TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
CADILLAC TELECASTING CO. Doing Business As: CADILLAC TELECASTING CO.	Alexander Bolea PO Box 627 CADILLAC, MI 49601 United States	+1 (231) 775-3478	JRNBOLEA@AOL.COM	Corporation

Applicant

Address

Phone

Applicant Type

CADILLAC TELECASTING CO.

Doing Business As: CADILLAC TELECASTING CO.

Alexander Bolea

PO Box 627

CADILLAC, MI 49601

United States

+1 (231) 775-3478

JRNBOLEA@AOL.COM

Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
William T Godfrey , Jr . Consulting Engineers Kessler and Gehman Associates, Inc.	William T Godfrey Jr Kessler and Gehman Associates, Inc. 507-D NW 60 Street Gainesville, FL 32607 United States	+1 (352) 332-3157	bill@kesslerandgehman.com

Applicant

Address

Phone

William T Godfrey , Jr .

Consulting Engineers

Kessler and Gehman Associates, Inc.

William T Godfrey Jr

Kessler and Gehman Associates, Inc.

507-D NW 60 Street

Gainesville, FL 32607

United States

+1 (352) 332-3157

bill@kesslerandgehman.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, main antenna and interim antenna. Re-use main and interim transmission lines. Map and analyze main and interim towers. Modify, strengthen or replace tower(s) as required based on structural analysis reports for main and interim towers

Transmitters

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

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	Diamond
	Year	2005
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	3.6 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	UAXTE-8
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	4.8 kW
	Justification for New Transmitter	The manufacturer of the existing solid state transmitter advises that the transmitter cannot be re-tuned to the assigned channel.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	Yes
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	300 kVA
	Rigid Conduit and Wiring	Yes
	Size	3 inches
	Length	100.0 feet
	Other Electrical Service	Yes
	Description	Electrical modifications required for new transmitter in building addition. See attached quote and justification statement.
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Heating and Cooling
	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?	Yes
	Size	576.0 square feet
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 AUX Transmission line
Standby Exciter and Switch	Standby Exciter with Automatic Change Over Switch

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?	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	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:	108.0 kW
	Manufacturer
	Model	ALP24M3-HSOC-45
	Year	2005

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?	No
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	66.0 kW
	Manufacturer
	Model	TFU-24DSB-B/VP
	Year	2018
	Justification for New Antenna	The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel.

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	Single Channel
	Feed Line Size	3 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
High VSWR troubleshooting	High VSWR troubleshooting
Other Antenna Costs	Other Antenna Costs

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?	No
	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:	108.0 kW
	Manufacturer
	Model	TFU-8WB-R S230
	Year	2019
	Justification for New Antenna	Interim antenna on existing interim tower is required on pre-auction channel: 1) To keep station on the air while the new main tower is strengthened; 2) To support new post-auction antenna and while new antenna is installed; and 3) To operate thru 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	3 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?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Interim Antenna

Other Antenna Cost Not Listed

Name	Description
Reducer	Reducer
Support pole	Support pole

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	Utilize Existing
	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	ERI
	Type	Flexible Air
	Diameter	5 inches
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	700 feet per run

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Sweep Tests	Sweep tests to verify performance of line on assigned channel
Flex Line	Flex Line 5" Air Dielectric 20 FT

Interim Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Type	Flexible Air
	Diameter	5 inches
	Segment Length	N/A
	Other Segment Length
	Number of parallel runs	1
	Length	580 feet per run
	Justification for New Transmission Line	Required to operate interim facility throughout build-out and assigned phase.

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

Auxiliary Tower

Add Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Auxiliary (Backup)
	Description of Use	Interim Tower
	Ownership	Owned
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	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	1000437
Coordinates (NAD83)	Latitude (NAD83)	45° 10' 12.0" N-
	Longitude (NAD83)	084° 45' 04.0" W-
	Overall Structure Height	498.68 feet
	Support Structure Height	469.15 feet
	Ground Elevation Above Mean Sea Level (AMSL)	1541.98 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	CADILLAC TELECASTING, CO.
	Date Constructed	07/12/1992

Auxiliary Tower

Tower Modification Costs

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

Auxiliary Tower

Tower Rigging Costs

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

Auxiliary Tower

Other Tower Expenses Not Listed

Information not provided.

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?	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	1000438
Coordinates (NAD83)	Latitude (NAD83)	45° 10' 12.0" N-
	Longitude (NAD83)	084° 45' 04.0" W-
	Overall Structure Height	633.19 feet
	Support Structure Height	629.91 feet
	Ground Elevation Above Mean Sea Level (AMSL)	1534.10 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	CADILLAC TELECASTING, CO
	Date Constructed	08/28/1996

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
56073	WGFM	FM
84479	WTLI	FM

Other Types of Users

Users
Two-way Tenants

Primary Tower

Tower Modification Costs

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

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Weather Days	Weather Days

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	500
	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	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	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	Yes
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	Yes
	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	Yes
	RF exposure measurements	Yes
	Additional Field Engineering Service	Yes
	Number of Days	27
	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

Name	Description
Other Engineering Services	Other Engineering Services such as Actual Cost invoice prep & submission, are required.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Facility Expenses	Name	N/A
	Other Distributed Transmission System Expenses Not listed	N/A
	Name	N/A
	Is Notification of a Medical Facility required as a result of DTV broadcasting?	Yes
Permit and Filing Costs	Local Zoning	No
	Non-zoning permits	Yes
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	No
	FCC License to Cover Application	No
	FCC Special Temporary Authority Application	No
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	Yes
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	Yes
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Name	Description
Sales Tax	Not included in Widelity; therefore station is budgeting for sales tax.

Cost Information

Transmitters

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,647,505.00	$1,325,461.55	N/A	$648,685.02	N/A
Total for all systems	$5,294,756.19	$4,792,163.30	N/A	$1,501,156.91	N/A
Primary Transmitter UAXTE-8	$1,647,505.00	$1,325,461.55		$648,685.02
Standby Exciter and Switch	$25,000.00	$25,000.00	N/A	N/A	N/A
Additional Interior RF System	$140,000.00	$140,000.00	N/A	N/A	N/A
Other -- Building Addition Size: 576.0	$777,117.00	$777,117.00	See UPDATED attached quote and justification, attachment name WFUP bldg justification 20180418jgv1.pdf	$488,928.47	N/A
Other Electrical Service: Electrical modifications required for new transmitter in building addition. See attached quote and justification statement.	$199,438.00	$199,438.00	See attached quote and justification	N/A	N/A
3" Rigid Conduit and Wiring (Cost per foot)	$5,200.00	$4,900.00	N/A	N/A	N/A
Transformer 3 phase/480v - 300 KVA	$36,800.00	$0.00	Covered under "Other Electrical Service" section in 399	N/A	N/A
Switchgear - industrial 800 amp	$38,200.00	$0.00	Covered under "Other Electrical Service" section in 399	N/A	N/A
Service entrance 3 phase/800 amp/208 volt	$14,400.00	$0.00	Covered under "Other Electrical Service" section in 399	N/A	N/A
UHF - Air Cooled Solid State Transmitter 4 - 6 kW	$236,500.00	$64,900.35	N/A	$64,900.35	N/A
Other -- HVAC Service Type: H Size:5 (Other)	$19,250.00	$19,250.00	N/A	N/A	N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW	$155,600.00	$94,856.20	*System Notice: Estimate adjusted and locked because line has been superseded.*	$94,856.20	N/A

Components

Actual Information Description	File Name
Standby Exciter and Switch	Information not provided.
Additional Interior RF System	Information not provided.
Other -- Building Addition Size: 576.0	Component Description: Orshal WFUP 1 v190604jgv1 Amount: $184,576.00 Component Description: Inv 28332 WFUP Professional Services: Building design. 0.9152 percent complete UL20180418jg Amount: $716.78 Component Description: Osborn inv #30464 Prof Srvcs thru 180831 UL20181212jgv1 Amount: $12,606.17 Component Description: Osborn inv #30649 Prof Srvcs thru 180928 UL20180801jgv1 Amount: $10,800.00 Component Description: Osborn 35273 v190927jgv1 Amount: $184.27 Component Description: Osborn inv #32584 Prof Srvcs 190201 - 190301 UL20190320jgv1 Amount: $16,894.70 Component Description: Osborn inv #30200 Prof Srvcs thru 180727 UL20181212jgv1 Amount: $9,448.90 Component Description: Osborn 33398 Prof Srvcs thru 190426 Bldg v190522jgv1 Amount: $227.26 Component Description: Osborn inv #32955 Prof Srvcs thru 190302-190329 UL20190417jgv1 Amount: $8,071.39 Component Description: Orshal WFUP 2 v190823jgv1 Amount: $245,403.00
Other Electrical Service: Electrical modifications required for new transmitter in building addition. See attached quote and justification statement.	Information not provided.
3" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Transformer 3 phase/480v - 300 KVA	Information not provided.
Switchgear - industrial 800 amp	Information not provided.
Service entrance 3 phase/800 amp/208 volt	Information not provided.
UHF - Air Cooled Solid State Transmitter 4 - 6 kW	Component Description: Gates US0331503 v191101jgv1 Amount: $64,900.35
Other -- HVAC Service Type: H Size:5 (Other)	Information not provided.
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW	Component Description: Gates JW30004601-1 v190817jgv1 Amount: $47,428.10 Component Description: Gates JW30004601-2 v190817jgv1 Amount: $47,428.10

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	$349,569.00	$249,297.00	N/A	$235,672.00	N/A
Total for all systems	$5,294,756.19	$4,792,163.30	N/A	$1,501,156.91	N/A
Interim Antenna TFU-8WB-R S230	$188,239.00	$127,379.00		$127,379.00
Support pole	$59,582.00	$59,582.00	See attached Dielectric invoice MAN01314 and associated Quote 900006CMZ-4.	$59,582.00	N/A
Reducer	$1,777.00	$1,777.00	See attached Dielectric invoice MAN01314 and associated Quote 900006CMZ-4.	$1,777.00	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$2,600.00	See attached Dielectric invoice MAN01314 and associated Quote 900006CMZ-4.	$2,600.00	N/A
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed)	$7,600.00	$9,100.00	See attached Dielectric invoice MAN01314 and associated Quote 900006CMZ-4.	$9,100.00	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	$89,400.00	$47,920.00	See attached Dielectric invoice MAN01314 and associated Quote 900006CMZ-4.	$47,920.00	N/A
Primary Antenna TFU-24DSB-B/VP	$161,330.00	$121,918.00		$108,293.00
Other Antenna Costs	$6,865.00	$6,865.00	N/A	$6,865.00	N/A
High VSWR troubleshooting	$8,625.00	$8,625.00	See attached / uploaded PDF file titled "SGP qte SGP0165 v200806jg.pdf"	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
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$6,008.00	N/A	$6,008.00	N/A
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed)	$7,600.00	$1,912.00	N/A	$1,912.00	N/A
Sweep test of existing antenna	$6,730.00	$6,700.00	N/A	$6,700.00	Sweep test of antenna-transmission line system for WFUP
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized	$103,100.00	$86,808.00	N/A	$86,808.00	N/A

Components

Actual Information Description	File Name
Support pole	Component Description: Die MAN01314 Int pole pct pmt 1 v190725jgv1 Amount: $26,811.90 Component Description: Die MAN01315 Int pole pct pmt 2 v190725jgv1 Amount: $26,811.90 Component Description: Die 555003 v190726pmv1 Amount: $5,958.20
Reducer	Component Description: Die MAN01314 Int reducer pct pmt 1 v190725jgv1 Amount: $799.65 Component Description: Die 563033 v200221pmv1 Amount: $177.70 Component Description: Die MAN01315 Int reducer pct pmt 2 v190725jgv1 Amount: $799.65
Side mount brackets for high power antennas (if not included in antenna base cost)	Component Description: Die MAN01315 Int mt bkts pct pmt 2 v190725jgv1 Amount: $1,170.00 Component Description: Die 563033 v200221pmv1 Amount: $260.00 Component Description: Die MAN01314 Int mt bkts pct pmt 1 v190725jgv1 Amount: $1,170.00
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed)	Component Description: Die MAN01314 Int elbow complex pct pmt 1 v190725jgv1 Amount: $4,095.00 Component Description: Die MAN01315 Int elbow complex pct pmt 2 v190725jgv1 Amount: $4,095.00 Component Description: Die 563033 v200221pmv1 Amount: $910.00
Sweep test of existing antenna	Component Description: Die MAN01314 Int sweep pct pmt 1 v190725jgv1 Amount: $2,880.00 Component Description: Die MAN01315 Int sweep pct pmt 2 v190725jgv1 Amount: $2,880.00 Component Description: Die 927017 v210309pmv1 Amount: $640.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	Component Description: Die MAN01315 Int TFU-8WB-R S230 45 pct pmt 2 v190725jgv1 Amount: $21,564.00 Component Description: Die MAN01314 Int TFU-8WB-R S230 45 pct pmt 1 v190725jgv1 Amount: $21,564.00 Component Description: Die 555003 v190726pmv1 Amount: $4,792.00
Other Antenna Costs	Component Description: Die 929017 v210309pmv1 Amount: $6,642.00 Component Description: Die 947014 v210309pmv1 Amount: $223.00
High VSWR troubleshooting	Information not provided.
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: Die 558008 v190802pmv1 Amount: $600.80 Component Description: Die MAN01211 Side mt bkts 45 pct pmt 2 v190725jgv1 Amount: $2,703.60 Component Description: Die MAN01131 Side mt bkts 45 pct pmt 1 v190723jgv1 Amount: $2,703.60
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed)	Component Description: Die MAN01131 Elbow 45 pct pmt 1 v190723jgv1 Amount: $860.40 Component Description: Die 558008 v190802pmv1 Amount: $191.20 Component Description: Die MAN01211 Elbow 45 pct pmt 2 v190725jgv1 Amount: $860.40
Sweep test of existing antenna	Component Description: WFUP 5 inch and 3 inch heliax transmission line measurements on Aug 21 2017 Amount: $300.00 Component Description: Die 927004 v210309pmv1 Amount: $640.00 Component Description: Die MAN01211 Sweep 45 pct pmt 2 v190725jgv1 Amount: $2,880.00 Component Description: Die MAN01131 Sweep 45 pct pmt 1 v190723jgv1 Amount: $2,880.00
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized	Component Description: Die MAN01131 TFU-24DSB-B/VP 45 pct pmt 1 v190723jgv1 Amount: $39,063.60 Component Description: Die MAN01211 TFU-24DSB-B/VP 45 pct pmt 2 v190725jgv1 Amount: $39,063.60 Component Description: Die 558008 v190802pmv1 Amount: $8,680.80

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	$83,273.81	$71,231.37	N/A	$64,831.37	N/A
Total for all systems	$5,294,756.19	$4,792,163.30	N/A	$1,501,156.91	N/A
Interim Transmission Line	$60,900.00	$48,857.56		$48,857.56
Flexible Air Transmission Line - dielectric, 5"	$60,900.00	$48,857.56	See attached Dielectric invoice MAN01314 and associated Quote 900006CMZ-4.	$48,857.56	N/A
Primary Transmission Line	$22,373.81	$22,373.81		$15,973.81
Flex Line	$15,973.81	$15,973.81	See attached Dielectric Invoice MAN01131 and associated Quote 900007CMZ-1	$15,973.81	N/A
Sweep Tests	$6,400.00	$6,400.00	N/A	$0.00	Transmission Line Sweep

Components

Actual Information Description	File Name
Flexible Air Transmission Line - dielectric, 5"	Component Description: Die MAN01315 Int flex line pct pmt 2 v190725jgv1 Amount: $21,985.90 Component Description: Die MAN01314 Int flex line pct pmt 1 v190725jgv1 Amount: $21,985.90 Component Description: Die 563033 v200221pmv1 Amount: $4,885.76
Flex Line	Component Description: Die 927004 v210309pmv1 Amount: $1,597.39 Component Description: Die MAN01131 Flex line 45 pct pmt 1 v190723jgv1 Amount: $7,188.21 Component Description: Die MAN01211 Flex line 45 pct pmt 2 v190725jgv1 Amount: $7,188.21
Sweep Tests	Component Description: Inv: WFUP Line sweeps UL20180329 rev'd 20180330jg Amount: $300.00

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	$2,513,310.00	$2,392,010.00	N/A	$271,712.68	N/A
Total for all systems	$5,294,756.19	$4,792,163.30	N/A	$1,501,156.91	N/A
Auxiliary Tower TOWER	$1,162,500.00	$1,105,000.00		$11,159.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$25,000.00	N/A	$11,159.00	N/A
Short Tower (less than 500')	$84,200.00	$80,000.00	N/A	N/A	N/A
Serious tower reinforcement/modifications	$1,052,000.00	$1,000,000.00	N/A	N/A	N/A
Primary Tower TOWER	$1,350,810.00	$1,287,010.00		$260,553.68
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$25,000.00	N/A	$5,700.00	N/A
Serious tower reinforcement/modifications	$1,052,000.00	$1,000,000.00	N/A	$192,843.68	N/A
Tall Tower (greater than 500')	$210,500.00	$200,000.00	N/A	N/A	N/A
Weather Days	$62,010.00	$62,010.00	See attached/uploaded PDF file titled "Spartacus SGP0097B v191125jgv2.pdf"	$62,010.00	N/A

Components

Actual Information Description	File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: WFUP Vert Structures inv #20181550 Structural Analysis Aux twr UL20181019jgv1 Amount: $5,700.00 Component Description: Spartacus SGP0037 v191003jgv1 Amount: $1,696.00 Component Description: Spartacus SGP0038 v191003jgv1 Amount: $3,763.00
Short Tower (less than 500')	Information not provided.
Serious tower reinforcement/modifications	Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: WFUP Vert Structures inv #20181549 Structural Analysis Main twr UL20181019jgv1 Amount: $5,700.00
Serious tower reinforcement/modifications	Component Description: Spartacus SGP0016 REV 1 v190520jgv3 Amount: $96,421.84 Component Description: Spartacus SGP0086 v191025jgv2 Amount: $96,421.84
Tall Tower (greater than 500')	Information not provided.
Weather Days	Component Description: Spartacus SGP0097C v200210jgv3 Amount: $62,010.00

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	$352,446.74	$406,061.74	N/A	$253,205.97	N/A
Total for all systems	$5,294,756.19	$4,792,163.30	N/A	$1,501,156.91	N/A
Outside Professional Services	$352,446.74	$406,061.74		$253,205.97
Other Engineering Services	$54,551.74	$54,551.74	Cost estimate for other engineering services such as RF calculations, evolving transition plan calculations, bid spec prep / distribution / award recommendation / etc and discussion, etc.	$54,551.74	N/A
Additional Field Engineering Service, 27 Days	$54,000.00	$54,000.00	N/A	$0.00	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	$39,971.14	N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,000.00	N/A	$550.00	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,000.00	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	$3,680.00	$3,500.00	N/A	N/A	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	N/A	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$4,000.00	N/A	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$2,500.00	Prepare Legal Portion of CP application
Prepare request for Special Temporary Authorization	$2,050.00	$1,500.00	N/A	$1,500.00	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	$675.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$675.00	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	$2,000.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$3,000.00	FCC CP application for Main Facility
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$7,000.00	Engineering Study for new channel assignment and antenna development
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	N/A	N/A
Project management of the transition	$79,000.00	$120,000.00	See attached Invoices and Quotes, and the Estimate Cost has been increased above the current $108,323.09 total of those to $120,000.	$117,023.09	Project Management of the Transition WFUP
Prepare and or review reimbursement form	$2,630.00	$23,760.00	The Estimated Cost includes Form 399 submissions including ongoing Actual Cost invoice prep and submission, and amendments as needed.	$23,760.00	N/A

Components

Actual Information Description	File Name
Other Engineering Services	Component Description: Osborn 32890 v190611jgv2 Amount: $35,050.00 Component Description: Osborn 37285 v200331jgv1 Amount: $14,026.74 Component Description: Osborn inv #32192 Prof Srvcs 190101 - 190131 Actual Cost invoices UL20190227jgv1 Amount: $950.00 Component Description: KGA 960-18 v200921jgv2 Amount: $4,525.00
Additional Field Engineering Service, 27 Days	Component Description: Osborn inv 27268 withdrawal Cover Letter v1 Amount: N/A
RF Exposure Measurements	Information not provided.
Comprehensive coverage verification via field study, if needed	Component Description: Osborn 41618 v210323jgv2 Amount: $2,171.14 Component Description: Osborn 42049 v210323jgv1 Amount: $37,800.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Component Description: Osborn 37285 v200331jgv1 Amount: $550.00
ASR modification (prepare FCC Form 854)	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	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: KGA Inv 918-68 Prepare Legal Portion of WFUP CP application Amount: $2,500.00
Prepare request for Special Temporary Authorization	Component Description: Osborn 35592 Prof Srvcs thru 190831-190927 STA v191023jgv1 Amount: $1,500.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	Component Description: Osborn 36104 Lic to Cov Aux v191126jgv1 Amount: $675.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Osborn 36104 Lic to Cov Main v191126jgv1 Amount: $675.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Component Description: Osborn inv #32954 Aux CP app UL20190417jgv1 Amount: $2,000.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: KGA Inv 918-63 Form 2100 CP application for main facility Amount: $3,000.00
Perform engineering study for new channel assignment and antenna development	Component Description: KGA Inv 918-63 Eng Study for new channel assignment & antenna development Amount: $7,000.00
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Project management of the transition	Component Description: Osborn inv #32192 Prof Srvcs 190101 - 190131 UL20190227jgv1 Amount: $9,150.00 Component Description: Osborn inv #30462R Prof Srvcs thru 180831 UL20190102jgv1 Amount: $2,325.00 Component Description: WFUP Osborn inv #27268 Proj Mgt UL20180904jgv6 Amount: $15,969.64 Component Description: Osborn inv #30200 Prof Srvcs thru 180727 UL20181212jgv1 Amount: $9,448.90 Component Description: Osborn inv #29844R Prof Srvcs thru 180629 UL20190227jgv3 Amount: $22,315.60 Component Description: Osborn 35271 v190927jgv1 Amount: $1,425.00 Component Description: Osborn inv #32954 Prof Srvcs thru 190302-190329 Reimbusables UL20190417jgv1 Amount: $0.30 Component Description: Osborn inv #32583 Prof Srvcs 190201 - 190301 UL20190320jgv1 Amount: $1,952.10 Component Description: Osborn 33397 Prof Srvcs thru 190426 PM v190328jgv1 Amount: $1,807.30 Component Description: Osborn 36104 PM v191126jgv1 Amount: $1,500.00 Component Description: Osborn inv #32191 Prof Srvcs 190101-190131 UL20190227jgv1 Amount: $3,173.13 Component Description: Osborn inv #31099R Prof Srvcs thru 181026 UL20190102jgv1 Amount: $375.00 Component Description: Osborn inv #31629 Prof Srvcs 181027 - 181130 UL20190109jgv1 Amount: $2,325.00 Component Description: Osborn inv #32954 Prof Srvcs thru 190302-190329 UL20190417jgv1 Amount: $2,400.00 Component Description: Osborn 34243 Prof Srvcs 19601 - 190628 PM v190726jgv1 Amount: $1,575.00 Component Description: Osborn 33898 v190618jgv1 Amount: $2,025.00 Component Description: WFUP Osborn inv #29843 Prof Srvcs thru 180629 UL20180907jgv2 Amount: $23,342.53 Component Description: Osborn 36104 PM 387 2019 Q3 v191126jgv1 Amount: $300.00 Component Description: Osborn inv #31742 Prof Srvcs 181201 - 181231 UL20190109jgv1 Amount: $225.00 Component Description: Osborn 34786 v190927jgv1 Amount: $2,175.00 Component Description: Osborn 37285 v200331jgv1 Amount: $600.00 Component Description: Osborn 35592 Prof Srvcs thru 190831-190927 PM v191023jgv1 Amount: $1,125.00 Component Description: PM Labor $19,860.00 PM Expenses $1,077.49 Amount: $20,937.49 Component Description: Osborn inv #30464 Prof Srvcs thru 180831 UL20181212jgv1 Amount: $12,606.17
Prepare and or review reimbursement form	Component Description: KGA 960-09 v200706jgv1 Amount: $1,375.00 Component Description: KGA 960-19 v200804jgv1 Amount: $3,460.00 Component Description: KGA 960-16 v200706jgv1 Amount: $195.00 Component Description: KGA 960-34 v210406jgv1 Amount: $2,240.00 Component Description: Osborn inv #32954 Prof Srvcs 190101 - 190131 Actual Cost invs Jan 2019 UL20190417jgv1 Amount: $750.00 Component Description: Osborn 34243 Prof Srvcs 19601 - 190628 PRRF v190726jgv1 Amount: $1,250.00 Component Description: Osborn inv #32954 Prof Srvcs 190101 - 190131 Actual Cost invs Feb 2019 UL20190417jgv1 Amount: $625.00 Component Description: KGA 960-08 v200320jgv1 Amount: $830.00 Component Description: Osborn 37285 v200331jgv1 Amount: $2,425.00 Component Description: KGA 960-13 v200804jgv1 Amount: $225.00 Component Description: Osborn 34786 v190927jgv1 Amount: $1,200.00 Component Description: Osborn 33898 v190618jgv1 Amount: $800.00 Component Description: Prepare original FCC Form 399 for reimbursement Amount: $2,500.00 Component Description: KGA 960-35 v210628jgv1 Amount: $100.00 Component Description: KGA 960-11 v200514jgv1 Amount: $100.00 Component Description: Osborn 36104 PRRF v191126jgv1 Amount: $550.00 Component Description: Osborn 33397 Prof Srvcs thru 190426 PRRF v190522jgv1 Amount: $625.00 Component Description: KGA 960-17 v200804jgv1 Amount: $2,375.00 Component Description: Osborn 35592 Prof Srvcs thru 190831-190927 PRRF v191023jgv1 Amount: $2,135.00

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	$348,651.64	$348,101.64	N/A	$27,049.87	N/A
Total for all systems	$5,294,756.19	$4,792,163.30	N/A	$1,501,156.91	N/A
Other Expenses	$348,651.64	$348,101.64		$27,049.87
MVPD Notification of Channel Change	$5,000.00	$5,000.00	N/A	$2,000.00	N/A
Develop and air announcement of upcoming channel change	$3,000.00	$3,000.00	N/A	N/A	N/A
Non-zoning permits	$15,000.00	$15,000.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$3,000.00	N/A
Sales Tax	$249,101.64	$249,101.64	N/A	N/A	N/A
Equipment Storage	$15,000.00	$15,000.00	N/A	N/A	N/A
Equipment Delivery and Handling Charges	$25,000.00	$25,000.00	N/A	$22,049.87	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$25,000.00	$25,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
MVPD Notification of Channel Change	Component Description: Osborn 34243 Prof Srvcs 19601 - 190628 MVPD notifs v190726jgv1 Amount: $2,000.00
Develop and air announcement of upcoming channel change	Information not provided.
Non-zoning permits	Information not provided.
DTV Medical Facility Notification	Component Description: Osborn 34243 Prof Srvcs 19601 - 190628 Med notifs v190726jgv1 Amount: $3,000.00
Sales Tax	Information not provided.
Equipment Storage	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Die 610016 v191028pmv1 Amount: $5,831.25 Component Description: Die 611007 v191028pmv1 Amount: $4,955.00 Component Description: Smith Equip 709 v200313jgv4 Amount: $10,918.00 Component Description: Die 947014 v210309pmv1 Amount: $58.99 Component Description: Die 931005 v210309pmv1 Amount: $286.63
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$5,294,756.19	$4,792,163.30	$1,501,156.91

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.	Jeffrey C Gehman Engineering Associate 04/21/2022

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.

Jeffrey C Gehman

Engineering Associate

04/21/2022

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.

Jeffrey C Gehman

Engineering Associate

04/21/2022

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.

Jeffrey C Gehman

Engineering Associate

04/21/2022

(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

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

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

Auxiliary Tower

Add Tower

Auxiliary Tower

Tower Modification Costs

Auxiliary Tower

Tower Rigging Costs

Auxiliary Tower

Other Tower Expenses Not Listed

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 Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services