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FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

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

(REFERENCE COPY - Not for submission)FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

File Number:
0000026701
FRN:
0001910066
Facility ID:
69397
Repack Channel:
27 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
07/07/2017

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

UNIVERSITY OF NORTH CAROLINA

Doing Business As: UNIVERSITY OF NORTH CAROLINA

PO Box 14900

RESEARCH TRIANGLE PARK, NC 27709

United States

+1 (919) 549-7000 fcc_notice@unctv.org Government Entity

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

Donald Smith

Director of New Technologies Compliance & Planning

University of North Carolina Center for Public Television

Donald Smith

10 T.W. Alexander Drive

Research Triangle Park, NC 27709

United States

+1 (919) 549-7000 dsmith@unctv.org

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. No
Briefly describe transition plan The transition plan is to construct an interim facility at the existing site. The interim facility would be used when operation on the new channel begins. After that the necessary changes would be made to the primary transmission system.

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 Aux
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DHD45P2
Year 2001
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 10.5 kw
Other Transmitter Type  

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Description of Use Auxiliary (Backup to Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model ULXTE-20
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 11.75 kw
Other Transmitter Type  
Justification for New Transmitter The transmitter manufacturer has indicated that components necessary to modify the transmitter for operation on its new channel are no longer available and it will not be able to provide re-channelization services for the transmitter. See attached letter

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) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 120.0 feet
Other Electrical Service Yes
Description Electrical feed disconnects and other items necessary to meet electrical code requirements
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

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  
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DCX-2
Year 2001
Type Inductive Output Tube
IOT Power Type Two
Description  
Power capacity 40 kw
Solid State Cooling  
Solid State Power Capacity  
Other Transmitter Type  

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Description of Use  
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-60
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 34 kw
Other Transmitter Type  
Justification for New Transmitter The transmitter manufacturer has indicated that components necessary to modify the transmitter for operation on its new channel are no longer available and it will not be able to provide re-channelization services for the transmitter. See attached letter

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) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 150.0 feet
Other Electrical Service Yes
Description Electrical feed disconnects and other items necessary to meet electrical code requirements
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Auxiliary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Aux
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 205.70 kW
Manufacturer
Model ATW24HS3-HSO-36S
Year 2008

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Interim Facility and Eventual Auxiliary
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization 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: 248.00 kW
Manufacturer
Model TFU-30DSC/VP-O4
Year 2019
Justification for New Antenna The antenna can only operate on channel 36. The replacement antenna will be initially used as part of the interim facility during the transition. Following the transition it will become a permanent auxiliary antenna.

Auxiliary 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 N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 4 1/16 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Auxiliary 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? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top-mount single
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 125.00 kW
Manufacturer
Model TFU-15JTH/VP-R O4
Year 2010

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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Top-mount single
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: 117.00 kW
Manufacturer
Model TFU-13JTH/VP-R O4
Year 2019
Justification for New Antenna The antenna is a single channel slotted pylon style antenna. It cannot operate on a channel other than what it was designed, channel 36. The only viable option is to replace the antenna.

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 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
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

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Auxiliary Transmission Line

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Add Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Interim and Eventual Auxiliary
Ownership Owned
Owner N/A
Site N/A
Is this transmission currently shared with any other stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 3 1/8 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 800 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use Interim and Eventual Auxiliary
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 4 1/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 800 feet per run
Justification for New Transmission Line Constructing a viable interim facility with meaningful coverage area requires a system with increased power handling capability. This is best addressed by replacing the transmission line with higher power handling capability. See transition plan narrative

Auxiliary 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 Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1014576
Coordinates (NAD83) Latitude (NAD83) 36° 17' 29.2" N-
Longitude (NAD83) 077° 50' 09.4" W-
Overall Structure Height 1143.03 feet
Support Structure Height 1112.19 feet
Ground Elevation Above Mean Sea Level (AMSL) 284.12 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner UNIVERSITY OF NORTH CAROLINA
Date Constructed 05/13/2011


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 120
Explanation Because the transmission site is owned by the State of North Carolina, it is subject to various state construction project rules. One rule is the hiring of a designer to create submittals for project review and approval by the state.
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 N/A
For Main Facility Yes N/A
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review 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 No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
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

Information not provided.

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 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? No
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 $1,606,650.00 $1,606,350.00 N/A $0.00 N/A
Total for all systems $2,549,000.00 $2,538,700.00 N/A $0.00 N/A
Primary Transmitter ULXTE-60 $1,079,350.00 $1,079,050.00 $0.00
Switchgear - industrial 800 amp $36,300.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 34 kW $1,000,000.00 $1,000,000.00 A quote from Comark for a replacement IOT transmitter is attached. That quote is substantially higher than the catalog pricing amount for the proposed solid state transmitter. The proposed transmitter should be eligible for full reimbursement. N/A N/A
Transformer 3 phase/480v - 150 KVA $24,300.00 $24,000.00 N/A N/A N/A
Other Electrical Service: Electrical feed disconnects and other items necessary to meet electrical code requirements $15,000.00 $15,000.00 Estimate for non-categorized items necessary to meet electrical code requirements N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $3,750.00 $3,750.00 N/A N/A N/A
Auxiliary Transmitter ULXTE-20 $527,300.00 $527,300.00 $0.00
Transformer 3 phase/480v - 150 KVA $24,300.00 $24,300.00 N/A N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $3,000.00 $3,000.00 N/A N/A N/A
Other Electrical Service: Electrical feed disconnects and other items necessary to meet electrical code requirements $30,000.00 $30,000.00 Estimate for non-categorized items necessary to meet electrical code requirements N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $470,000.00 $470,000.00 N/A N/A N/A

Components

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 $551,600.00 $551,600.00 N/A $0.00 N/A
Total for all systems $2,549,000.00 $2,538,700.00 N/A $0.00 N/A
Primary Antenna TFU-13JTH/VP-R O4 $293,100.00 $293,100.00 $0.00
Sweep test of existing antenna $6,400.00 $6,400.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $11,700.00 $11,700.00 N/A N/A N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $275,000.00 $275,000.00 N/A N/A N/A
Auxiliary Antenna TFU-30DSC/VP-O4 $258,500.00 $258,500.00 $0.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,000.00 $5,000.00 N/A N/A N/A
Sweep test of existing antenna $6,400.00 $6,400.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,100.00 $9,100.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $22,000.00 $22,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized $216,000.00 $216,000.00 N/A N/A N/A

Components

Information not provided.

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 $108,000.00 $108,000.00 N/A $0.00 N/A
Total for all systems $2,549,000.00 $2,538,700.00 N/A $0.00 N/A
Auxiliary Transmission Line $108,000.00 $108,000.00 $0.00
Rigid Transmission Line - copper, 4 1/16" $108,000.00 $108,000.00 N/A N/A N/A

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 $200,000.00 $200,000.00 N/A $0.00 N/A
Total for all systems $2,549,000.00 $2,538,700.00 N/A $0.00 N/A
Primary Tower TOWER $200,000.00 $200,000.00 $0.00
Tall Tower (greater than 500') $200,000.00 $200,000.00 N/A N/A N/A

Components

Information not provided.

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 $58,250.00 $53,250.00 N/A $0.00 N/A
Total for all systems $2,549,000.00 $2,538,700.00 N/A $0.00 N/A
Outside Professional Services $58,250.00 $53,250.00 $0.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,000.00 $2,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,500.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,500.00 $1,500.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $1,500.00 $1,500.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,000.00 $5,000.00 N/A N/A N/A
Project management of the transition $18,000.00 $18,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,500.00 $2,500.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,500.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,000.00 $2,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,000.00 $3,000.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,000.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,250.00 $2,250.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,000.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,000.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,500.00 $3,500.00 N/A N/A N/A

Components

Information not provided.

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 $24,500.00 $19,500.00 N/A $0.00 N/A
Total for all systems $2,549,000.00 $2,538,700.00 N/A $0.00 N/A
Other Expenses $24,500.00 $19,500.00 $0.00
DTV Medical Facility Notification $11,000.00 $6,000.00 Preliminary estimate of service N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $6,000.00 $6,000.00 Preliminary estimate N/A N/A
Develop and air announcement of upcoming channel change $2,000.00 $2,000.00 Preliminary estimate N/A N/A
MVPD Notification of Channel Change $5,500.00 $5,500.00 Preliminary estimate of service N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,549,000.00 $2,538,700.00 $0.00

Construction Status

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Question Response
Is construction complete? No

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.

Thomas Brooks Skinner

Associate General Manage and General Counsel


07/07/2017

Attachments

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