TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
Tribune Media Company	Elizabeth Ryder PO Box 75062 Irving, TX 75062 United States	+1 (972) 373-8000	eryder@nexstar.tv	Corporation

Applicant

Address

Phone

Applicant Type

Tribune Media Company

Elizabeth Ryder

PO Box 75062

Irving, TX 75062

United States

+1 (972) 373-8000

eryder@nexstar.tv

Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
The Preparer is same as the reimbursement contact.

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	Add antenna above current antenna and replace transmission line. Current Support ple will not meet Rev G structural requirements. Replacement with a Top mount antenna and support was the least costly solution. Replace current transmitters.

Transmitters

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

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Auxiliary
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	Diamond
	Year	2000
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	7.5 kW

Auxiliary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Auxiliary (Backup)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Manufacturer
	Model	ULXTE-10
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	6.2 kW
	Justification for New Transmitter	Current AUx transmitter is not re-tunable

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

Information not provided.

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	Power CD
	Year	2004
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	25 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	ULXTE-20
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	12.9 kW
	Justification for New Transmitter	Upgrade to Solid state transmitter and not re-tune existing. No room in building for additional Tube type RF system. ULXTE-20 Non Epole

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	150 kVA
	Rigid Conduit and Wiring	Yes
	Size	4 inches
	Length	400.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Site Survey	Site survey for new transmitter

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	870.0 kW
	Manufacturer
	Model	TFU-24DSB C260(C
	Year	2001

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top 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:	576.0 kW
	Manufacturer
	Model	TFU-30GTH/VP-R C260
	Year	2019
	Justification for New Antenna	Current antenna will not work on assigned channel Support pole will not meet Rev G, Top mount antenna chosen to to save cost of replacing Support pole

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	No
	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	4 1/16 inches inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Mounting Pole with wedding cake	Support pole, wedding cake to extend antenna to the correct height

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	1100 feet per run

Primary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Type	Rigid
	Diameter	4 1/16 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1100 feet per run
	Justification for New Transmission Line	Use existing to feed pre transition antenna during construction

Primary 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?	No
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	Yes
	Others Types of Users	No
	Is tower documented for structural analysis?	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	1026127
Coordinates (NAD83)	Latitude (NAD83)	39° 24' 27.0" N-
	Longitude (NAD83)	086° 08' 52.0" W-
	Overall Structure Height	1131.88 feet
	Support Structure Height	1049.86 feet
	Ground Elevation Above Mean Sea Level (AMSL)	869.41 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Tribune Broadcasting Indianapolis, LLC
	Date Constructed	01/01/1957

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
59141	WTTS	FM

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	N/A
Helicopter Services Required	Are helicopter services required?	No

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	No
	Number of Hours	N/A
	Explanation	N/A
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	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	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare and file Form FCC License to Cover Application	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	No
	Address transition timing and coordination issues w/ other stations and wireless providers	No
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	Yes
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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

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	$891,850.00	$663,163.21	N/A	$492,029.57	N/A
Total for all systems	$2,914,385.00	$1,913,648.21	N/A	$1,409,843.95	N/A
Primary Transmitter ULXTE-20	$618,350.00	$463,163.21		$320,802.68
Site Survey	$5,300.00	$5,300.00	N/A	$5,294.38	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	N/A	N/A
Service entrance 3 phase/800 amp/208 volt	$14,400.00	$13,700.00	N/A	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW	$494,500.00	$345,163.21	The tax on this order is $20,934.06. That was on the P.O. and marked as taxable on the quote.	$315,508.30	N/A
4" Rigid Conduit and Wiring (Cost per foot)	$40,400.00	$38,400.00	N/A	N/A	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$24,300.00	N/A	N/A	N/A
Auxiliary Transmitter ULXTE-10	$273,500.00	$200,000.00		$171,226.89
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	$273,500.00	$200,000.00	N/A	$171,226.89	N/A

Components

Actual Information Description	File Name
Site Survey	Component Description: Site survey Amount: $5,294.38
Switchgear - industrial 800 amp	Information not provided.
Service entrance 3 phase/800 amp/208 volt	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW	Component Description: ULXTE-20 Amount: $92,415.13 Component Description: deposit for ULXTE-20 transmitter Amount: $107,178.20 Component Description: 2nd payment - ULXTE-20 transmitter Amount: $107,178.20 Component Description: site survey Amount: N/A Component Description: payment for ULXTE-20 Amount: $8,736.77
4" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Transformer 3 phase/480v - 150 KVA	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	Component Description: 2nd payment - ULXTE-10 transmitter Amount: $54,662.54 Component Description: ULXTE-10 Amount: $35,651.36 Component Description: payment for ULTXE-10 Amount: $26,250.45 Component Description: deposit for ULXTE-10 Amount: $54,662.54

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	$446,800.00	$406,400.00	N/A	$341,641.22	N/A
Total for all systems	$2,914,385.00	$1,913,648.21	N/A	$1,409,843.95	N/A
Primary Antenna TFU-30GTH/VP-R C260	$446,800.00	$406,400.00		$341,641.22
Mounting Pole with wedding cake	$141,000.00	$141,000.00	N/A	$126,020.48	N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	$9,570.00	$9,000.00	N/A	$7,249.50	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$250,000.00	N/A	$201,971.24	N/A

Components

Actual Information Description	File Name
Mounting Pole with wedding cake	Component Description: Wedding Cake Amount: $63,010.24 Component Description: Wedding Cake Amount: $63,010.24
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	Component Description: deposit - elbow complex Amount: $3,624.75 Component Description: elbow complex - 2nd payment Amount: $3,624.75 Component Description: deposit - elbow complex Amount: $3,624.75 Component Description: elbow complex - 2nd payment Amount: $3,624.75
Sweep test of existing antenna	Component Description: last 10% of sweep test Amount: $640.00 Component Description: deposit - sweep test Amount: $2,880.00 Component Description: SWEEP TEST Amount: $2,880.00 Component Description: 2nd payment - sweep test Amount: $2,880.00 Component Description: 2nd payment - sweep test Amount: $2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: TFU-30GTH/VP-R C260 CH 27 - 2nd payment Amount: $98,105.62 Component Description: TFU-30GTH/VP-R C260 CH 27 - 2nd payment Amount: $98,105.62 Component Description: putting dollars here because of zero balance invoice. Amount: $5,760.00 Component Description: deposit - TFU-30GTH/VP-R C260 CH 27 Amount: $98,105.62 Component Description: TFU-30GTH/VP-R C260 CH27 Amount: $98,105.62

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	$156,200.00	$101,000.00	N/A	$98,695.62	N/A
Total for all systems	$2,914,385.00	$1,913,648.21	N/A	$1,409,843.95	N/A
Primary Transmission Line	$156,200.00	$101,000.00		$98,695.62
Rigid Transmission Line - copper, 4 1/16"	$156,200.00	$101,000.00	N/A	$98,695.62	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 4 1/16"	Component Description: cut pieces Amount: $1,141.00 Component Description: deposit - TLSCR's Amount: $1,540.35 Component Description: deposit - transmission line 4-1/16 50 OHM 1,100 feet Amount: $43,543.71 Component Description: 2nd payment - transmission line 4-1/16 50 OHM 1,100 feet Amount: $43,543.71 Component Description: Dir Cplr 6-50 EIA 12.00 LG Amount: $2,565.00 Component Description: cut pieces and hangers Amount: $3,181.50 Component Description: 2nd payment - TLSCR'S Amount: $1,540.35 Component Description: deposit - transmission line 4-1/16 50 OHM 1,100 feet Amount: $43,543.71 Component Description: 2nd payment - TLSCR'S Amount: $1,540.35 Component Description: transmission line 4-1/16 50 OHM 1,100 feet Amount: $43,543.71 Component Description: cut piece Amount: $1,640.00 Component Description: deposit - TLSCR's Amount: $1,540.35

Actual Information Description

File Name

Rigid Transmission Line - copper, 4 1/16"

Component Description:: cut pieces
Amount:: $1,141.00

Component Description:: deposit - TLSCR's
Amount:: $1,540.35

Component Description:: deposit - transmission line 4-1/16 50 OHM 1,100 feet
Amount:: $43,543.71

Component Description:: 2nd payment - transmission line 4-1/16 50 OHM 1,100 feet
Amount:: $43,543.71

Component Description:: Dir Cplr 6-50 EIA 12.00 LG
Amount:: $2,565.00

Component Description:: cut pieces and hangers
Amount:: $3,181.50

Component Description:: 2nd payment - TLSCR'S
Amount:: $1,540.35

Component Description:: deposit - transmission line 4-1/16 50 OHM 1,100 feet
Amount:: $43,543.71

Component Description:: 2nd payment - TLSCR'S
Amount:: $1,540.35

Component Description:: transmission line 4-1/16 50 OHM 1,100 feet
Amount:: $43,543.71

Component Description:: cut piece
Amount:: $1,640.00

Component Description:: deposit - TLSCR's
Amount:: $1,540.35

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	$1,275,100.00	$612,000.00	N/A	$421,801.90	N/A
Total for all systems	$2,914,385.00	$1,913,648.21	N/A	$1,409,843.95	N/A
Primary Tower TOWER	$1,275,100.00	$612,000.00		$421,801.90
Structural engineering tower load study for well documented tower	$12,600.00	$12,000.00	N/A	$6,900.00	N/A
Tall Tower (greater than 500')	$210,500.00	$300,000.00	see attached quotes and invoices	$297,842.50	N/A
Serious tower reinforcement/modifications	$1,052,000.00	$300,000.00	N/A	$117,059.40	N/A

Components

Actual Information Description	File Name
Structural engineering tower load study for well documented tower	Component Description: ADDITIONAL LOADING CONFIGURATION Amount: $1,000.00 Component Description: STRUCTURAL ANALYSIS AND REPORT Amount: $5,900.00
Tall Tower (greater than 500')	Component Description: Weather days Amount: N/A Component Description: Deposit Amount: N/A Component Description: down payment Amount: $148,413.00 Component Description: Final payment Amount: N/A Component Description: Mobilization Amount: N/A Component Description: mobilization Amount: $118,730.40 Component Description: payment for antenna installation Amount: $30,699.10
Serious tower reinforcement/modifications	Component Description: down payment Amount: $53,915.00 Component Description: in progress billing Amount: $47,823.40 Component Description: Mobilization Amount: N/A Component Description: final payment Amount: $9,471.00 Component Description: weather days Amount: $5,850.00 Component Description: Deposit Amount: N/A

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	$37,245.00	$24,500.00	N/A	$0.00	N/A
Total for all systems	$2,914,385.00	$1,913,648.21	N/A	$1,409,843.95	N/A
Outside Professional Services	$37,245.00	$24,500.00		$0.00
RF Exposure Measurements	$21,050.00	$10,000.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	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	N/A	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	N/A	N/A
Prepare request for Special Temporary Authorization	$4,100.00	$3,000.00	N/A	N/A	N/A

Components

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	$107,190.00	$106,585.00	N/A	$55,675.64	N/A
Total for all systems	$2,914,385.00	$1,913,648.21	N/A	$1,409,843.95	N/A
Other Expenses	$107,190.00	$106,585.00		$55,675.64
Taxes	$23,000.00	$23,000.00	N/A	$22,377.74	N/A
MVPD Notification of Channel Change	$11,000.00	$11,000.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$0.00	$0.00	N/A	N/A	N/A
Equipment Storage	$25,000.00	$25,000.00	N/A	$10,245.00	N/A
Equipment Delivery and Handling Charges	$20,000.00	$20,000.00	N/A	$19,302.90	N/A
Local Zoning	$15,000.00	$15,000.00	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	$325.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,070.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$3,750.00	N/A

Components

Actual Information Description	File Name
Taxes	Component Description: Indiana State tax Amount: $188.78 Component Description: Indiana State tax Amount: $510.54 Component Description: Indiana State Taxes Amount: $20,934.06 Component Description: Indiana State taxes Amount: $346.58 Component Description: State Taxes Amount: $138.36 Component Description: Indiana State taxes Amount: $79.87 Component Description: State Taxes Amount: $179.55
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: Storage fees Amount: $10,245.00
Equipment Delivery and Handling Charges	Component Description: FREIGHT Amount: $3,426.47 Component Description: Freight and shipping Amount: $336.51 Component Description: Freight charges Amount: $7,293.37 Component Description: Freight charges Amount: $1,769.63 Component Description: Freight charges Amount: $2,696.92 Component Description: Freight charges Amount: $3,780.00
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.
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.
DTV Medical Facility Notification	Component Description: Medical Notification Amount: $3,750.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,914,385.00	$1,913,648.21	$1,409,843.95

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.	Elizabeth Ryder General Counsel 05/05/2022

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.

Elizabeth Ryder

General Counsel

05/05/2022

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Elizabeth Ryder General Counsel 05/05/2022

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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

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

Elizabeth Ryder

General Counsel

05/05/2022

(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

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

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

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification