TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
KTBS, LLC Doing Business As: KTBS, LLC	PO Box 44227 SHREVEPORT, LA 71134 United States	+1 (318) 861-5800	dcassidy@ktbs.com	Limited Liability Company

Applicant

Address

Phone

Applicant Type

KTBS, LLC

Doing Business As: KTBS, LLC

PO Box 44227

SHREVEPORT, LA 71134

United States

+1 (318) 861-5800

dcassidy@ktbs.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
Samuel Hariton Widelity, Inc.	Sam Hariton 4031 University Drive Suite 100 Fairfax, VA 22030 United States	+1 (339) 222-8107	sam.hariton@widelity.com

Applicant

Address

Phone

Samuel Hariton

Widelity, Inc.

Sam Hariton

4031 University Drive

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107

sam.hariton@widelity.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	KPXJ is planning a direct like-for-like swap on all equipment. KPXJ's new equipment will include upgraded equipment to add VPOL capability. See Narrative for details.

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	Retune Existing
	Use	Auxiliary (Backup)
	Ownership	Owned
	Owner	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	GatesAir
	Model	ULXTD-60
	Year	2016
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	34.6 kW

Auxiliary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	Other
	Other Power	0 kW
New Exciter	Is a new exciter needed?	No

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	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

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Aux Transmitter - System Sweep Post Retune	Aux Transmitter - System Sweep Post Retune
Aux Transmitter - RF System Modifications	Aux Transmitter - RF System Modifications
Aux Transmitter - Additional Installation	Aux Transmitter - Additional Installation
Aux Transmitter - Proof of Performance	Aux Transmitter - Proof of Performance

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	DCXP-2 Paragon
	Year	2005
	Type	Inductive Output Tube
	IOT Power Type	Two
	Power Capacity	50 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	ULXTED-120
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	76.0 kW
	Justification for New Transmitter	The existing transmitter is capable of being retuned, however doing so would require disconnecting the transmitter to have it retuned on site. The retuning process was quoted to take 16 to 20 weeks and during this time the transmitter would be unavailable

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	Yes
	Power	300 kVA
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	Yes
	Description	The new main transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Cooling Only
	Size	5 tons
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Primary Transmitter - Decommission	Primary Transmitter - Decommission
Primary Transmitter - RF Accessories	Primary Transmitter - RF Accessories
Relocating Ground equipment	Relocating existing equipment for other stations to make room for new transmitter
Primary Transmitter - Interior RF and Switching	Primary Transmitter - Interior RF and Switching
Building Reconfiguration	The existing building will need to be reconfigured (walls removed/added) to allow for the new transmitter combiner configuration
Combiner 5 ton HVAC	The Combiner will need its own dedicated Cooling only HVAC
Primary Transmitter - Installation	Primary Transmitter - Installation
Primary Transmitter - Generator	Primary Transmitter - Generator

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?	Yes
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:	1000.0 kW
	Manufacturer
	Model	TFU-30DSC-R S20000
	Year	2006

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?	Yes
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:	1000.0 kW
	Manufacturer
	Model	TFU-30DSC/VP-R S200
	Year	2017
	Justification for New Antenna	A New antenna is necessary because the existing antenna cannot support the new channel. Additionally, KPXJ needs to replace the un-used bottom-stack antenna at the top of the tower due to structural limitations.

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
Wedding Cake Adapter	Wedding Cake Adapter

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?	Yes
	Is antenna directional?	No
	Will antenna be located on or in close proximity to an antenna farm?	Yes
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Slot
	Number of Stations Supported	2
	Number of Panels/Bays	24
	Lower Limit	512.00 MHz
	Upper Limit	584.00 MHz
	Design power capacity in use	50.0 %
	Other Antenna Type	N/A
	ERP:	800.0 kW
	Manufacturer
	Model	TFU-24WB C160
	Year	2017
	Justification for New Antenna	This broadband antenna will cover KTBS's channel 28, as well both KPXJ's pre-transition channel 21 and post-transition channel 32. This will drastically reduce the risk of delays or risk of KPXJ not being able to transition channels on schedule.

Interim Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	Yes
	Type	New
	Number of channels supported	3
	Frequencies of channels supported	RF channel
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	No
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	B
	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

Enter a list of RF channel numbers.

RF Channel Number
21
28
32

Interim Antenna

Other Antenna Cost Not Listed

Information not provided.

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	4 1/16 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1731 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?	Yes
	Type	Rigid
	Diameter	8 3/16 inches
	Other Diameter	N/A
	Segment Length	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1760 feet per run
	Justification for New Transmission Line	The existing line is not capable of supporting the new channel. Additionally, the new main antenna will be installed in a different location than the existing main antenna.

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	Rigid
	Diameter	6 1/8 inches
	Segment Length	Broadband
	Other Segment Length
	Number of parallel runs	1
	Length	1560 feet per run
	Justification for New Transmission Line	The interim line is needed to connect the combiner system on the ground with the new interim antenna. The Line needs to support two stations of power as well as be broadband to allow all channel combinations to operate on the same line.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

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?	Terrain Constrained
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	Yes
	Others Types of Users	No
	Is tower documented for structural analysis?	Yes
	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	1020877
Coordinates (NAD83)	Latitude (NAD83)	32° 41' 08.5" N-
	Longitude (NAD83)	093° 56' 00.6" W-
	Overall Structure Height	1825.77 feet
	Support Structure Height	1822.48 feet
	Ground Elevation Above Mean Sea Level (AMSL)	249.01 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	KTBS, LLC
	Date Constructed	06/25/2013

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
1304	KRMD-FM	FM
35652	KTBS-TV	DTV

Primary Tower

Tower Modification Costs

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

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Field Verifications	Field Verification for Actual mechanicals for existing antennas prior to antenna ordering.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	2562
	Explanation	See attached Narrative
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	Yes
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	2
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	2
	NEPA Section 106 environmental review	Yes
	Environmental Assessment	Yes
	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	Yes
	RF exposure measurements	Yes
	Additional Field Engineering Service	Yes
	Number of Days	20
	Justification	Field investigation of tower site and building status will be needed in order to design and scope project.

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Attorney - Other Matters	Legal Services

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

Other Expenses

Other Expenses Not Listed

Name	Description
Road Repairs	Repairs required to fix damage done by equipment during repack

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	$3,744,228.77	$3,756,183.77	N/A	$2,144,836.68	N/A
Total for all systems	$8,387,002.90	$8,578,574.70	N/A	$5,827,166.97	N/A
Primary Transmitter ULXTED-120	$3,341,783.90	$3,338,983.90		$1,762,675.49
Primary Transmitter - RF Accessories	$101,238.92	$101,238.92	Please see Technical Services Group, Inc. estimate 2015865-RF	$38,288.03	N/A
Primary Transmitter - Generator	$206,169.93	$206,169.93	Please see TSG Estimate 2015865F	$0.00	N/A
Primary Transmitter - Installation	$98,812.50	$98,812.50	Please see TSG Estimate #20158651 and Invoice #20158651.pdf	$98,812.50	N/A
Combiner 5 ton HVAC	$15,333.33	$15,333.33	See attached TSG Quote “Sec 1 Main TX” line 63	$0.00	N/A
Building Reconfiguration	$20,000.00	$20,000.00	N/A	$0.00	N/A
Primary Transmitter - Interior RF and Switching	$101,238.92	$101,238.92	Please see TSG Estimate #2015865-RF and Invoice #2015865-RF	$0.00	N/A
Primary Transmitter - Decommission	$32,381.20	$32,381.20	Please see Line 1 on Technical Services Group, Inc. estimate 2015865-9A	$32,381.20	N/A
5 Ton system	$20,250.00	$19,250.00	N/A	$0.00	N/A
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.	$75,000.00	$75,000.00	N/A	$40,250.00	N/A
Transformer 3 phase/480v - 300 KVA	$36,800.00	$35,000.00	N/A	$0.00	N/A
UHF - Liquid Cooled Solid State Transmitter 76.0 kW	$2,614,559.10	$2,614,559.10	see Estimated Cost Justification KPXJ-110-Primary Transmitter - UHF liquid-cooled 76 kW v0	$1,552,943.76	N/A
Relocating Ground equipment	$20,000.00	$20,000.00	N/A	$0.00	N/A
Auxiliary Transmitter ULXTD-60	$402,444.87	$417,199.87		$382,161.19
Aux Transmitter - Proof of Performance	$24,000.00	$24,000.00	Please see TSG Estimate 2015865G	$24,000.00	N/A
Aux Transmitter - Additional Installation	$93,163.68	$93,163.68	Please see TSG Estimate 2015865G	$58,125.00	N/A
Aux Transmitter - RF System Modifications	$173,681.19	$173,681.19	Please see TSG Estimate 2015865G and Cost Reconciliation	$173,681.19	N/A
Aux Transmitter - System Sweep Post Retune	$6,400.00	$6,400.00	Please see TSG Estimate 2015865G	$6,400.00	N/A
Other 0 kW mask filter	$0.00	$0.00	No new mask filter required - this category is only present because LMS requires that it be here.	N/A	N/A
UHF and VHF - minor banding issues	$105,200.00	$119,955.00	Please see TSG Estimate 2015865G and Cost Reconciliation	$119,955.00	N/A

Components

Actual Information Description	File Name
Primary Transmitter - RF Accessories	Component Description: Invoice #2015865-RF: Main Transmitter Interior RF and Switching Amount: $38,288.03
Primary Transmitter - Generator	Component Description: KPXJ Generator Amount: $206,169.93
Primary Transmitter - Installation	Component Description: Installation Services Amount: $98,812.50
Combiner 5 ton HVAC	Information not provided.
Building Reconfiguration	Information not provided.
Primary Transmitter - Interior RF and Switching	Component Description: Main Transmitter Interior RF and Switching Amount: $38,288.03
Primary Transmitter - Decommission	Component Description: TSG Primary Transmitter Amount: $32,381.20
5 Ton system	Information not provided.
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.	Component Description: Remove power and wiring from existing transmitter and reconnect power to equipment Amount: $6,162.47 Component Description: Material- KPXJ Transmitter Equipment Amount: $13,074.00 Component Description: Install wiring for new KPXJ Transmitter Equipment Amount: $11,459.27 Component Description: Material-New KPXJ Service Amount: $4,044.00 Component Description: Install wiring for new electrical service for KPXJ transmitter Amount: $5,510.26
Transformer 3 phase/480v - 300 KVA	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 76.0 kW	Component Description: "GatesAir Maxiva Series ULXTED-120 High Efficiency Broadband Liquid-Cooled, Solid-State, Television Transmitter" Amount: $720,046.49 Component Description: 50% prepayment deposit on new transmitter Amount: $828,967.15 Component Description: KPXJ-110-Primary Transmitter - UHF liquid cooled 68.5-75 kW Amount: $3,930.12
Relocating Ground equipment	Information not provided.
Aux Transmitter - Proof of Performance	Component Description: KPXJ-150-Auxiliary Transmitter - Proof of Performance Amount: $24,000.00
Aux Transmitter - Additional Installation	Component Description: KPXJ- Aux Transmitter- Additional Installation Amount: $58,125.00
Aux Transmitter - RF System Modifications	Component Description: KPXJ-150-Auxiliary Transmitter - RF System Modifications Amount: $173,681.19
Aux Transmitter - System Sweep Post Retune	Component Description: KPXJ-150-Auxiliary Transmitter - System Sweep Post Retune Amount: $6,400.00
Other 0 kW mask filter	Information not provided.
UHF and VHF - minor banding issues	Component Description: UHF and VHF - minor banding issues Amount: $119,955.00

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	$1,026,678.30	$1,063,932.16	N/A	$614,835.28	N/A
Total for all systems	$8,387,002.90	$8,578,574.70	N/A	$5,827,166.97	N/A
Interim Antenna TFU-24WB C160	$401,869.30	$584,058.60		$262,321.36
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$22,000.00	N/A	$0.00	N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	$13,700.00	$13,000.00	N/A	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
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 800 kW input, horizontally polarized	$268,829.30	$268,829.30	see Justifying Quote KPXJ-280-Interim Antenna - High Power Side Mount TSG proposal for Job 2015865A	$262,321.36	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	N/A	N/A
New combiner, cost per channel (without antenna)	$84,200.00	$268,829.30	Based on Quote.	$0.00	N/A
Primary Antenna TFU-30DSC/VP-R S200	$624,809.00	$479,873.56		$352,513.92
Wedding Cake Adapter	$33,314.78	$33,314.78	Please see TSG Estimate and Invoice #2015865W.pdf	$33,314.77	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
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$31,969.11	see Estimated Cost Justification KPXJ-210-Primary Antenna - Side Mount Brackets - Custom Mount Brackets v0	$31,906.19	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
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	N/A	N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized	$254,554.22	$254,554.22	Per Dielectric quote 513326JKT Rev 5. Vpol adder is not included here. Previous superseded component has $136,935.45 forwarded for payment.	$150,357.51	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$136,935.45	*System Notice: Estimate adjusted and locked because line has been superseded.*	$136,935.45	N/A

Components

Actual Information Description	File Name
Side mount brackets for high power antennas (if not included in antenna base cost)	Information not provided.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 800 kW input, horizontally polarized	Component Description: overpayment in interim antenna category due to deductive change order Amount: ($6,507.93) Component Description: Pre-shipment deposit on KPXJ Interim Antenna Purchase Amount: $67,207.32 Component Description: Interim Antenna Purchase Amount: $134,414.65 Component Description: Dielectric 11000000077 UHF - Broadband Side Mount AUX / Interim TFU-24WB C160 CH 14-51. Amount: $67,207.32
Sweep test of existing antenna	Information not provided.
New combiner, cost per channel (without antenna)	Information not provided.
Wedding Cake Adapter	Component Description: Structural / Tower Modifications Amount: $33,314.77
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)	Component Description: KPXJ-210-Primary Antenna - Side Mount Brackets - Custom Mount Brackets Amount: $4,839.53 Component Description: KPXJ-210-Primary Antenna - Side Mount Brackets - Custom Mount Brackets to existing Amount: $6,766.66 Component Description: KPXJ-210-Primary Antenna - Side Mount Brackets - Custom Mount Brackets to existing Amount: $20,300.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Information not provided.
Sweep test of existing antenna	Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized	Component Description: UHF - High Power Side Mount TV Antenna Amount: $61,701.06 Component Description: Main Antenna purchase Amount: $48,167.71 Component Description: KPXJ Additional Materials Amount: $40,488.74
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: This section has been superseded and the invoice moved. Amount: N/A Component Description: Main Antenna Purchase Amount: $136,935.45 Component Description: This section has been superceded and the invoice moved. Amount: N/A

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	$1,328,160.00	$1,351,418.61	N/A	$1,032,845.51	N/A
Total for all systems	$8,387,002.90	$8,578,574.70	N/A	$5,827,166.97	N/A
Interim Transmission Line	$361,920.00	$548,493.77		$548,493.77
Rigid Transmission Line - copper, 6 1/8" broadband	$361,920.00	$548,493.77	per KPXJ-380-Interim Transmission Line - 6 1-8 Rigid Copper, Broadband Budget Increase Justification v0	$548,493.77	N/A
Primary Transmission Line	$966,240.00	$802,924.84		$484,351.74
Rigid Transmission Line - copper, 8 3/16"	$610,720.00	$565,433.18	See attached TSG Sec 7 Main Coax Price Quote. Previous transmission line category erroneously labelled at a diameter of 6 1/8". The correct 8 3/16" line has already been partially reimbursed per the invoice 202986. Actual costs will reflect this.	$246,860.08	N/A
Rigid Transmission Line - copper, 6 1/8"	$355,520.00	$237,491.66	*System Notice: Estimate adjusted and locked because line has been superseded.*See attached TSG “Sec 7 Main Coax” price quote;	$237,491.66	Please reject 203254 from this component

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 6 1/8" broadband	Component Description: KPXJ-380-Interim Transmission Line - 6 1/8"" Rigid Copper, Broadband Amount: $35,806.33 Component Description: Dielectric 11000000077 6 1/8" Line and Connectors: Run is 1460' Vertical and 100' Horizontal Amount: $127,789.51 Component Description: Transmission Line Coax Interim Purchase Amount: $128,171.86 Component Description: Transmission Line Coax Interim Purchase Amount: $256,726.07
Rigid Transmission Line - copper, 8 3/16"	Component Description: KPXJ-310-Primary Transmission Line - 8 3/16"" Rigid Copper Amount: $12,750.65 Component Description: KPXJ Transmission Line Coax Main Amount: $117,900.27 Component Description: Dielectric 11000000077 TRANSMISSION LINE - RIGID Amount: $116,209.16
Rigid Transmission Line - copper, 6 1/8"	Component Description: Transmission Line Coax Main Amount: $237,491.66 Component Description: Please reject this invoice Amount: N/A

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	$1,490,600.00	$1,598,823.88	N/A	$1,497,073.78	N/A
Total for all systems	$8,387,002.90	$8,578,574.70	N/A	$5,827,166.97	N/A
Primary Tower GTOWER	$1,490,600.00	$1,598,823.88		$1,497,073.78
Serious tower reinforcement/modifications	$1,052,000.00	$1,257,188.88	KPXJ-410-Existing Primary Tower - Serious Tower Reinforcement and modifications Verified Budget Increase Justification v1	$1,239,688.78	N/A
Structural engineering tower load study for well documented tower	$12,600.00	$13,820.00	Invoices total this amount.	$13,820.00	N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$322,815.00	TCI proposals TCI-17-149E, TCI-18-025B, and JRTarver Quote Q-7015. Please see KPXJ_TowerRigging_CostEstimate_cover letter for more information.	$243,565.00	N/A
Field Verifications	$5,000.00	$5,000.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
Serious tower reinforcement/modifications	Component Description: Tower Modification, repack antenna installation Amount: $271,391.80 Component Description: Tower Modification: Engineering, materials, labor services, project management and insurance to preform the complex tower modifications on the 1,693-ft guyed Kline Tower Amount: $286,635.00 Component Description: Tower Consultants, Inc. tower mods Amount: $31,400.00 Component Description: Tower modification Amount: $28,800.00 Component Description: 70'-8" Ladder with Platform Amount: $19,532.00 Component Description: Job# 39946- manufactured a two piece custom ladder 20' overall length galvanized to specs Amount: $4,252.95 Component Description: Tower Modifications Amount: $550,339.20 Component Description: Cleanup work area around concrete slab Amount: $400.00 Component Description: Engineering, materials, labor services, project management and insurance to preform the complex tower modifications on the 1,693-ft guyed Kline Tower Amount: $102,154.00 Component Description: 3" x 3" X 1/4" Angle Iron 15' Long, Freight for complete order Amount: $4,540.00 Component Description: Job# 39945 Amount: $443.83
Structural engineering tower load study for well documented tower	Component Description: Tower Analysis Amount: $8,420.00 Component Description: Second Tower Analysis Amount: $1,800.00 Component Description: Analysis prepared for one (1) additional Load Case to determine conformance with the ANSI/TIA?EIA Standard 222-G with basic wind speeds required for the tower location. Amount: $1,800.00 Component Description: Analysis prepared for one additional Load Case to determine conformance with the ANSI/TIA?EIA Standard 222-G Amount: $1,800.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: Repack Antenna Installation Amount: $109,291.20 Component Description: KPXJ-410-Existing Primary Tower - Complex Tower, Tower Equipment and Rigging Amount: $38,707.30 Component Description: Clearing lane for TV tower crew @ Channel 3 TV tower Amount: $1,000.00 Component Description: 2. Existing Primary Tower, Complex Tower, Tower Equipment and Rigging, Repack Antenna Installation, Mobilization 25%, Amount: $56,922.50 Component Description: Antenna Services: Engineering, materials, labor services, project management and insurance to preform the specified antenna installation services Amount: $14,875.00 Component Description: KPXJ-410-Existing Primary Tower -Complex Tower, Tower Equipment and Rigging Amount: $22,769.00
Field Verifications	Information not provided.

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	$609,532.25	$621,302.70	N/A	$439,827.70	N/A
Total for all systems	$8,387,002.90	$8,578,574.70	N/A	$5,827,166.97	N/A
Outside Professional Services	$609,532.25	$621,302.70		$439,827.70
Attorney - Other Matters	$2,531.25	$2,531.25	Please see Estimated Cost Justification KPXJ-550-Attorney - Other Matters v1	$2,531.25	N/A
RF Exposure Measurements	$21,050.00	$20,000.00	N/A	N/A	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$80,000.00	N/A	N/A	N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet	$10,520.00	$10,000.00	N/A	N/A	N/A
NEPA Section 106 environmental review, if needed	$6,310.00	$6,000.00	N/A	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$7,360.00	$7,000.00	N/A	$375.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$3,162.50	see Estimated Cost Justification KPXJ-550-Attorney - Prepare and File License to Cover Application (Main) v0	$3,162.50	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$3,500.00	N/A
Prepare request for Special Temporary Authorization	$4,100.00	$3,000.00	N/A	$0.00	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	$1,580.00	$1,500.00	N/A	$0.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$750.00	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	$2,105.00	$2,000.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$1,750.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$650.00	N/A
Prepare and or review reimbursement form	$2,630.00	$2,750.00	see Estimated Cost Justification KPXJ-590-Prepare and Review Reimbursement Form v0	$2,750.00	N/A
Project management of the transition	$404,796.00	$424,358.95	The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time.	$424,358.95	N/A
Additional Field Engineering Service, 20 Days	$40,000.00	$40,000.00	N/A	N/A	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

Components

Actual Information Description	File Name
Attorney - Other Matters	Component Description: Legal services Amount: $750.00 Component Description: Professional Services Amount: $125.00 Component Description: Legal Services Amount: $906.25 Component Description: T.C. w/ G. Sirven, D. Cassidy re reimbursement issues. Amount: $250.00 Component Description: KPXJ-550-Attorney - Other Matters Amount: $500.00
RF Exposure Measurements	Information not provided.
Comprehensive coverage verification via field study, if needed	Information not provided.
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	Component Description: Exchange e-mails re documentation of fee payment for KTBS STA required to allow KPXJ transition construction Amount: $375.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: KPXJ-550-Attorney - Prepare and File License to Cover Application (Main) Amount: $1,687.50 Component Description: Attorney Fees for Regarding Channel Change Amount: $525.00 Component Description: Attorney fees to assist with Post Auction Repack Amount: $950.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Attorney Fees associated with Construction Permit Amount: $3,500.00
Prepare request for Special Temporary Authorization	Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Attorney Fees Associated with FCC Form 399 Amount: $375.00 Component Description: Assistance with engineering portion of license application for KPXJ-DT Amount: $375.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Engineering Work for Construction Permit Amount: $1,750.00
Perform engineering study for new channel assignment and antenna development	Component Description: Engineering RF Analysis Amount: $650.00
Prepare and or review reimbursement form	Component Description: Attorney fees for Public Notice Reminder and Filings Amount: $250.00 Component Description: Legal Services Amount: $125.00 Component Description: Attorney Fees Associated with Reimbursements Amount: $625.00 Component Description: Attorney fees for discussing Channel Reassignment, Cores Registration and Form 1876 Amount: $1,625.00 Component Description: Legal Services Amount: $125.00
Project management of the transition	Component Description: Legal Services Amount: $125.00 Component Description: Project management Amount: $2,770.15 Component Description: Project Management Amount: $3,531.30 Component Description: Legal services Amount: $1,375.00 Component Description: Project Management Amount: $7,204.95 Component Description: Project Management Amount: $3,592.65 Component Description: Project Management Amount: $9,220.65 Component Description: Project Management Amount: $1,462.25 Component Description: Project Management Amount: $6,537.05 Component Description: Follow up re KPXJ transition status report. Amount: $125.00 Component Description: Project Management Amount: $9,761.20 Component Description: FCC 387 Quarterly reports Amount: $225.00 Component Description: Project Management Amount: $3,008.55 Component Description: Outside Services, Project Management of the Transition, Professional Services provided by TSG. Amount: $57,825.00 Component Description: Project Management Amount: $1,368.85 Component Description: Outside Professional Services Amount: $70,700.00 Component Description: Project Management Amount: $9,731.35 Component Description: Project Management Amount: $15,321.85 Component Description: KPXJ Repack Ch 32 Amount: $6,921.00 Component Description: Widelity August services Amount: $10,741.05 Component Description: Project Management Amount: $9,061.70 Component Description: Project Management Amount: $11,164.40 Component Description: Legal services Amount: $1,625.00 Component Description: Project Management Amount: $4,421.30 Component Description: Project Management Amount: $4,457.40 Component Description: Professional services Amount: $35,486.65 Component Description: Project Management Amount: $9,713.35 Component Description: Project Management Amount: $2,770.15 Component Description: Project Management Amount: $3,039.85 Component Description: Project Management Amount: $4,428.70 Component Description: Project Management Amount: $10,947.90 Component Description: KPXJ Repack Ch 32 Amount: $6,427.70 Component Description: Project Management Amount: $3,330.10 Component Description: Project Management Amount: $3,418.70 Component Description: Project Management Amount: $3,335.90 Component Description: Project Management Amount: $6,219.95 Component Description: Project Management Amount: $11,077.75 Component Description: Project management Amount: $3,810.05 Component Description: Project Management Amount: $2,036.65 Component Description: KPXJ seeks reimbursement Widelity services provided & charged during December 2018 Amount: $4,418.30 Component Description: Project Management Amount: $11,198.70 Component Description: KPXJ Repack Ch 32 Amount: $6,099.15 Component Description: Project Management Amount: $1,286.25 Component Description: Project Management Amount: $11,105.80 Component Description: Project Management Amount: $3,918.65 Component Description: Project Management Amount: $6,706.05 Component Description: Project Management Amount: $4,733.85 Component Description: Project Management Amount: $5,216.25 Component Description: Project Management Amount: $375.00 Component Description: Project Management Amount: $6,790.40 Component Description: Project Management Amount: $4,314.50
Additional Field Engineering Service, 20 Days	Information not provided.
Address transition timing and coordination issues w/ other stations and wireless	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	$187,803.58	$186,913.58	N/A	$97,748.02	N/A
Total for all systems	$8,387,002.90	$8,578,574.70	N/A	$5,827,166.97	N/A
Other Expenses	$187,803.58	$186,913.58		$97,748.02
Equipment Delivery and Handling Charges	$20,000.00	$20,000.00	See attached TSG “Sec 11 Other Expenses” quote, Item 11;	$4,956.32	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$50,000.00	$50,000.00	See attached TSG “Sec 11 Other Expenses” quote, item 9;	$13,172.05	N/A
Non-zoning permits	$5,000.00	$5,000.00	N/A	$0.00	N/A
Local Zoning	$10,000.00	$10,000.00	N/A	N/A	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$190.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$0.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$5,316.25	N/A
Road Repairs	$53,723.58	$53,723.58	Please see Technical Services Group, Inc. estimate 2015865R	$53,723.58	N/A
MVPD Notification of Channel Change	$2,000.00	$2,000.00	N/A	$625.00	N/A
Develop and air announcement of upcoming channel change	$15,000.00	$15,000.00	N/A	$93.75	N/A
Equipment Storage	$20,000.00	$20,000.00	N/A	$19,861.07	N/A

Components

Actual Information Description	File Name
Equipment Delivery and Handling Charges	Component Description: KPXJ-610-Equipment Delivery and Handling Amount: $4,956.32
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Equipment Rentals Amount: $3,609.55 Component Description: Cleanup work area around concrete slab Amount: $400.00 Component Description: KPXJ-610-Disposal Costs Amount: $9,562.50
Non-zoning permits	Information not provided.
Local Zoning	Information not provided.
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
DTV Medical Facility Notification	Component Description: KPXJ-610-Medical Facility Notification Amount: $750.00 Component Description: DTV Medical Facility Notification Amount: $4,566.25
Road Repairs	Component Description: KPXJ Driveway Restoration Amount: $53,723.58
MVPD Notification of Channel Change	Component Description: T.C. re MVPD addresses for notification of channel changes. Amount: $250.00 Component Description: Professional Services Rendered Amount: $375.00
Develop and air announcement of upcoming channel change	Component Description: KPXJ-610-Develop and Air Channel Change Announcement Amount: $93.75
Equipment Storage	Component Description: TSG Site Consolidation Equipment Storage Primary Transmitter Amount: $19,861.07

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$8,387,002.90	$8,578,574.70	$5,827,166.97

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.	Dale E. Cassidy Chief Engineer 04/05/2022

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.

Dale E. Cassidy

Chief Engineer

04/05/2022

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.

Dale E. Cassidy

Chief Engineer

04/05/2022

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.

Dale E. Cassidy

Chief Engineer

04/05/2022

(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

Retuning 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

Enter a list of RF channel numbers.

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