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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:
83965
Service:
DTV
Call Sign:
WNBW-DT
Channel:
8 (High VHF)
File Number:
0000028843
FRN:
0017998352
Date Submitted:
12/05/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MPS MEDIA OF GAINESVILLE LICENSE, LLC

Doing Business As: MPS MEDIA OF GAINESVILLE LICENSE, LLC

1181 HIGHWAY 315

WILKES BARRE, PA 18702

United States

 +1 (570) 970-5600 genebrownsc@gmail.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 

Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Paul A. Cicelski , Esq .

Lerman Senter PLLC

2001 L Street NW

Suite 400

Washington, DC 20036

United States

 +1 (202) 416-6756 pcicelski@lermansenter.com

Broadcaster Information and Transition Plan

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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 See Exhibit A.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup
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 DT435B
Year 2008
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.4 kW

Auxiliary Transmitter

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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 UAXTE-3
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.66 kW
Justification for New Transmitter The current auxiliary transmitter cannot be retuned because the manufacturer is no longer in business.

Auxiliary Transmitter

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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 Yes
Size 2 inches
Length 600.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

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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 VAX3D-8R44
Year 2016
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 3 kW

Primary Transmitter

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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 THV9-12
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 15 kW
Justification for New Transmitter The existing transmitter was not retunable.

Primary Transmitter

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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

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Other Transmitter Cost Not Listed

Name Description

Consolidation Service

Consolidation Service

Additional Site Work

Additional Site Work

Additional parts

Additional parts

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Retune Existing
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 4
Design power capacity in use 11.9 %
Lower Limit 174.00 MHz
Upper Limit 230.00 MHz
Other Antenna Type N/A
ERP: 4.9 kW
Manufacturer Systems With Reliability Inc.
Model SWDDP1-1-1-1/9
Year 2008

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

Primary Antenna

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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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 4
Design power capacity in use 11.9 %
Lower Limit 174.00 MHz
Upper Limit 230.00 MHz
Other Antenna Type N/A
ERP: 4.9 kW
Manufacturer
Model SWDDP1-1-1-1/9
Year 2008

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Other
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 Slot Side Mount
ERP: 65.0 kW
Manufacturer
Model TLS-V12/VP-R
Year 2020
Justification for New Antenna Old antenna would not handle suggested power input. Design of old antenna had four bays and input splitter and is too small to handle power level.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Input

Antenna Input

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
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 980 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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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? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1242355
Coordinates (NAD83) Latitude (NAD83) 29° 37' 47.7" N-
Longitude (NAD83) 082° 34' 24.0" W-
Overall Structure Height 962.91 feet
Support Structure Height 962.91 feet
Ground Elevation Above Mean Sea Level (AMSL) 85.96 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner BUDD BROADCASTING COMPANY, INC.
Date Constructed 01/20/2006

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
7727 WGFL DTV

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 450
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Sinclair Internal Costs

Internal Employee Time Costs

Other Expenses

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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 No
Non-zoning permits No
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? No
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

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Other Expenses Not Listed

Information not provided.

Cost Information

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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 $487,481.12 $479,381.12 N/A $364,240.87 N/A
Total for all systems $1,705,642.52 $1,109,963.15 N/A $618,582.78 N/A
Primary Transmitter THV9-12 $319,381.12 $319,381.12 $364,240.87
Additional parts $9,561.52 $9,561.52 N/A $9,561.52 N/A
Consolidation Service $9,748.59 $9,748.59 N/A $9,748.59 N/A
High VHF - Liquid Cooled Solid State Transmitter 15 kW $253,762.23 $253,762.23 N/A $253,762.23 N/A
Additional Site Work $46,308.78 $46,308.78 N/A $91,168.53 The need more information can be removed.
Auxiliary Transmitter UAXTE-3 $168,100.00 $160,000.00 $0.00
2" Rigid Conduit and Wiring (Cost per foot) $15,600.00 $15,000.00 N/A N/A N/A
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW $152,500.00 $145,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Additional parts

Component Description:
Transmitter related cost. #9500118910
Amount:
$7,057.72

Component Description:
Additional transmitter parts. #9500123120
Amount:
$2,503.80
Consolidation Service

Component Description:
Transmitter related cost. #9500118912
Amount:
$9,748.59
High VHF - Liquid Cooled Solid State Transmitter 15 kW

Component Description:
Transmitter related cost 75%. #9500118867
Amount:
$194,014.11

Component Description:
Transmitter related cost 25%. #9500111380
Amount:
$59,748.12
Additional Site Work

Component Description:
Transmitter related cost. #9500138182
Amount:
$1,851.11

Component Description:
Transmitter related cost. #9500135633
Amount:
$44,859.75

Component Description:
Additional site work. #9500135633
Amount:
$44,859.75

Component Description:
Transmitter related cost. #9500135633
Amount:
$44,859.75

Component Description:
Transmitter related cost. #9500135633
Amount:
$44,457.67
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW Information not provided.

Cost Information

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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 $275,967.41 $148,176.66 N/A $5,000.00 N/A
Total for all systems $1,705,642.52 $1,109,963.15 N/A $618,582.78 N/A
Primary Antenna TLS-V12/VP-R $269,237.41 $143,176.66 $0.00
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $15,045.30 N/A $0.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $1,603.00 N/A $0.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $0.00 N/A
High-VHF, One station antenna . side mount,, elliptically or circularly polarized $218,000.00 $111,070.95 N/A $0.00 N/A
Antenna Input $9,057.41 $9,057.41 N/A $0.00 N/A
Primary Antenna SWDDP1-1-1-1/9 $6,730.00 $5,000.00 $5,000.00
Sweep test of existing antenna $6,730.00 $5,000.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $5,000.00 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Total invoice amount reduced by 8.40%. #742017
Amount:
$15,045.30
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Total invoice amount reduced by 8.40%. #1603
Amount:
$1,603.00
Sweep test of existing antenna

Component Description:
Antenna related cost reduced by 8.40%. #820022
Amount:
$5,862.40
High-VHF, One station antenna . side mount,, elliptically or circularly polarized

Component Description:
Total invoice amount reduced by 8.40%. #725002
Amount:
$111,070.95
Antenna Input

Component Description:
Total invoice amount reduced by 8.40%. #725002
Amount:
$9,057.41
Sweep test of existing antenna

Component Description:
Antenna system checkout. #1419
Amount:
$5,000.00

Cost Information

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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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $1,705,642.52 $1,109,963.15 N/A $618,582.78 N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

Information not provided.

Cost Information

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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 $657,800.00 $224,272.00 N/A $140,608.00 N/A
Total for all systems $1,705,642.52 $1,109,963.15 N/A $618,582.78 N/A
Primary Tower TOWER $657,800.00 $224,272.00 $140,608.00
Major tower reinforcement/modifications $421,000.00 $17,372.00 N/A $17,372.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $6,900.00 N/A $5,800.00 N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $117,436.00 N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications

Component Description:
Tower related cost. #SIN001631
Amount:
$8,686.00

Component Description:
Tower related cost. #SIN000775
Amount:
$8,686.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
50% invoiced upon analysis completion. #E-189869
Amount:
$1,900.00

Component Description:
Broadcast analysis down payment 50%. #SIN000025
Amount:
$2,000.00

Component Description:
Structural analysis cost. #E-188486
Amount:
$1,900.00

Component Description:
50% invoiced upon analysis completion. #E-188486
Amount:
$1,900.00
Tall Tower (greater than 500')

Component Description:
Tower related cost. #SIN008365
Amount:
$29,000.00

Component Description:
Tower related cost. #SIN008365
Amount:
$29,000.00

Component Description:
Tower cost. #SIN008365
Amount:
$29,000.00

Component Description:
Tower related cost. #SIN001631
Amount:
$40,643.00

Component Description:
Tower related cost. #2069
Amount:
$7,150.00

Component Description:
Tower related cost. #SIN000775
Amount:
$40,643.00

Cost Information

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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 $200,697.99 $175,002.37 N/A $106,283.91 N/A
Total for all systems $1,705,642.52 $1,109,963.15 N/A $618,582.78 N/A
Outside Professional Services $200,697.99 $175,002.37 $106,283.91
Sinclair Internal Costs $537.99 $537.99 N/A $537.99 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $27,000.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $0.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $0.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $221.92 N/A $221.92 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $926.25 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,123.75 N/A $3,123.75 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,402.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,452.79 N/A
Project management of the transition $71,100.00 $70,618.71 N/A $70,618.71 Line item with attachment WNBW 12-16-2019 ITV Tech Inv 1988.pdf and status Need More Information can be removed. An updated version has been attached.

Components

Actual Information Description File Name
Sinclair Internal Costs

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$5.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$15.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 60 stations.
Amount:
$4.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$6.09

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #IL-SBG-11012021-SD
Amount:
$6.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$25.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations.
Amount:
$23.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$9.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations.
Amount:
$8.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations.
Amount:
$41.33

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 36 stations. #IL-SBG-12012021-SD
Amount:
$7.92

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$17.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$32.09

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$1.69

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #IL-SBG-09012021-SD
Amount:
$14.26

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #IL-SBG-10012021-SD
Amount:
$14.16

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #IL-SBG-09012021-LB
Amount:
$10.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 21 stations. #IL-SBG-03012022-SD
Amount:
$16.01

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 29 stations. #IL-SBG-01012022-SD
Amount:
$15.69

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$33.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.39

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$16.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$23.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$8.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #IL-SBG-08012021-SD
Amount:
$24.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 60 stations.
Amount:
$23.77

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$26.93

Component Description:
Portion of general repack matter internal time card attributable to this station - divided by 100.
Amount:
$66.55

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations.
Amount:
$9.79

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 21 stations. #IL-SBG-02012022-SD
Amount:
$20.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.86
Comprehensive coverage verification via field study, if needed

Component Description:
UAS broadcast measurement. #207031
Amount:
$27,000.00
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.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
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 Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$99.92

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$122.00
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Outside professional service cost. #882-03-0003
Amount:
$926.25
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Consulting engineering cost. #882-03-0002
Amount:
$1,833.75

Component Description:
Consulting engineering cost.
Amount:
$1,290.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting engineering cost.
Amount:
$1,402.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Legal services cost. #461738
Amount:
$120.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$1,311.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$152.01

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$869.30
Project management of the transition

Component Description:
Outside professional service cost. #1964
Amount:
$650.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations. #481318
Amount:
$814.01

Component Description:
Legal services cost. #479828
Amount:
$103.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 29 stations. #491288
Amount:
$136.03

Component Description:
Project management. #2006
Amount:
$2,400.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479829
Amount:
$458.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #488810
Amount:
$256.62

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations.
Amount:
$30.47

Component Description:
$207.48 credit to be split across 52 Sinclair stations reimbursed $269.71 for invoice #1093 (correct reimbursement amount is $265.72). #CM-7-29-2019-1093
Amount:
($3.99)

Component Description:
Legal services cost. #470346
Amount:
$392.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$818.59

Component Description:
Legal services cost. #479874
Amount:
$1,282.50

Component Description:
$26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for Invoice 461759 (correct reimbursement amount is $709.74). #CM-11-21-2019-461759
Amount:
($289.46)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465001
Amount:
$596.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$86.88

Component Description:
Legal services cost. #474468
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #489238
Amount:
$403.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #468718
Amount:
$349.51

Component Description:
Legal Service Cost. #477367
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985
Amount:
$282.68

Component Description:
Legal Service Cost. #478834
Amount:
$57.50

Component Description:
Legal Service Cost. #465250
Amount:
$235.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #1086
Amount:
$275.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #339
Amount:
$1,816.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809
Amount:
$395.77

Component Description:
Project management. #2026
Amount:
$1,500.00

Component Description:
Legal services cost. #472219
Amount:
$163.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1072
Amount:
$237.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477305
Amount:
$393.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1090
Amount:
$176.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations. #236
Amount:
$1,117.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$91.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1151
Amount:
$388.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1055
Amount:
$243.38

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$716.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1079
Amount:
$177.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$20.91

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$43.71

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 36 stations. #367
Amount:
$1,051.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations. #153
Amount:
$1,287.27

Component Description:
Legal services cost. #481368
Amount:
$1,445.00

Component Description:
Outside professional service cost. #1988
Amount:
$1,700.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475283
Amount:
$384.08

Component Description:
Legal services cost. #471593
Amount:
$278.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 36 stations. #490126
Amount:
$214.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations.
Amount:
$185.10

Component Description:
Legal services cost. #489812
Amount:
$58.75

Component Description:
Project management cost. #1970
Amount:
$1,550.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #318
Amount:
$1,586.15

Component Description:
Project management. #2055
Amount:
$150.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1105
Amount:
$216.88

Component Description:
Legal services cost. #487061
Amount:
$58.75

Component Description:
Project management cost. #2034
Amount:
$2,100.00

Component Description:
Legal services cost. #460897
Amount:
$177.50

Component Description:
Legal services cost. #476949
Amount:
$51.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #464321
Amount:
$683.07

Component Description:
Outside professional service cost. #2006
Amount:
$2,400.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$29.98

Component Description:
Legal Service Cost. #466765
Amount:
$182.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #480175
Amount:
$377.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473506
Amount:
$421.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475744
Amount:
$305.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 59 stations. #295
Amount:
$997.50

Component Description:
Project management. #2047
Amount:
$1,500.00

Component Description:
Legal services cost. #457793
Amount:
$737.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #132
Amount:
$589.44

Component Description:
Legal services cost. #473484
Amount:
$51.25

Component Description:
$207.48 credit to be split across 52 Sinclair stations reimbursed $269.71 for invoice #1093 (correct reimbursement amount is $265.72). #7-29-2019-1093
Amount:
($3.99)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474405
Amount:
$490.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093
Amount:
$269.71

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1161
Amount:
$267.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations.
Amount:
$105.97

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478288
Amount:
$194.86

Component Description:
Project management. #2051
Amount:
$1,650.00

Component Description:
Legal services cost. #479828
Amount:
$103.50

Component Description:
Project management cost. #1979
Amount:
$850.00

Component Description:
Project management cost. #1967
Amount:
$1,200.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473885
Amount:
$318.62

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478780
Amount:
$271.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #471524
Amount:
$322.83

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 43 stations. #487620
Amount:
$337.32

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467378
Amount:
$576.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 21 stations. #399
Amount:
$2,137.88

Component Description:
Legal Service Cost. #464751
Amount:
$177.50

Component Description:
Legal services cost. #480219
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479285
Amount:
$372.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$836.44

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467861
Amount:
$470.30

Component Description:
Legal Service Cost. #488554
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1156
Amount:
$399.52

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 43 stations. #306
Amount:
$1,691.34

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$999.04

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #483809
Amount:
$868.77

Component Description:
Legal services cost. #480804
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1058
Amount:
$187.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #107
Amount:
$602.28

Component Description:
Project management cost. #1988
Amount:
$1,700.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1141
Amount:
$406.17

Component Description:
Outside service professional cost. #1979
Amount:
$850.00

Component Description:
Outside professional service cost. #2020
Amount:
$1,900.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1099
Amount:
$266.93

Component Description:
Legal services cost. #487647
Amount:
$57.50

Component Description:
Legal Service Cost. #477882
Amount:
$115.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 21 stations. #491039
Amount:
$539.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #488547
Amount:
$228.12

Component Description:
Project management. #1967
Amount:
$1,200.00

Component Description:
Legal services cost. #472648
Amount:
$157.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173
Amount:
$311.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #466690
Amount:
$446.87

Component Description:
Project management cost. #1964
Amount:
$1,473.83

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1145
Amount:
$369.98

Component Description:
Legal Service Cost. #479345
Amount:
$212.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #328
Amount:
$1,864.33

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$20.64

Component Description:
Legal services cost. #462960
Amount:
$174.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1167
Amount:
$313.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 29 stations. #387
Amount:
$1,184.44

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #118
Amount:
$468.97

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472583
Amount:
$279.89

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1130
Amount:
$281.49

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1078
Amount:
$215.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #355
Amount:
$1,413.31

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476885
Amount:
$403.34

Component Description:
Legal services cost. #476438
Amount:
$205.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$943.95

Component Description:
Project management cost. #1988
Amount:
$1,700.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470923
Amount:
$406.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1111
Amount:
$159.58

Component Description:
Project management cost. #1970
Amount:
$1,550.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1063
Amount:
$262.29

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470237
Amount:
$436.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #489800
Amount:
$598.13

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1117
Amount:
$282.68

Component Description:
Outside professional service cost. #1964
Amount:
$1,473.83

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #469573
Amount:
$377.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 60 stations. #487016
Amount:
$267.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463567
Amount:
$566.48

Component Description:
Legal services cost. #474882
Amount:
$108.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1069
Amount:
$246.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1123
Amount:
$342.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1098
Amount:
$238.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$32.35

Component Description:
Legal Service Cost. #467917
Amount:
$120.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1143
Amount:
$436.90

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476367
Amount:
$364.80

Component Description:
Legal services cost. #491011
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1114
Amount:
$242.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477820
Amount:
$320.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026
Amount:
$801.57

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1133
Amount:
$307.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465173
Amount:
$654.26

Component Description:
Project management cost. #2020
Amount:
$1,900.00

Cost Information

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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 $83,696.00 $83,131.00 N/A $2,450.00 N/A
Total for all systems $1,705,642.52 $1,109,963.15 N/A $618,582.78 N/A
Other Expenses $83,696.00 $83,131.00 $2,450.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 See Exhibit J. N/A N/A
Develop and air announcement of upcoming channel change $28,050.00 $28,050.00 See Response to August 27 Inquiry. N/A N/A
Equipment Delivery and Handling Charges $10,000.00 $10,000.00 See Exhibit J. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $28,566.00 $28,566.00 See Response to August 27 Inquiry. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,450.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) 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:
Medical notification cost. #1455
Amount:
$2,450.00

Cost Information

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Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $1,705,642.52 $1,109,963.15 $618,582.78

Reimbursement Status

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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

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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.

Eugene Brown

Sole Member


12/05/2022

Certification

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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.

Eugene Brown

Sole Member


12/05/2022

Attachments

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