TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
NBC TELEMUNDO LICENSE LLC	Angela Ball 300 NEW JERSEY AVE, N.W. SUITE 700 WASHINGTON, DC 20001 United States	+1 (202) 524-6413	ANGELA.BALL@NBCUNI.COM	Limited Liability Company

Applicant

Address

Phone

Applicant Type

NBC TELEMUNDO LICENSE LLC

Angela Ball

300 NEW JERSEY AVE, N.W.

SUITE 700

WASHINGTON, DC 20001

United States

+1 (202) 524-6413

ANGELA.BALL@NBCUNI.COM

Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Angela Ball Assistant Secretary NBCUniversal, LLC	300 New Jersey Ave. NW Suite 700 Washington, DC 20001 United States	+1 (202) 524-6413	Angela.Ball@nbcuni.com

Applicant

Address

Phone

Angela Ball

Assistant Secretary

NBCUniversal, LLC

300 New Jersey Ave. NW

Suite 700

Washington, DC 20001

United States

+1 (202) 524-6413

Angela.Ball@nbcuni.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	Use current main antenna as interim, install new antenna in reserved space above it for new channel. Retune transmitter and filter for new channel. Replace no longer supported backup transmitter to use to stay on air during retuning.

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	Retune Existing
	Use	Primary (Main)
	Ownership	Owned
	Owner	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer	Rohde & Schwarz
	Model	THU9-24
	Year	2014
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	25 kW

Primary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	30 kW
	Other Power	N/A
New Exciter	Is a new exciter needed?	No

Primary 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

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Primary Transmitter Retune	Retuning, Filter, proofing and reroute of RF for primary transmitter

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Used to maintain coverage during transiton
	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	Ultimate
	Year	2001
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	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	THU9-12
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	19 kW
	Justification for New Transmitter	Existing transmitter is no longer supported by vendor. See attached notice.

Auxiliary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	Yes
	Power	150 kVA
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	Yes
	Description	Installation costs outlined below include electrical work
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Auxilary Transmitter Installation Costs	Installation, RF, and electrical work associated with auxiliary transmitter install

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	550.0 kW
	Manufacturer
	Model	TFU-16JSC C165 SP
	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?	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	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:	425.0 kW
	Manufacturer
	Model	TFU-14ETT/VP-R 4C165
	Year	2018
	Justification for New Antenna	Current antenna (ch 39) will not work on new channel (ch 29)

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	6 1/8 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
Antenna Mounting Equipment	Adapter and support pole required to mount antenna to tower.

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	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 3/4 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	370 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	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	400 feet per run
	Justification for New Transmission Line	Current line will not work on the channel (ch 29)

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Line Adapters	Line Adapters

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	Leased
	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?	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	1204586
Coordinates (NAD83)	Latitude (NAD83)	33° 20' 03.2" N-
	Longitude (NAD83)	112° 03' 40.5" W-
	Overall Structure Height	395.99 feet
	Support Structure Height	301.83 feet
	Ground Elevation Above Mean Sea Level (AMSL)	2627.92 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	America 51, L.P.
	Date Constructed	12/20/1998

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
81458	KTAZ	DTV
26655	KPPX-TV	DTV

Primary Tower

Tower Modification Costs

Section	Question	Response
Engineering Study	Please what type of engineering study is required, if any:	Study needed for tower with candelabra
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?	Yes

Primary Tower

Other Tower Expenses Not Listed

Name	Description
KTAZ Support Pole Install- Relocated Existing Antenna from side tower to the new Stacked pole	Move existing antenna, exchange stacked pole

Outside Professional Services Costs

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	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	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	Yes
	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	40
	Justification	Transmitter and RF design at ground level

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?	Yes
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	No
	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?	No
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Name	Description
ITI- KTAZ Sweeps Remobilization	De-mobilize from and re-mobilize to the KTAZ tower.
Removal of interim RF system	Removal of interim RF system upon cutover

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	$1,099,179.45	$572,169.80	N/A	$451,736.35	N/A
Total for all systems	$3,427,223.02	$3,071,427.45	N/A	$2,609,531.81	N/A
Primary Transmitter THU9-24	$219,389.29	$154,189.29		$37,755.84
Primary Transmitter Retune	$81,589.29	$81,589.29	N/A	$0.00	N/A
30 kW mask filter	$32,600.00	$32,600.00	costs included in retune	$0.00	N/A
UHF and VHF - minor banding issues	$105,200.00	$40,000.00	N/A	$37,755.84	N/A
Auxiliary Transmitter THU9-12	$879,790.16	$417,980.51		$413,980.51
Auxilary Transmitter Installation Costs	$166,240.16	$166,240.16	N/A	$166,240.16	N/A
Other Electrical Service: Installation costs outlined below include electrical work	$4,000.00	$4,000.00	N/A	$0.00	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$4,887.00	N/A	$4,887.00	N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	$684,000.00	$242,853.35	See attached quote from Rohde and Schwarz. Needed to remain on air during and after transmitter retune before final transition date. Replaces existing backup transmitter. 7.29% tax added	$242,853.35	N/A

Components

Actual Information Description	File Name
Primary Transmitter Retune	Information not provided.
30 kW mask filter	Information not provided.
UHF and VHF - minor banding issues	Component Description: TMU9-3 Installation, receive and transport transmitter cost requested except Aux filter Re-tuning. please attached Cover letter. Amount: $37,755.84
Auxilary Transmitter Installation Costs	Component Description: See 2nd item of invoice Amount: $83,120.08 Component Description: This is just for the installation of the cabinet. See line 2 of invoice. Also, updated invoice with cover letter and vendor name. As well as added project manager name to invoice. Amount: $83,120.08
Other Electrical Service: Installation costs outlined below include electrical work	Information not provided.
Transformer 3 phase/480v - 150 KVA	Component Description: Transformers for 1 cabinet DTV transmitter, 75KVA K13 480/400Y-230, plus AZ sales tax Amount: $4,887.00
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	Component Description: See line 1 of invoice and a proportional amount of the tax on line 3. See attached explanation of variance for remaining invoice amount. Amount: $242,853.35

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	$458,046.08	$338,021.08	N/A	$306,255.60	N/A
Total for all systems	$3,427,223.02	$3,071,427.45	N/A	$2,609,531.81	N/A
Primary Antenna TFU-14ETT/VP-R 4C165	$458,046.08	$338,021.08		$306,255.60
Antenna Mounting Equipment	$149,516.08	$149,516.08	See lines 1 and 2 in attachment "KTAZ Antenna Additional Proposal", as well as the attachment "KTAZ Mounting Brackets"	$149,516.08	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$173,707.50	N/A	$142,971.76	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$10,297.50	N/A	$9,267.76	N/A
Sweep test of existing antenna	$6,730.00	$4,500.00	actual cost exceed predetermined estimation	$4,500.00	N/A

Components

Actual Information Description	File Name
Antenna Mounting Equipment	Component Description: Antenna mounting brackets Amount: $8,607.15 Component Description: ANT WEDDING CAKE MOUNTING ADAPTER 5FT LONG. REVISED Amount: $87,652.78 Component Description: Antenna Wedding Cake Mounting Adapter and Pole Amount: $87,652.78 Component Description: See lines 1 and 2 of invoice. Amount: $44,649.00 Component Description: Custom mounting brackets to relocate antenna Amount: $8,607.15
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: See line 1 of invoice. See attached explanation of variance for line 2. Amount: $71,485.88 Component Description: See line 1 of invoice. See attached explanation of variance for line 2. Amount: $71,485.88
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: See line 3 of invoice. Amount: $4,633.88 Component Description: See line 3 of invoice. Amount: $4,633.88
Sweep test of existing antenna	Component Description: This is just for the antenna line sweep. See line 3 of invoice. Also, updated invoice with cover letter and vendor name. As well as added project manager name to invoice. Amount: $2,250.00 Component Description: See 3rd item of invoice. Amount: $2,250.00

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	$151,448.70	$143,281.40	N/A	$126,405.80	N/A
Total for all systems	$3,427,223.02	$3,071,427.45	N/A	$2,609,531.81	N/A
Primary Transmission Line	$151,448.70	$143,281.40		$126,405.80
Line Adapters	$70,648.70	$70,648.70	See lines 3-12 in attachment "KTAZ Antenna Additional Proposal"	$58,561.82	N/A
Rigid Transmission Line - copper, 6 1/8"	$80,800.00	$72,632.70	N/A	$67,843.98	N/A

Components

Actual Information Description	File Name
Line Adapters	Component Description: Adapter installation with the Dielectric support pole included tax Amount: $26,769.90 Component Description: Installation of the adaptor for the tower pole with tax and expedited delivery cost included Amount: $31,744.90 Component Description: See lines 3-12 of invoice. Amount: $31,791.92
Rigid Transmission Line - copper, 6 1/8"	Component Description: See line 4 of invoice. Amount: $32,684.72 Component Description: Please see line 1, Rigid Transmission Line expenses less sales tax (789.30). Amount: $1,912.70 Component Description: Please see Line item 1. ($789.30) adjusted for reimbursement. Amount: $1,912.70 Component Description: See line 4 of invoice. Amount: $32,684.72 Component Description: Please see line item 1, deducted proportional tax from it REVISED Amount: $2,474.54

Actual Information Description

File Name

Line Adapters

Component Description:: Adapter installation with the Dielectric support pole included tax
Amount:: $26,769.90

Component Description:: Installation of the adaptor for the tower pole with tax and expedited delivery cost included
Amount:: $31,744.90

Component Description:: See lines 3-12 of invoice.
Amount:: $31,791.92

Rigid Transmission Line - copper, 6 1/8"

Component Description:: See line 4 of invoice.
Amount:: $32,684.72

Component Description:: Please see line 1, Rigid Transmission Line expenses less sales tax (789.30).
Amount:: $1,912.70

Component Description:: Please see Line item 1. ($789.30) adjusted for reimbursement.
Amount:: $1,912.70

Component Description:: See line 4 of invoice.
Amount:: $32,684.72

Component Description:: Please see line item 1, deducted proportional tax from it REVISED
Amount:: $2,474.54

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	$1,221,200.00	$1,484,406.38	N/A	$1,344,780.96	N/A
Total for all systems	$3,427,223.02	$3,071,427.45	N/A	$2,609,531.81	N/A
Primary Tower TOWER	$1,221,200.00	$1,484,406.38		$1,344,780.96
Serious tower reinforcement/modifications	$1,052,000.00	$1,010,566.38	After structural study, more tower modifications necessary. Attached "KTAZ ITI Additional Charges", all tower mod & other charges not included in 1st Marsand proposal. PO to be revised, & Marsand to credit what was paid on "estimated charges" originally	$903,938.19	N/A
Short Tower (less than 500')	$84,200.00	$367,980.00	Tower crew to install antenna and line (cost includes helicopter lift)	$367,980.00	N/A
Tower Helicopter Lift	$0.00	$0.00	included in rigging costs	$0.00	N/A
KTAZ Support Pole Install- Relocated Existing Antenna from side tower to the new Stacked pole	$65,000.00	$65,000.00	N/A	$32,182.77	N/A
Structural engineering tower load study for a documented tower with candelabra	$20,000.00	$40,860.00	Includes structural study and tower mods design study.	$40,680.00	N/A

Components

Actual Information Description	File Name
Serious tower reinforcement/modifications	Component Description: Please see cover letter and calc. for proportional amount, line items 1,3,5,7,9,11 and 13. Serious tower reinforcement and modification. All item from 1-13 proportional amount except tax line expenses are requested here for reimbursement. REVISED Amount: $106,628.19 Component Description: please see details attached over letter and calculation sheet. proportional amount requested for the payment. Amount: $103,031.36 Component Description: See "estimated tower modifications" on invoice Amount: $175,000.00 Component Description: Serious tower reinforcement and modification. All item from 1-15 proportional amount except tax line expenses are requested for the reimbursement here REVISED. Please see cover letter and calc. worksheet for proportional amount. Amount: $106,628.19 Component Description: tax amount deducted from the total invoice amount. Amount: $473,010.00 Component Description: Revised invoice. Please see item 1 for Tower alteration costs are only requested this section for reimbursement. tax is not included Amount: $367,878.00 Component Description: Please see line item 1-5 expenses for the tower. All tax deducted for the reimbursement request. Amount: $447,310.00 Component Description: This is just for the estimated tower modifications. See line 6 of invoice. Also, updated invoice with cover letter and vendor name. As well as added project manager name to invoice. Amount: $175,000.00 Component Description: KTAZ- South mountain alteration cost requested for reimbursement after credit adjustment and taxes deductions. Please see item 1 on the invoice. Amount: $5,520.84
Short Tower (less than 500')	Component Description: This is just for the tower crew antenna line install. See line 5 of invoice. Also, updated invoice with cover letter and vendor name. As well as added project manager name to invoice. Amount: $183,990.00 Component Description: See "Tower crew antenna/line install" on invoice Amount: $183,990.00
Tower Helicopter Lift	Information not provided.
KTAZ Support Pole Install- Relocated Existing Antenna from side tower to the new Stacked pole	Component Description: Promotional amount requested under this section. See spreadsheet calculation. REVISED Amount: $3,004.09 Component Description: Only line item 5 is requested in this package attached Amount: $3,004.09 Component Description: Existing KTAZ antenna relocation cost- Remining Balance Amount: $8,410.61 Component Description: Support Pole Installation and Relocated existing antenna from side to the new stacked support pole cost excluded tax. Please see item 3 and 4 on the invoice Amount: $18,932.24 Component Description: Pole installation and antenna removal cost and requested for the remining balance. Amount: $23,772.16 Component Description: Installation and relocation of existing antenna from side tower to new tower to a new stacked pole are requested here. REVISED Amount: $3,004.09
Structural engineering tower load study for a documented tower with candelabra	Component Description: please see line item 3 only for the proportional payment request from the attached invoice with Cover letter. Amount: $2,668.22 Component Description: Structural engineering tower load study for a document tower with candelabra. Proportional amount requested. REVISED Amount: $2,668.22 Component Description: Mount Analysis Amount: $1,330.00 Component Description: Broadcast Tower Modification Design Amount: $9,864.00 Component Description: Broadcast Tower Modification Design Amount: $4,500.00 Component Description: Permit for structural modification, analysis, and documentation studies Amount: $6,260.00 Component Description: Structural Analysis of an Existing Tower Amount: $4,250.00 Component Description: KTAZ- Steel verification, Inspection, documentation verification excluded tax. Please see item 2 on the invoice Amount: $7,426.55 Component Description: Broadcast Tower Modification Design. Note that the line mentioning "Add KPPX" only refers to the fact that the vendor added consideration of the KPPX antenna to their designs. These costs are all related to KTAZ Amount: $4,660.00 Component Description: 8900 - Field Observation8900 - Field Observation. please find revised package Amount: $7,500.00 Component Description: 800- field Observation Amount: $7,500.00 Component Description: Broadcast Tower Modification Design Amount: $6,576.00 Component Description: Structural engineering tower load study costs are under this section. REVISED Amount: $2,668.22 Component Description: Investigative inspection, documentation, steel verification and analysis. Please see invoice item 2 excluded tax Amount: $11,956.00 Component Description: Structural Analysis of existing tower (Add MW Dish) Amount: $2,000.00

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	$310,875.00	$354,875.00	N/A	$287,056.57	N/A
Total for all systems	$3,427,223.02	$3,071,427.45	N/A	$2,609,531.81	N/A
Outside Professional Services	$310,875.00	$354,875.00		$287,056.57
Additional Field Engineering Service, 40 Days	$20,000.00	$20,000.00	Transmitter and RF design at ground level	$10,000.00	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	$73,875.00	N/A	$73,875.00	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$4,000.00	N/A	$0.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$3,000.00	Exceeded	$2,635.60	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	$283.50	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	$436.50	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$832.86	N/A
Project management of the transition	$164,320.00	$220,000.00	Project Management services for KTAZ tower, Antenna, and other professional services	$198,993.11	N/A

Components

Actual Information Description	File Name
Additional Field Engineering Service, 40 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 Measurements of KTAZ signals at Phoenix, AZ. Amount: $73,875.00 Component Description: Field Measurements of KTAZ signals at Phoenix, Arizona. Amount: $73,875.00
Attorney Fees - Negotiation of lease and other matters for shared locations	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $180.00 Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $2,019.10 Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $436.50
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: See lines 2, 3, and half of line 1, less 10% vendor discount. Amount: $245.70 Component Description: See line 1 of invoice, less 10% vendor discount. Amount: $37.80
Address transition timing and coordination issues w/ other stations and wireless	Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $436.50
Prepare and or review reimbursement form	Component Description: See line 1 of invoice. Amount: $43.65 Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $45.00 Component Description: See half of line 1, less 10% vendor discount. Amount: $94.50 Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $45.00 Component Description: Review of Form 399 Amount: $43.65 Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $43.65 Component Description: Post-Auction Repacking - KTAZ; NBCU1811; Wilkinson Barker Knauer, LLP Amount: $87.30 Component Description: Additional information for Form 399. Amount: $113.40 Component Description: Review of Form 399 Amount: $43.65 Component Description: See lines 2-4 of invoice, less 10% vendor discount. Amount: $273.06 Component Description: Review of Form 399 Amount: $87.30
Project management of the transition	Component Description: Please see line item 16 from the attached cover letter. Proportional amount requested for the reimbursement. please calc. worksheet attached with this package. Amount: $2,075.48 Component Description: Professional services from PointB for KTAZ Amount: $8,024.94 Component Description: Project management service for KTAZ in Phoenix, AZ. Revised invoice attached Amount: $11,741.13 Component Description: Please see cover letter for PM cost explanation Amount: $600.00 Component Description: April 2018 project management and travel expenses, see attached receipts Amount: $8,859.86 Component Description: Project Management services received from PointB for KTAZ Amount: $8,055.00 Component Description: Project Management Services Amount: $2,145.00 Component Description: Site Survey $2,700 and Management services 1,299.60 split into between KTAZ and KPPX. rest of the item are requesting in full Amount: $9,741.33 Component Description: Project Management Services Amount: $3,510.00 Component Description: Please see cover letter for variance. 50% of the work performed for Non-Repack Station KPPX. Amount: $600.00 Component Description: Project Management over tower work portion. 2nd payment Amount: $25,700.00 Component Description: KTAZ 50% shared of project management costs plus other costs associated with project management services rendered by Anthony Flores are requested here for reimbursement. REVISED Amount: $9,741.33 Component Description: Project Management Services- KTAZ Amount: $5,740.00 Component Description: KTAZ- Phoenix- Program Leader- Project Management Services- 81458 KTAZ- Phoenix- Repack Finance Resource- Project Management Services- 81458 Amount: $1,810.00 Component Description: Project Management cost with Engineer name and rate on it Amount: $9,300.00 Component Description: Updated and corrected the Invoice Date and Invoice due date for October 2018 Project Management Amount: $6,000.00 Component Description: See "Project Management" portion of invoice, itemized with completed work Amount: $21,246.30 Component Description: KTAZ- Phoenix- Engagement Leader- Project Management Services- 81458. REVISED Amount: $7,990.94 Component Description: Professional Service for KTAZ Amount: $5,740.00 Component Description: Professional services from PointB. Amount: $3,300.00 Component Description: KTAZ-Phoenix-Engagement Leader- Project Management Services-81458 Amount: $3,300.00 Component Description: Invoice has included service period Amount: $3,300.00 Component Description: Project Management Services Amount: $6,630.00 Component Description: cost split 50/50 with the station KPPX Amount: $300.00 Component Description: Project Management Services Amount: $348.95 Component Description: Coordination with Ion/ KPPX and Paul J. Ford on tower modification plan and KTAZ transition plan Amount: $699.20 Component Description: Coordination with Ion/ KPPX and Paul J. Ford on tower modification plan and KTAZ transition plan Amount: $974.70 Component Description: Project Management Amount: $8,024.94 Component Description: Tower elevation verification. Project status meeting participation, Coordination with Point B, KPPX antenna stack verification structural engineering review with Paul J Ford, Conference calls with w PJF and Project team. Amount: $617.50 Component Description: Project Management Services Amount: $4,290.00 Component Description: KTAZ- Phoenix- Engagement Leader- Project Management Services- 81458 Amount: $1,501.00 Component Description: Jan 2018 Project Management Amount: $14,025.00 Component Description: KTAZ- Phoenix- Repack Finance Resource- Project Management Services- 81458 Amount: $5,767.00 Component Description: Permitting follow-up with City of Phoenix. Tower elevation verification. Project status meeting participation. Amount: $760.00 Component Description: Professional Service for KTAZ- period ending 06-30-2018 Amount: $2,850.00 Component Description: This is just for the Project Management Services. See line 4 of invoice. Also, updated invoice with cover letter and vendor name. As well as added project manager name to invoice. Amount: $21,246.30 Component Description: KTAZ- Phoenix- Repack Finance Resource - Project Management Services- 81458 Amount: $3,476.00 Component Description: Professional services from PointB for KTAZ. Amount: $8,274.20 Component Description: Project Management Services for station call sign "KTAZ" Amount: $2,850.00 Component Description: Professional Service for KTAZ- Period ending 12/31/2017 Amount: $6,630.00 Component Description: Only project management work expenses are requested for the reimbursement. please see line item 6. Amount: $25,700.00 Component Description: Project management Amount: $10,050.00 Component Description: Professional Services from Patrick including Travel-Airfare. Amount: $8,274.20 Component Description: Professional Service for KTAZ Amount: $8,055.00 Component Description: Project management services performed on site during daylight hours are requested here for reimbursement. REVISED Amount: $25,700.00 Component Description: KTAZ- Phoenix- Repack Finance Resource - Project Management Services- 81458 Amount: $1,106.00 Component Description: Professional Service for KTAZ- period Ending 3/31/2018 Amount: $6,150.00 Component Description: Project management Amount: $6,150.00 Component Description: Coordination with Ion/ KPPX and Paul J. Ford on tower modification plan and KTAZ transition plan Amount: $1,299.60 Component Description: Professional services from Point B for KTAZ, less WI-FI expense Amount: $7,956.94 Component Description: Permitting follow-up with City of Phoenix. Amount: $308.75 Component Description: Project Management Services Amount: $2,145.00 Component Description: Professional Service for KTAZ Amount: $3,510.00

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	$186,473.79	$178,673.79	N/A	$93,296.53	N/A
Total for all systems	$3,427,223.02	$3,071,427.45	N/A	$2,609,531.81	N/A
Other Expenses	$186,473.79	$178,673.79		$93,296.53
Removal of interim RF system	$50,956.99	$50,956.99	N/A	$0.00	N/A
ITI- KTAZ Sweeps Remobilization	$16,894.40	$16,894.40	KTAX Sweeps Remobilization. De-mobilize from and re-mobilize to the KTAZ tower and World cup Remobilization.	$0.00	N/A
MVPD Notification of Channel Change	$2,000.00	$2,000.00	N/A	N/A	N/A
Equipment Storage	$20,000.00	$20,000.00	N/A	$13,913.11	N/A
Equipment Delivery and Handling Charges	$30,000.00	$30,000.00	*System Notice: Estimate adjusted and locked because line has been superseded.*antenna shipment and delivery	$28,451.02	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$47,182.40	$47,182.40	*System Notice: Estimate adjusted and locked because line has been superseded.*Disposal of Thales Auxiliary Transmitter and associated equipment	$47,182.40	N/A
DTV Medical Facility Notification	$11,550.00	$3,750.00	*System Notice: Estimate adjusted and locked because line has been superseded.*	$3,750.00	N/A
AM Pattern Disturbance -- Impact study	$7,890.00	$7,890.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Removal of interim RF system	Information not provided.
ITI- KTAZ Sweeps Remobilization	Component Description: Sweep mobilization and World Cup remobilization costs are requested for reimbursement without Tax. Please see line item 5-6 on the invoice Amount: $4,969.26 Component Description: requested only for KTAZ remobilization cost included tax. please see item 3 and 4 from the invoice. 2nd Payment without tax Amount: $8,000.00
MVPD Notification of Channel Change	Information not provided.
Equipment Storage	Component Description: FLATBED TRAILER STORAGE CHARGES are due here for reimbursement. REVISED Amount: $10,980.00 Component Description: Line 3, Five MONTHS STORAGE IN WAREHOUSE, ENTRY and EXIT costs, less taxes are requested here REVISED Amount: $2,033.11 Component Description: Requesting Line 3, five months storage expenses Amount: $2,220.00 Component Description: Only storage cost is requesting for the payment. Amount: $10,980.00 Component Description: Storage of Antenna Amount: $900.00 Component Description: FLATBED TRAILER FOR STORAGE. REVISED Amount: $900.00 Component Description: Storage expenses are requested in this package. REVISED Amount: $10,980.00
Equipment Delivery and Handling Charges	Component Description: Freight Shipping, Handling and Storage Cost_ Revised Amount: $20,652.00 Component Description: Total Line Haul Amount: $9,250.85 Component Description: Shipping charge requested in shipping and Equipment delivery section. REVISED Amount: $9,672.50 Component Description: Only shipping expenses are requested, line item 2 & 4 (deducted proportional tax) Amount: $4,079.04 Component Description: Freight, Shipping, and handling cost Amount: $9,672.50 Component Description: Only shipping expenses are requested in this package. please see line item 2 & 4. Amount: $4,453.99 Component Description: only shipping charges are requested for the payment. Amount: $9,672.50 Component Description: Total Line Haul. REVISED Amount: $4,625.42 Component Description: 50% cost shared with KHRR Amount: $4,625.42 Component Description: Line Haul, Fuel Surcharge Percent, Notify Consignee and Gap Insurance Amount: $803.13 Component Description: Requesting Line 2 and 4, Freight, shipping, and handling expenses less adjusted proportional sales tax to be process under this section. REVISED Amount: $4,079.04 Component Description: Shipping and handling expenses are requested here for reimbursement. REVISED Amount: $9,672.50 Component Description: Shipping expenses shared 50/50 between KHRR and KTAZ. Amount: $401.56 Component Description: Total Line Haul, Fuel Surcharge Percentage, Gap Insurance, Limited Access Deliver, Lift Gate Destination and Notify Consignee Amount: $733.66 Component Description: Please see line 2,3, and 4 for freight and storage cost Amount: $6,673.99
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Please see line item for Antenna and line final Removal cost/disposal cos, line item 7. tax is not included Amount: $36,943.93 Component Description: KTAZ Antenna and final line removal cost without tax. Amount: $59,476.00 Component Description: See 1st item of invoice Amount: $23,591.20 Component Description: This is just for the disposal of the aux transmitter. See line 1 of invoice. Also, updated invoice with cover letter and vendor name. As well as added project manager name to invoice. Amount: $23,591.20
DTV Medical Facility Notification	Component Description: Medical Notification Mailing Amount: $3,750.00
AM Pattern Disturbance -- Impact study	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$3,427,223.02	$3,071,427.45	$2,609,531.81

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.	Angela Ball Assistant Secretary 11/17/2022

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.

Angela Ball

Assistant Secretary

11/17/2022

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.	Angela Ball Assistant Secretary 11/17/2022

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.

Angela Ball

Assistant Secretary

11/17/2022

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.	Angela Ball Assistant Secretary 11/17/2022

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.

Angela Ball

Assistant Secretary

11/17/2022

(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

Retuning Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary 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