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

FCC Form 399: Reimbursement Request

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

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

Facility ID:
64984
Service:
DTV
Call Sign:
KTMD
Channel:
22 (UHF)
File Number:
0000028246
FRN:
0019509470
Date Submitted:
05/11/2022

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NBC TELEMUNDO LICENSE LLC

Margaret L. Tobey

300 NEW JERSEY AVE, N.W.

SUITE 700

WASHINGTON, DC 20001

United States

+1 (202) 524-6401 MARGARET.TOBEY@NBCUNI.COM Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

Margaret L Tobey

NBCUniversal, LLC

300 New Jersey Ave. NW

Suite 700

Washington, DC 20001

United States

+1 (202) 524-6401 Margaret.Tobey@nbcuni.com

Broadcaster Information and Transition Plan

Back to Top
Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Use existing transmitter and aux antenna as interim facility on old channel.. Remove old antenna. Install new transmitter and replacement top mount antenna for new channel. After transition remove old transmitter and channel 48 aux antenna.

Transmitters

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

Primary Transmitter

Back to Top

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 DCX-2H
Year 2002
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 kW

Primary Transmitter

Back to Top

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 THU9-60
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 88.5 kW
Justification for New Transmitter New Transmitter required as the current transmitter is not longer supported (see attached note) Solid State transmitter chosen as it is less expensive then a new solid state (see attached proposal) and will allow old transmitter to be used as interim

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Electrical Connectivity to new transmitter
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

Back to Top

Other Transmitter Cost Not Listed

Name Description

Transmitter Installation

Installation of Transmitter, Filter, and ground level RF components

RF Filter installation

RF Filter for new channel (ch 22)

Antennas

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

Auxiliary Antenna

Back to Top

Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use To maintain coverage when primary antenna is unavailable
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this 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: 676.0 kW
Manufacturer
Model TFU-24DSB-C
Year 2004

Auxiliary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Used to maintain coverage when main antenna is unavailable
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types 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: 600.0 kW
Manufacturer
Model TFU-16DSB-D
Year 2019
Justification for New Antenna New antenna required because existing auxiliary is single channel and will not work on new channel.

Auxiliary Antenna

Back to Top

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? No
Broadband or Single Channel? N/A
Feed Line Size N/A
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? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Auxiliary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Elbow for Aux

Elbow Assemby for Aux Antenna 4 1/16

Reducer

4-50 to 3-50 antenna input reducer

Aux Antenna Installation

New Aux Antenna Installation

Primary Antenna

Back to Top

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 Top Mount
Antenna position in stack Top
Polarization Elliptical
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 ATW26HS6-ETCXL-22H
Year 2002

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Top
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: 592.0 kW
Manufacturer
Model ATW19HS6-ETCX-22H
Year 2019
Justification for New Antenna A new antenna is required as the current antenna is designed for channel 48 will not work on the new channel (Ch 22)

Primary Antenna

Back to Top

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 8 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Antenna Mount

Tower Stub, 6 ft., 42" face triangular tower, structural mount for antenna

Antenna Installation

Install Antenna- Structural Installation

Additional Installation Weather Days

Additional Installation Weather Days

Transmission Line

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

Primary Transmission Line

Back to Top

Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Waveguide
Diameter N/A
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 2045 feet per run

Primary Transmission Line

Back to Top

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 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 2045 feet per run
Justification for New Transmission Line New line is required because the existing GLW1500 waveguide will not work on channel 22.

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
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
ASR Number 1064696
Coordinates (NAD83) Latitude (NAD83) 29° 34' 16.0" N-
Longitude (NAD83) 095° 30' 38.0" W-
Overall Structure Height 1973.07 feet
Support Structure Height 1842.17 feet
Ground Elevation Above Mean Sea Level (AMSL) 76.77 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 11/19/2001

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
35337 KODA FM
70492 KUBE-TV DTV
60537 KFTH-DT DTV
25439 KILT-FM FM
25449 KKHH FM
35073 KLOL FM
66790 KUGB-CD DTV
47749 KHMX FM
18516 KTBZ-FM FM
24436 KLTJ DTV
35524 KRBE FM
58835 KPXB-TV DTV
53847 KXLN-DT DTV
12895 KETH-TV DTV

Other Types of Users

Users
KVVV-LD
KDHU-LD
KPBX-LD
KVQT-LD

Primary Tower

Back to Top

Tower Modification Costs

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

Primary Tower

Back to Top

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Candelabra
Helicopter Services Required Are helicopter services required? Yes

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Ground and Building Permit Drawing Package

Ground & Building A&E Permit Drawing Package (Cost per customer of ATC)

Tower Drawling Package

Tower Permit Drawing Package (Cost per customer of ATC)

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 1040
Explanation Project oversight of transmitter install, electrical connectivity, tower work, and antenna installation. Additional time will be spent tracking financial and legal process and coordinating with other broadcasters
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development No
Prepare engineering section of Form FCC Construction Permit Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare engineering section of 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
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 No
Quantity N/A
NEPA Section 106 environmental review Yes
Environmental Assessment No
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 20
Justification Ground Level RF Engineering

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
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

Back to Top

Other Expenses Not Listed

Name Description

Public Hearing

Public Hearing (cost per customer) as per ATC documentation

Cost Information

Back to Top

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 $2,859,527.94 $1,264,970.94 N/A $1,165,184.70 N/A
Total for all systems $5,965,480.94 $3,297,740.17 N/A $2,887,946.54 N/A
Primary Transmitter THU9-60 $2,859,527.94 $1,264,970.94 $1,165,184.70
Transmitter Installation $189,825.49 $189,825.49 N/A $90,112.75 N/A
Other Electrical Service: Electrical Connectivity to new transmitter $9,652.45 $9,652.45 Electrical connection costs are reflected in the installation cost estimate $9,652.45 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $11,200.00 N/A $11,200.00 N/A
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW $2,630,000.00 $1,049,793.00 N/A $1,049,793.00 N/A
RF Filter installation $4,500.00 $4,500.00 N/A $4,426.50 N/A

Components

Actual Information Description File Name
Transmitter Installation

Component Description:
Install new THU9-60evo transmitter
Amount:
$90,112.75
Other Electrical Service: Electrical Connectivity to new transmitter

Component Description:
Installation expenses for KTMD
Amount:
$9,652.45
Transformer 3 phase/480v - 150 KVA

Component Description:
Transformers for 3 cabinet DTV transmitter.
Amount:
$11,200.00
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW

Component Description:
Changed the transmitter model and associated information.
Amount:
$1,049,793.00
RF Filter installation

Component Description:
50 Percent of payment with order for RF Installation costs.
Amount:
$4,426.50

Component Description:
RF installation for antenna input, 50% payment with order
Amount:
$4,426.50

Cost Information

Back to Top

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 $458,333.00 $466,663.00 N/A $346,850.00 N/A
Total for all systems $5,965,480.94 $3,297,740.17 N/A $2,887,946.54 N/A
Primary Antenna ATW19HS6-ETCX-22H $364,555.00 $363,475.00 $258,700.00
Additional Installation Weather Days $10,075.00 $10,075.00 N/A $8,450.00 N/A
Antenna Installation $25,000.00 $25,000.00 N/A $13,000.00 N/A
Antenna Mount $18,000.00 $18,000.00 N/A $18,000.00 N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $14,500.00 N/A $0.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $289,500.00 N/A $219,250.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $0.00 N/A
Auxiliary Antenna TFU-16DSB-D $93,778.00 $103,188.00 $88,150.00
Aux Antenna Installation $32,000.00 $32,000.00 N/A $31,505.00 N/A
Reducer $868.00 $868.00 N/A $868.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $0.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 600 kW input, directional,, horizontally polarized $45,000.00 $45,000.00 N/A $39,032.00 N/A
Elbow for Aux $3,920.00 $3,920.00 N/A $3,920.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $15,000.00 Actual exceed predetermined cost $12,825.00 N/A

Components

Actual Information Description File Name
Additional Installation Weather Days

Component Description:
In climate Weather_ ERI Installation Inc. performed word for weather day.
Amount:
$1,950.00

Component Description:
Installation expenses due to weather delay
Amount:
$1,950.00

Component Description:
Weather Days expenses - cost shared 50/50 w/KUBE.
Amount:
$4,550.00
Antenna Installation

Component Description:
revised invoice attached. Non-reimbursable expenses
Amount:
N/A

Component Description:
DAC monitoring system is not reimbursable
Amount:
N/A

Component Description:
installation for Main Antenna with quote attached
Amount:
$2,925.00

Component Description:
ERI Hoist removal from the job site. cost shared between KTMD and KUBE
Amount:
$3,408.75

Component Description:
Installation expenses for Main Antenna split 50/50 between KTMD and KUBE.
Amount:
$4,550.00

Component Description:
Weather day- Split 50/50 between KTMD and KUBE
Amount:
$1,950.00

Component Description:
weather days ERI Installation expenses for KTMD
Amount:
$10,075.00

Component Description:
Uploaded in wrong category. please see Aux Antenna Installation section
Amount:
N/A

Component Description:
Line items are the list of Date of services in Cover letter. please find attached quote
Amount:
$10,075.00

Component Description:
expenses shared between KUBE and KTMD.
Amount:
$1,950.00

Component Description:
Installation for High Wind- Weather day cost split 50/50 with KUBE.
Amount:
$2,925.00

Component Description:
Duplicate submission. Please see invoice KTMD004.
Amount:
N/A

Component Description:
Installation expenses- Weather Days -Split 50/50 W/KUBE
Amount:
$4,550.00

Component Description:
wrong category
Amount:
$5,850.00

Component Description:
Wrong category
Amount:
N/A

Component Description:
DAC system non-reimbursable
Amount:
N/A
Antenna Mount

Component Description:
10% of the line item 2. please see attached cover letter.
Amount:
$1,800.00

Component Description:
30% of the line item 2 from the attached invoice.
Amount:
$5,400.00

Component Description:
30% of the line item 2, Tower stub, 6' 42" face mount
Amount:
$5,400.00

Component Description:
30% of the line item 2 from the attached invoice.
Amount:
$5,400.00

Component Description:
30% of line 2, plus 8.25% sales tax.
Amount:
$5,845.50

Component Description:
8.25% reimbursed tax amount should be credited from the 30% of the line item 2.
Amount:
($445.50)

Component Description:
10% of the line item 2. please see attached cover letter.
Amount:
$1,800.00

Component Description:
30% of the line 2 from the attached invoice. Tax is not included
Amount:
$5,400.00

Component Description:
8.25% reimbursed tax amount should be credited from the 30% of the line item 2.
Amount:
($445.50)

Component Description:
30% of the line 2 requested for the payment
Amount:
$5,400.00

Component Description:
30% of the line item 2 from the attached invoice is requested for the payment
Amount:
$5,400.00

Component Description:
10% of the line item 2 from the attached invoice, tax excluded
Amount:
$1,800.00
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) Information not provided.
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
please see line 1, 30% invoiced
Amount:
$65,775.00

Component Description:
30% of the line item 1 from the attached invoice is requesting for the payment
Amount:
$65,775.00

Component Description:
please line 1, 30% invoiced for the item Top mounted Elliptically polarized UHF.
Amount:
$65,775.00

Component Description:
wrong category
Amount:
N/A

Component Description:
30% of the line item 1. please attached cover letter
Amount:
$65,775.00

Component Description:
10% of the line item 1 is requested for the reimbursement. tax is not included
Amount:
$21,925.00

Component Description:
Wrong category.
Amount:
N/A

Component Description:
30% of line 1.
Amount:
$65,775.00

Component Description:
30% of the line 1 from the attached invoice.
Amount:
$65,775.00

Component Description:
30% of the line item 1. tax are not included since we are exempted. please see cover letter
Amount:
$65,775.00

Component Description:
8.25% of the 30% of the line item 1 should credited.
Amount:
($5,426.44)

Component Description:
10% of the line item 1 from the attached invoice, tax excluded
Amount:
$21,925.00

Component Description:
Wrong attachment
Amount:
N/A

Component Description:
30% of line 1, plus 8.25% sales tax.
Amount:
$71,201.44
Sweep test of existing antenna Information not provided.
Aux Antenna Installation

Component Description:
Weather day reallocation expenses shared w/KUVE 50/50 split
Amount:
$5,850.00

Component Description:
Cost shared 50/50 with KUBE
Amount:
$15,275.00

Component Description:
50% payment with order
Amount:
$5,190.00

Component Description:
40% Prior to Mobilization
Amount:
$4,152.00

Component Description:
Wrong category
Amount:
N/A

Component Description:
10% upon substantial completion
Amount:
$1,038.00
Reducer

Component Description:
See line 3 of invoice
Amount:
$390.60

Component Description:
10% of the line 3 from attached invoice.
Amount:
$86.80

Component Description:
please see line item 3 from the attached invoice
Amount:
$390.60

Component Description:
reducer - 10% of the line item 3 from the attached invoice.
Amount:
$86.80

Component Description:
Reducer costs are requested here. 10% of the line item 3.
Amount:
$86.80
Sweep test of existing antenna Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 600 kW input, directional,, horizontally polarized

Component Description:
Antenna UHF Side mount- 10% of the line item 1.
Amount:
$3,903.20

Component Description:
Remaining 10% invoices for Antenna UHF Side Mount
Amount:
$3,903.20

Component Description:
please see line item 1 from the attached invoice
Amount:
$17,564.40

Component Description:
Antenna UHF Mount Installation costs are requested here, 10% of the line item 1.
Amount:
$3,903.20

Component Description:
See line 1 of invoice
Amount:
$17,564.40
Elbow for Aux

Component Description:
Elbow Assembly 4 1/16
Amount:
$3,920.00

Component Description:
Add cover letter with explanation or Expedited shipping and add call sign "KTMD"
Amount:
$3,920.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
Custom Mounts for TFU-16DSB-D for Scatter Study
Amount:
$10,125.00

Component Description:
scatter study. 10% of the line item 2-remaining balance
Amount:
$270.00

Component Description:
10% of the line item 2, scatter study.
Amount:
$270.00

Component Description:
please see line item 2
Amount:
$1,215.00

Component Description:
See line 2 of invoice
Amount:
$1,215.00

Component Description:
scatter studies are costs requested here. 10% of the line item 2.
Amount:
$270.00

Cost Information

Back to Top

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 $709,615.00 $578,704.23 N/A $560,186.83 N/A
Total for all systems $5,965,480.94 $3,297,740.17 N/A $2,887,946.54 N/A
Primary Transmission Line $709,615.00 $578,704.23 $560,186.83
Rigid Transmission Line - copper, 8 3/16" $709,615.00 $578,704.23 Line, adapters, and deign services from attached Antenna Proposal $560,186.83 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 8 3/16"

Component Description:
Additional parts and Equipment purchased
Amount:
$19,034.82

Component Description:
10% of the line items from 4-23. tax is not included.
Amount:
$53,459.97

Component Description:
Transmission Line accessories
Amount:
$6,552.28

Component Description:
T/L equipment Purchased- Repack Parts REVISED
Amount:
$6,552.28

Component Description:
10% of the line items 4 thru 23 from the attached invoice, tax excluded
Amount:
$53,459.97

Component Description:
Please line item 4 thru 23 from the attached invoice.
Amount:
$160,379.92

Component Description:
Additional parts for Transmission line expenses.
Amount:
$19,034.82

Component Description:
Rigid Transmission line
Amount:
$4,550.00

Component Description:
8.25% tax reimbursed before from the 30% line item 4-23 should be credited
Amount:
($13,231.35)

Component Description:
10% of the line items from 4-23. tax is not included.
Amount:
$53,459.98

Component Description:
30% of the line 4 thru 23, excluding tax amount
Amount:
$160,379.92

Component Description:
30% of them lines from 4 to 23. Tax was credited from the vendor
Amount:
$160,379.93

Component Description:
8.25% tax reimbursed before from line items 4-23 of 30% should be credited
Amount:
($13,231.35)

Component Description:
30% of lines 4-23, plus 8.25% sales tax.
Amount:
$173,611.27

Component Description:
30% of the line item 4-23. Tax is not included.
Amount:
$160,379.92

Component Description:
please see line item 4 to 23, 30% of the line items invoiced for this attached invoice.
Amount:
$160,379.92

Component Description:
T/L equipment Purchased- Repack Parts
Amount:
$6,552.28

Component Description:
30% of the line items 4 thru 23. tax is not included.
Amount:
$160,379.92

Cost Information

Back to Top

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 $1,501,700.00 $516,355.00 N/A $454,464.00 N/A
Total for all systems $5,965,480.94 $3,297,740.17 N/A $2,887,946.54 N/A
Primary Tower GTOWER $1,501,700.00 $516,355.00 $454,464.00
Tower Drawling Package $4,700.00 $4,700.00 see attached American Tower cost estimate form $4,700.00 N/A
Tower Helicopter Lift $3,000.00 $3,000.00 As per M. Rhodes: cost reflected in "Complex Tower" line item $0.00 N/A
Ground and Building Permit Drawing Package $1,000.00 $1,000.00 see attached American Tower cost estimate form $750.00 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $31,655.00 Price for tower mapping and structural engineering, as per ATC documentation $31,655.00 N/A
Serious tower reinforcement/modifications $1,052,000.00 $55,000.00 see attached American Tower cost estimate form $12,899.50 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $421,000.00 See proposal from ERI for antenna installation services $404,459.50 N/A

Components

Actual Information Description File Name
Tower Drawling Package

Component Description:
KTMD - American Tower invoice for Tower Permit Drawing Package
Amount:
$4,700.00
Tower Helicopter Lift Information not provided.
Ground and Building Permit Drawing Package

Component Description:
Building and Ground Permit fees
Amount:
$750.00
Structural engineering tower load study for a documented tower with candelabra

Component Description:
structural Engineering tower load study for a documented tower with candelabra
Amount:
$9,775.00

Component Description:
Please see PO line 3 for the project management cost for KTMD
Amount:
$9,480.00

Component Description:
Towers cost- Project management services
Amount:
$9,480.00

Component Description:
Please see PO line 1
Amount:
$12,400.00
Serious tower reinforcement/modifications

Component Description:
wrong category
Amount:
N/A

Component Description:
Capital Contribution- Broadcast Repack Channel 22.
Amount:
$5,399.50

Component Description:
Capital Contribution- Broadcast Repack Channel 22.
Amount:
$5,399.50

Component Description:
Wrong category
Amount:
N/A

Component Description:
Wrong Category
Amount:
N/A

Component Description:
Capital contributions for Tower Reinforcement
Amount:
$7,500.00

Component Description:
Capital contributions- Tower Reinforcement cost
Amount:
$7,500.00

Component Description:
Main antenna and line installation
Amount:
$8,100.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
30% of the line items 3 and 24. tax is not included
Amount:
$119,292.60

Component Description:
tax not included. 30% of the line item 3 and 24 only. Television services
Amount:
$119,292.60

Component Description:
30% of the line items 3 and 24. tax is not included
Amount:
$119,292.60

Component Description:
10% of the line item 3 and 24. tax excluded. please see cover letter.
Amount:
$39,764.20

Component Description:
previously reimbursed tax should be credited. 8.25% from the the 30% of the line item 3 and 24
Amount:
($9,841.64)

Component Description:
previously reimbursed tax should be credited. 8.25% from the the 30% of the line item 3 and 24
Amount:
($9,841.64)

Component Description:
10% of the line items 3 and 24 from the attached invoice, tax excluded
Amount:
$39,764.20

Component Description:
30% of the line item of 3 and 24, tax excluded
Amount:
$119,292.60

Component Description:
10% of the line items from 3 & 24 is requesting for the payment. tax is not included.
Amount:
$39,764.20

Component Description:
please see line item 3 & 24, Television services, 30% of the line item.
Amount:
$119,292.60

Component Description:
30% of lines 3 and 24, plus 8.25% sales tax.
Amount:
$129,134.24

Component Description:
please see line item 3 and 24 for Television services from the attached invoice.
Amount:
$119,292.60

Component Description:
Hoist Removal from job site and labor cost for the station.
Amount:
$6,817.50

Cost Information

Back to Top

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 $312,975.00 $355,032.00 N/A $285,289.25 N/A
Total for all systems $5,965,480.94 $3,297,740.17 N/A $2,887,946.54 N/A
Outside Professional Services $312,975.00 $355,032.00 $285,289.25
Additional Field Engineering Service, 20 Days $20,000.00 $20,000.00 N/A $10,000.00 N/A
RF Exposure Measurements $21,050.00 $15,000.00 N/A $0.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $47,732.00 N/A $47,732.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $1,400.00 N/A $0.00 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $500.00 N/A $0.00 N/A
NEPA Section 106 environmental review, if needed $6,310.00 $5,400.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $1,500.00 N/A $91.80 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $2,500.00 N/A $415.80 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $8,500.00 Actual cost exceed predetermined cost estimate $8,471.60 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $816.86 N/A
Project management of the transition $164,320.00 $250,000.00 PM cost exceed predetermined cost $217,761.19 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 20 Days

Component Description:
Engineering site visit, inspection, measurements, drawing and planning for repack transmitter and RF installation, budgeting and planning.
Amount:
$10,000.00
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Field Survey and Measurements - Deposit, Station EIN used
Amount:
$23,866.00

Component Description:
Field Survey Study include mobilization- Final payment
Amount:
$23,866.00

Component Description:
Wrong Attachment REVISED
Amount:
N/A

Component Description:
Wrong attachment REVISED
Amount:
N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$270.00

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$183.60

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$91.80
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
See lines 1 & 2 of invoice, less 10% vendor discount.
Amount:
$189.00

Component Description:
See lines 1 & 2 of invoice, less 10% vendor discount. See explanation of variance for line 3.
Amount:
$226.80
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$90.00

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$1,575.00

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$174.60

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$2,132.00

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$4,500.00
Prepare and or review reimbursement form

Component Description:
Review of Form 399
Amount:
$43.65

Component Description:
please find attached cover letter for the variance.
Amount:
$260.00

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$35.70

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$35.70

Component Description:
See lines 3-5 of invoice, less 10% vendor discount.
Amount:
$310.86

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$43.65

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$360.00

Component Description:
Post-Auction Repacking - KTMD; NBCU1809; Wilkinson Barker Knauer, LLP
Amount:
$87.30
Project management of the transition

Component Description:
Project Management service for KTMD
Amount:
$6,860.00

Component Description:
July 2018 Project Management
Amount:
$4,060.00

Component Description:
Project Management Services
Amount:
$1,072.50

Component Description:
Project Management
Amount:
$30,788.00

Component Description:
Houston-Program Leader-Project Management Services Actions- 64984
Amount:
$4,705.77

Component Description:
KTMD-Houston-Program Leader-Project Management Services Actions- 64984 KTMD-Houston-Repack Finance Resource- Project Management Services- 64984
Amount:
$3,311.00

Component Description:
KTMD - Point B invoice April 2020
Amount:
$2,923.00

Component Description:
Project management services for KTMD
Amount:
$20,189.42

Component Description:
Point B Project Management October 2019
Amount:
$4,266.00

Component Description:
KTMD-Houston-Repack Finance ResourceProject Management Services Actions- 64984
Amount:
$3,792.00

Component Description:
Point B Project Management January 2020
Amount:
$3,476.00

Component Description:
August 2018 Project Management
Amount:
$2,650.00

Component Description:
June 2018 Project Management
Amount:
$6,250.00

Component Description:
Project Management Services
Amount:
$975.00

Component Description:
Project Management expenses- Excluded T-Mobile coordination services
Amount:
$31,754.29

Component Description:
Project Management Services
Amount:
$2,470.00

Component Description:
Wrong category
Amount:
N/A

Component Description:
Project Management Services Updated
Amount:
$4,800.00

Component Description:
October 2018 Project Management
Amount:
$8,575.00

Component Description:
Project Management service for KTMD
Amount:
$632.00

Component Description:
receipts not attached since expenses are below under $75.00. please find email thread.
Amount:
$415.14

Component Description:
Project management services, please see attached cover letter.
Amount:
$31,754.29

Component Description:
Point B Project Management January 2019
Amount:
$4,885.00

Component Description:
November 2018 Project Management
Amount:
$5,655.00

Component Description:
Project Management
Amount:
$6,150.00

Component Description:
Project Management
Amount:
$8,250.00

Component Description:
KTMD-Project Management Services - 64984
Amount:
$632.00

Component Description:
Project Management Services
Amount:
$348.95

Component Description:
KTMD - Point B invoice March 2020
Amount:
$2,686.00

Component Description:
Jan 2018 Project Management
Amount:
$9,750.00

Component Description:
D-Houston-Repack Finance Resource Project Management Services Actions- 64984
Amount:
$3,239.00

Component Description:
KTMD - Point B invoice February 2020
Amount:
$1,975.00

Component Description:
Houston-Engagement Leader-Project Management Services Actions- 64984 Houston-Program Leader-Project Management Services Actions- 64984
Amount:
$13,850.00

Component Description:
Project Management service for KTMD
Amount:
$4,345.00

Component Description:
Point B Project Management December 2019
Amount:
$4,746.27

Component Description:
KTMD-Houston-Repack Finance Resource Project Management Services Actions- 64984
Amount:
$2,212.00

Component Description:
Point B Project Management November 2019
Amount:
$1,501.00

Component Description:
This is for the project management services for Point B for the month of July 2019.
Amount:
$200.62

Component Description:
Project Management Invoice
Amount:
$20,539.75

Component Description:
Project Management Services
Amount:
$3,380.00

Component Description:
Project Management service for KTMD
Amount:
$1,027.00

Component Description:
M&E total on page 2 of invoice
Amount:
$1,678.36

Component Description:
Project Management Services
Amount:
$2,405.00

Component Description:
Repack Finance Resource-Project Management Services for KTMD- September
Amount:
$790.00

Component Description:
KTMD-Houston-Repack Finance ResourceProject Management Services Actions- 64984
Amount:
$2,528.00

Component Description:
Project Management
Amount:
$6,965.00

Component Description:
Project Management service for KTMD
Amount:
$4,029.00

Component Description:
Project Management
Amount:
$4,750.00

Component Description:
T&E expenses are not requested for this attached invoice.
Amount:
$460.00

Component Description:
KTMD - Point B invoice May 2020
Amount:
$1,580.00

Component Description:
Point B project management services for the month of February 2019. See line item.
Amount:
$4,800.00

Component Description:
Apr-18 Project Management
Amount:
$6,150.00

Cost Information

Back to Top

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 $123,330.00 $116,015.00 N/A $75,971.76 N/A
Total for all systems $5,965,480.94 $3,297,740.17 N/A $2,887,946.54 N/A
Other Expenses $123,330.00 $116,015.00 $75,971.76
Public Hearing $2,000.00 $2,000.00 see attached ATC documentation $0.00 N/A
MVPD Notification of Channel Change $12,000.00 $12,000.00 N/A $0.00 N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A $0.00 N/A
Equipment Storage $16,000.00 $16,000.00 N/A $15,237.00 N/A
Equipment Delivery and Handling Charges $58,000.00 $58,000.00 N/A $56,484.76 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $15,000.00 $15,000.00 N/A $0.00 N/A
Non-zoning permits $2,500.00 $2,500.00 N/A $0.00 N/A
Local Zoning $750.00 $750.00 N/A $0.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A $0.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A $0.00 N/A
DTV Medical Facility Notification $11,550.00 $4,250.00 N/A $4,250.00 N/A

Components

Actual Information Description File Name
Public Hearing Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change

Component Description:
This is an invoice from VoiceNation for call center support help to help deal with customers calling in with questions about retuning their televisions due to repack.
Amount:
$1,150.00
Equipment Storage

Component Description:
only storage expenses are requesting in this line.
Amount:
$2,445.00

Component Description:
only storage expenses are requesting in this package.
Amount:
$2,445.00

Component Description:
Consolidation Transmitter and 6 cabinet Equipment Storage charge
Amount:
$12,792.00

Component Description:
PAF Van storage- please see line item 2
Amount:
$2,445.00
Equipment Delivery and Handling Charges

Component Description:
FREIGHT, SHIPPING, AND HANDLING PAF VAN DELIVERY
Amount:
$3,220.00

Component Description:
Please see line item 1 for shipping and handling.
Amount:
$3,220.00

Component Description:
Station call sign "KTMD" added through cover letter and EIN# updated
Amount:
$4,030.32

Component Description:
"KTMD" call sign indicated through cover letter and EIN# corrected
Amount:
$695.72

Component Description:
Total Line Haul Gap Insurance-KTMD
Amount:
$11,090.15

Component Description:
Total Line haul-Fuel surcharge-Gap insurance
Amount:
$872.21

Component Description:
Missing Station name "KTMD" added through cover letter
Amount:
$11,090.15

Component Description:
Shipping expenses - Total line haul and Gap Insurance.
Amount:
$4,030.32

Component Description:
Total Line Haul-Gap Insurance
Amount:
$4,030.32

Component Description:
line item 2- Fuel Surcharge is not reimbursable
Amount:
$784.46

Component Description:
KTMD sign added though cover letter and Fuel Charge is not reimbursable per FCC
Amount:
$782.50

Component Description:
Total Line haul-Fuel surcharge
Amount:
$978.13

Component Description:
Freight only invoice
Amount:
$19,533.56

Component Description:
Total Line Haul-Layover fee-Gap Insurance
Amount:
$18,828.23

Component Description:
Total Line Haul-Fuel surcharge-Gap Insurance-Lift gate destination
Amount:
$810.07

Component Description:
Layover fees excluded. Adding cover cover letter for invoice missing "KTMD" station call sign
Amount:
$17,828.23

Component Description:
Shipping expenses for Total Line Haul and Gap Insurance.
Amount:
$695.72
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
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:
KTMD Medical Notification Complete per FCC Repack
Amount:
$4,250.00

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $5,965,480.94 $3,297,740.17 $2,887,946.54

Reimbursement Status

Back to Top
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

Back to Top
Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Margaret L. Tobey

Assistant Secretary


05/11/2022

Certification

Back to Top
Section Question Response
Submission of Actual Cost Documentation Statements

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

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

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

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

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

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

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

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

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

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

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

Margaret L. Tobey

Assistant Secretary


05/11/2022

Certification

Back to Top
Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

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

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

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

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

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

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

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

Margaret L. Tobey

Assistant Secretary


05/11/2022

Attachments

Back to Top