,834.00 Component Description: Project management services Nov 2019 Amount: $60.00 Component Description: Project management services 6.30.18 through 7.27.18 Amount: $1,275.00 Component Description: Project management services 4.27.19 through 5.31.19 Amount: $75.00 Component Description: Project management services Amount: $15,352.50 Component Description: Project management services 9.29.18 through 10.26.18 Amount: $300.00 Component Description: Project management services 7.28.18 through 9.28.18 Amount: $225.00 Component Description: Project management services Amount: $474.00 Component Description: Prepare Form 387 (10 Days After) Amount: $250.00 Component Description: Project management services Amount: $250.00
Additional Field Engineering Service, 20 Days	Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Component Description: Prepare Form 7460-1 Amount: $275.00
ASR modification (prepare FCC Form 854)	Component Description: Preparation of Forms 7460-1 and 854 Amount: $1,050.00 Component Description: Prepare Form 854 Amount: $325.00
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet	Information not provided.
NEPA Section 106 environmental review, if needed	Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Information not provided.
Prepare request for Special Temporary Authorization	Component Description: Prepare 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 Minor Modification of CP Application Amount: $1,525.00 Component Description: Prepare engineering sections of 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

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	$462,278.20	$461,978.20	N/A	$415,413.15	N/A
Total for all systems	$6,397,323.56	$5,397,358.19	N/A	$4,996,060.69	N/A
Other Expenses	$462,278.20	$461,978.20		$415,413.15
Pack and Secure Material for Shipping	$5,023.20	$5,023.20	Secure Packing and shipment of 6 and one eigth Feedline TFU24WB Antenna and associated Hardware to PCI in Grove OK. Please see Deep South Communications quote of April 30 2020 attached.	$3,469.10	N/A
Sales and Use Tax Due	$298,000.00	$298,000.00	Estimated taxes	$297,022.11	N/A
Tower Road Access Preparation	$28,205.00	$28,205.00	Costs to prep the access road to the tower site; See ERI change order and related invoice	$28,205.00	N/A
Waste Management and Toilet Rental Expenses	$9,000.00	$9,000.00	Monthly Rental Fees for Waste Management Dumpster and Porta Johnny at Remote Tower Site	$8,449.06	N/A
Land Survey for New Tower Construction	$9,000.00	$9,000.00	N/A	$3,464.75	N/A
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	Costs to produce spots and crawls for viewer notification.	N/A	N/A
Equipment Storage	$25,000.00	$25,000.00	N/A	$10,358.00	N/A
Equipment Delivery and Handling Charges	$51,500.00	$51,500.00	See related invoices	$51,426.13	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$8,000.00	$8,000.00	See USA Commercial Removal quote 56	$8,000.00	N/A
Non-zoning permits	$3,500.00	$3,500.00	Tower building permit fee	$3,091.00	N/A
Local Zoning	$10,000.00	$10,000.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,250.00	N/A	$1,928.00	N/A

Components

Actual Information Description	File Name
Pack and Secure Material for Shipping	Component Description: Pack and ship interim antenna, 50% shared cost with KTMJ Amount: $2,511.60 Component Description: Pack and ship interim antenna, 50% shared cost with KTMJ Amount: $957.50
Sales and Use Tax Due	Component Description: Tax on toilet rental June 2020 Amount: $7.65 Component Description: Kansas Use Tax Due Amount: $296,142.00 Component Description: Tax on drilling services Amount: $45.75 Component Description: Tax on electrical services Amount: $236.39 Component Description: Tax on toilet rental October 2020 Amount: $7.65 Component Description: Tax on toilet rental August 2020 Amount: $7.65 Component Description: Tax on toilet rental May 2020 Amount: $7.65 Component Description: Tax on rock base materials Amount: $536.77 Component Description: Tax on toilet rental July 2020 Amount: $7.65 Component Description: Tax on toilet rental September 2020 Amount: $7.65 Component Description: Tax on toilet rental December 2020 Amount: $7.65 Component Description: Tax on toilet rental November 2020 Amount: $7.65
Tower Road Access Preparation	Component Description: Prep tower site access road for tower and heavy equipment Amount: $28,205.00
Waste Management and Toilet Rental Expenses	Component Description: Dumpster rental 5/1/20-5/15/20 Amount: $254.07 Component Description: Toilet Rental June 2020 Amount: $100.00 Component Description: Dumpster rental 11/1/20-11/15/20 Amount: $471.55 Component Description: Dumpster rental 5/16/20-5/31/20 Amount: $181.50 Component Description: Dumpster rental 9/16/20-9/30/20 Amount: $1,035.68 Component Description: Dumpster rental 6/16/20-6/30/20 Amount: $481.50 Component Description: Dumpster rental 7/1/20-7/31/20 Amount: $781.50 Component Description: Toilet Rental November 2020 Amount: $100.00 Component Description: Dumpster rental 6/1/20-6/15/20 Amount: $583.60 Component Description: Dumpster rental 6/16/20-6/30/20 Amount: $487.85 Component Description: Dumpster rental 8/1/20-8/15/20 Amount: $336.48 Component Description: Dumpster rental 10/1/20-10/15/20 Amount: $335.88 Component Description: Dumpster rental 9/1/20-9/15/20 Amount: $336.28 Component Description: Dumpster rental final invoice Amount: $381.64 Component Description: Toilet Rental December 2020 Amount: $99.94 Component Description: Dumpster rental 8/16/20-8/31/20 Amount: $706.50 Component Description: Toilet Rental August 2020 Amount: $100.00 Component Description: Dumpster rental 11/16/20-11/30/20 Amount: $706.50 Component Description: Toilet Rental July 2020 Amount: $100.00 Component Description: Toilet Rental September 2020 Amount: $100.00 Component Description: Toilet Rental May 2020 Amount: $99.94 Component Description: Toilet Rental October 2020 Amount: $100.00 Component Description: Dumpster rental 10/16/20-10/31/20 Amount: $1,056.50
Land Survey for New Tower Construction	Component Description: Surveying services Amount: $2,807.75 Component Description: Surveying services Amount: $657.00
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: Main transmitter storage Amount: $9,613.00 Component Description: Main transmitter storage Amount: $375.00 Component Description: Aux transmitter storage Amount: $370.00
Equipment Delivery and Handling Charges	Component Description: Main transmitter consolidation services Amount: $10,631.00 Component Description: Aux transmitter consolidation services Amount: $10,465.00 Component Description: Hanger kit shipping, 50% shared cost with KTMJ Amount: $5.03 Component Description: Freight costs Amount: $77.32 Component Description: Main transmission line freight Amount: $537.96 Component Description: Antenna components freight, 50% shared cost with KTMJ Amount: $62.60 Component Description: Transmission line shipping Amount: $856.75 Component Description: Antenna freight Amount: $1,991.28 Component Description: Aux transmission line freight Amount: $4,713.44 Component Description: Main transmitter consolidation services Amount: $11,006.00 Component Description: Auxiliary transmitter consolidation services Amount: $10,835.00 Component Description: Guyed tower freight cost Amount: $22,085.75
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Disposal costs Amount: $8,000.00
Non-zoning permits	Component Description: Tower building permit application fee Amount: $3,091.00
Local Zoning	Information not provided.
DTV Medical Facility Notification	Component Description: Notification of medical facilities Amount: $1,928.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$6,397,323.56	$5,397,358.19	$4,996,060.69

Reimbursement Status

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

Certification

Section

Question

Response

Submission of Estimated Expenses Statements

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

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

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

Thomas J. Vaughan

Manager

03/21/2022

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.

Thomas J. Vaughan

Manager

03/21/2022

Certification

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.

Thomas J. Vaughan

Manager

03/21/2022

(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

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

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

Other Types of Users

Primary Tower

Tower Construction 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