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

FCC Form 399: Reimbursement Request

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

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

Facility ID:
188056
Service:
LPD
Call Sign:
KNPN-LD
Channel:
15 (UHF)
File Number:
0000089468
FRN:
0021454004
Eligibility Status:
Eligible
Date Submitted:
03/25/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

News-Press TV, LLC

Doing Business As: News-Press TV, LLC

825 Edmond Street

St. Joseph, MO 64501

United States

+1 (816) 271-8504 tim.hannan@npgco.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer Linear Industries
Model AT71K0
Year 2012
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.8 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New Mask Filter Does the transmitter require a new mask filter? Yes
Mask Filter Type Full Service
Power 1.1-2kW
New Exciter Is a new exciter needed? No

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service Yes
Description Labor and material for electrical work to install new manual transfer switch split with KCJO and KNPG
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model AT71K0
Year 2012
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.8 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE-4-G2
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.4 kW
Justification for New Transmitter Continued transmitter failure while attempting to re-tune

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Installation

Installation

Mask Filter

Mask Filter

RF Parts for New Transmitter

RF Parts for New Transmitter

Freight

Freight

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model SFN-2030-B-12 (E/P)
Year 2012

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model SFN-2030-B-12
Year 2018
Justification for New Antenna Please see Transition Plan Description Exhibit

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? No

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Sweep - KNPN-KNPG-KCJO

Antenna Sweep - KNPN-KNPG-KCJO

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
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 Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 0
Length 240 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 1 5/8 inches
Number of parallel runs 0
Length 240 feet per run
Justification for New Transmission Line Placeholder
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
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 No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1006991
Coordinates (NAD83) Latitude (NAD83) 39° 45' 02.8" N-
Longitude (NAD83) 094° 50' 25.8" W-
Overall Structure Height 259.84 feet
Support Structure Height 239.50 feet
Ground Elevation Above Mean Sea Level (AMSL) 973.09 feet
Structure Type LTOWER - Lattice Tower
Tower Owner MIDWEST MOBILE RADIO SERVICE
Date Constructed 07/01/2019

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
188055 KNPG-LD LPD
188057 KCJO-LD LPD

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

KNPN and KNPG Antenna Installation

KNPN and KNPG Antenna Installation

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Outside RF consulting Engineering Services Perform engineering study for displacement application 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
Prepare Form 601 No
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
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Additional Displacement Legal Services Not Otherwise Specified in Form 399

Additional Displacement Legal Services Not Otherwise Specified in Form 399

Project Management Services

Project Management Services

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $113,101.74 $62,604.96 N/A $62,604.96 N/A
Total for all systems $231,457.64 $129,399.42 N/A $112,892.32 N/A
Primary Transmitter AT71K0 $11,000.00 $2,617.22 $2,617.22
Retune - UHF and VHF - minor re-channel issues $11,000.00 $2,617.22 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $2,617.22 N/A
Primary Transmitter UAXTE-4-G2 $102,101.74 $59,987.74 $59,987.74
Freight $1,079.51 $1,079.51 N/A $1,079.51 N/A
RF Parts for New Transmitter $832.20 $832.20 N/A $832.20 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $41,886.00 N/A $41,886.00 N/A
Mask Filter $3,561.68 $3,561.68 N/A $3,561.68 N/A
Installation $12,628.35 $12,628.35 N/A $12,628.35 N/A

Components

Actual Information Description File Name
Retune - UHF and VHF - minor re-channel issues

Component Description:
For Transmitter Re-Tune
Amount:
$1,750.00

Component Description:
For Transmitter Re-Tune
Amount:
$2,711.30

Component Description:
For Transmitter Re-Tune
Amount:
$500.98

Component Description:
For Transmitter Re-Tune
Amount:
$660.63

Component Description:
For Transmitter Re-Tune
Amount:
$410.38

Component Description:
For Transmitter Re-Tune
Amount:
$2,116.24

Component Description:
For Transmitter Re-Tune
Amount:
$2,358.97
Freight

Component Description:
Freight for Transmitter
Amount:
$1,079.51
RF Parts for New Transmitter

Component Description:
RF Parts for New Transmitter
Amount:
$832.20
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
New UAXTE-4-G2 Transmitter
Amount:
$41,886.00
Mask Filter

Component Description:
Mask Filter
Amount:
$3,561.68
Installation

Component Description:
New Transmitter Installation
Amount:
$12,628.35

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $30,380.58 $25,755.58 N/A $25,755.58 N/A
Total for all systems $231,457.64 $129,399.42 N/A $112,892.32 N/A
Primary Antenna SFN-2030-B-12 $30,380.58 $25,755.58 $25,755.58
Antenna Sweep - KNPN-KNPG-KCJO $700.00 $700.00 N/A $700.00 N/A
Side Mount antenna brackets $4,625.00 $0.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical $25,055.58 $25,055.58 N/A $25,055.58 N/A

Components

Actual Information Description File Name
Antenna Sweep - KNPN-KNPG-KCJO

Component Description:
Antenna sweep split with KNPG-KNPN-KCJO
Amount:
$700.00
Side Mount antenna brackets Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical

Component Description:
Freight cost for new antenna
Amount:
$480.58

Component Description:
New Antenna
Amount:
$24,575.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $0.00 $0.00 N/A $0.00 N/A
Total for all systems $231,457.64 $129,399.42 N/A $112,892.32 N/A
Primary Transmission Line $0.00 $0.00 $0.00
Flexible Air Transmission Line - dielectric, 1 5/8" $0.00 $0.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 1 5/8"

Component Description:
Balance of Transmission Line
Amount:
N/A

Component Description:
Down Payment on Transmission Line
Amount:
N/A

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $67,686.41 $11,496.41 N/A $5,748.21 N/A
Total for all systems $231,457.64 $129,399.42 N/A $112,892.32 N/A
Primary Tower LTOWER $67,686.41 $11,496.41 $5,748.21
KNPN and KNPG Antenna Installation $11,496.41 $11,496.41 N/A $5,748.21 N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
KNPN and KNPG Antenna Installation

Component Description:
KNPN and KNPG Antenna Installation
Amount:
$5,748.21
Tower Rigging Short Tower (less than 500') Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $19,648.91 $28,902.47 N/A $18,613.57 N/A
Total for all systems $231,457.64 $129,399.42 N/A $112,892.32 N/A
Outside Professional Services $19,648.91 $28,902.47 $18,613.57
Prepare/ Review 399 reimbursement form $1,710.00 $9,596.90 Additional expenses were incurred as indicated in the attached invoices. $9,596.90 Additional expenses were incurred as indicated in the attached invoices.
Project Management Services $2,366.41 $2,366.41 N/A $2,366.41 N/A
Additional Displacement Legal Services Not Otherwise Specified in Form 399 $2,500.00 $2,500.00 N/A $1,038.10 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A $970.50 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $1,475.00 N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $3,166.66 Additional expenses were incurred as indicated in the attached invoices. $3,166.66 Additional expenses were incurred as indicated in the attached invoices.

Components

Actual Information Description File Name
Prepare/ Review 399 reimbursement form

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$234.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$130.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$196.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$104.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$637.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$759.50

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$775.50

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$26.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$1,133.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$434.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$1,676.50

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$566.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$784.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$1,791.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$78.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$272.40
Project Management Services

Component Description:
Please note the exhibit attached with this invoice. The invoice total is $2860.63. KNPN is requesting reimbursement of $1430.32 and the Form 399 for KNPG will be requesting reimbursement of $1430.31 for a total of $2860.63.
Amount:
$1,430.32

Component Description:
Project Management split with KNPG; KNPG will be requesting $936.08 of the $1872.17.
Amount:
$936.09
Additional Displacement Legal Services Not Otherwise Specified in Form 399

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$78.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$85.80

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$22.80

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$236.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$52.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$92.80

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$51.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$73.50

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$346.20
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

Component Description:
Prepare displacement application
Amount:
$654.00

Component Description:
Prepare displacement application
Amount:
$59.10

Component Description:
Prepare and file displacement application
Amount:
$257.40
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare engineering portion of displacement application
Amount:
$50.00

Component Description:
Prepare engineering portion of displacement application correction
Amount:
$375.00

Component Description:
Prepare engineering for displacement application
Amount:
$1,050.00
Prepare request for Special Temporary Authorization Information not provided.
Perform engineering study for displacement application

Component Description:
Application study
Amount:
$125.00

Component Description:
Restudy allocation/TPO for KCJO-KNPN-KNPG
Amount:
$83.33

Component Description:
Prepare study of competitors
Amount:
$475.00

Component Description:
Displacement options
Amount:
$250.00

Component Description:
Displacement studies and analysis
Amount:
$1,625.00

Component Description:
Prepare study of competitors
Amount:
$100.00

Component Description:
Prepare study of competitors
Amount:
$125.00

Component Description:
TPO Calculations
Amount:
$125.00

Component Description:
Research and results of FCC displacement of LPTVs
Amount:
$83.33

Component Description:
Prepare study of competitors
Amount:
$175.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $640.00 $640.00 N/A $170.00 N/A
Total for all systems $231,457.64 $129,399.42 N/A $112,892.32 N/A
Other Expenses $640.00 $640.00 $170.00
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A $170.00 N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A N/A

Components

Actual Information Description File Name
FCC Filing Fees - Form 2100 license to cover application

Component Description:
Filing fee for displacement license application
Amount:
$170.00
FCC Filing Fees - Special Temporary Authorization request Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $231,457.64 $129,399.42 $112,892.32

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

J Timothy Hannan

EVP & CFO of Parent, NPGCO


03/25/2022

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

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

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

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

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

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

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

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

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

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

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

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

J Timothy Hannan

EVP & CFO of Parent, NPGCO


03/25/2022

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

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

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

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

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

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

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

J Timothy Hannan

EVP & CFO of Parent, NPGCO


03/25/2022

Attachments

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