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

FCC Form 399: Reimbursement Request

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

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

Facility ID:
64549
Service:
DTV
Call Sign:
WXOW
Channel:
28 (UHF)
File Number:
0000027498
FRN:
0024972457
Date Submitted:
08/12/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WXOW-WQOW License, LLC

Doing Business As: WXOW-WQOW License, LLC

P.O. Box 909

Quincy, IL 62306

United States

+1 (217) 223-5100 bdreasler@quincymedia.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

Tony zumMallen

QCommunications, LLC

Tony zumMallen

705B SE Melody LN #314

Lees Summit, MO 64063

United States

+1 (816) 729-1177 tony@qcom1.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. No
Briefly describe transition plan Transition from ch48 to ch28 will require a new top mount antenna, line and transmitter. An interim system will be required to provide market coverage during the transition.

Transmitters

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

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 Atlas
Year 2004
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 13 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? No
Manufacturer
Model ULXTE-40
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25 kW
Justification for New Transmitter Existing transmitter is not tunable per the manufacturer.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 25 tons
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

FRIEGHT

FREIGHT FROM MFG TO STAGING AREA

Site Survey - TX

Site survey is required to be performed before the new transmitter and components installation plan can be finalized.

Transmitter Training

Transmitter training - offsite - 1 week in duration at mfg site.

Plumbing of the new transmitter cooling systems

new transmitter cooling systems needs to be installed and decommed

Transmitter Site Preparation

Site prep for installation of the interim and main transmitters and RF components not part of Installation SOW.

Disconnect existing Transmitter

Disconnect transmitter and components from existing configuration and move within building

Sales Tax

Sales tax for eq

Electrical systems installation for new transmitters

Electrician required to provide and install the equipment in preparation of the new transmitters electrical requirements.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model ULXTE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12 kW
Justification for New Transmitter Interim facility is required to avoid prolonged period of station silence during transition, and station currently has no aux facility to use for interim operation. Extended silent period during transition to new channel is unreasonable.

Interim 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) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 15 tons
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
Inside RF System Is an additional interior RF system required to support this interim transmitter? Yes

Interim Transmitter

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Other Transmitter Cost Not Listed

Name Description

FRIEGHT

FREIGHT FROM MFG TO STAGING AREA

Transmitter Site Preparation

Site prep for installation of the interim and main transmitters and RF components not part of Installation SOW.

Sales tax

sales tax for equipment

Antennas

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

Primary Antenna

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Add 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 this antenna currently shared with any other stations? No
Is this antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top 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: 371.0 kW
Manufacturer
Model TWS-30T
Year 1989

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 Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 18
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 251.0 kW
Manufacturer
Model TFU-18GTH
Year 2017
Justification for New Antenna Existing antenna is not tunable to new channel assignment. Adding Vertical component to Primary antenna and do not know of any upgraded pricing as of time of filing.

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? Broadband
Feed Line Size 4 1/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? Yes
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 Horizontal
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 75.0 %
Other Antenna Type N/A
ERP: 20.0 kW
Manufacturer
Model TFU-8WB
Year 2017
Justification for New Antenna Interim facility is required to avoid prolonged period of station silence during transition, and station currently has no aux facility to use for interim operation. Extended silent period during transition to new channel is unreasonable.

Interim Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? Yes
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 4 1/16 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Enter a list of RF channel numbers.

RF Channel Number
50
48

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

FREIGHT

FREIGHT FOR DELIVERY TO STAGING AREA OR STATION

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 Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 900 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 900 feet per run
Justification for New Transmission Line Required to make the channel reassignment change over.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Securirty - Site

This site requires security once the new transmission line and equipment arrive on site to be installed. Estimated length of 4-6 weeks.

Disconnect existing Interior RF components

Disconnect interior transmission line and filters from existing configuration and move within the building.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 4 1/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 900 feet per run
Justification for New Transmission Line Interim facility is required to avoid prolonged period of station silence during transition, and station currently has no aux facility to use for interim operation. Extended silent period during transition to new channel is unreasonable.

Interim 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 Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1035149
Coordinates (NAD83) Latitude (NAD83) 43° 48' 23.0" N-
Longitude (NAD83) 091° 22' 03.0" W-
Overall Structure Height 819.22 feet
Support Structure Height 763.44 feet
Ground Elevation Above Mean Sea Level (AMSL) 1225.71 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WXOW-WQOW Television, Inc.
Date Constructed 10/23/1982

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
20665 WIZM-FM FM

Other Types of Users

Users
2-Way service

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 documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor 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 1301
Explanation Scope & significance of project (QMI has multiple stations repacked) require outside management services to augment existing internal personnel to assist turnkey management of and ensure timely and safe execution of channel relocation.
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 No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement 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

General Repack Attorney

See uploaded memo-QMI Repack Invoice Memo for Shared Legal Expenses (Matter 104411 00054) for Form 399

Quarterly reporting -Atty

Preparation and submittal of the FCC required quarterly report 387 by the attorney.

PM Reimbursable expenses

Expenses in quotes that are reimbursable for travel and in field Per Diem

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? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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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 $2,171,167.45 $2,078,167.45 N/A $1,310,906.69 N/A
Total for all systems $3,865,023.45 $3,808,208.45 N/A $2,235,567.80 N/A
Interim Transmitter ULXTE-20 $786,663.12 $749,763.12 $402,682.29
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $470,000.00 N/A $326,509.60 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $9,293.85 N/A
2" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
15 Ton system $55,800.00 $53,000.00 N/A N/A N/A
UHF inside RF system including switching $147,500.00 $140,000.00 N/A $22,415.72 N/A
Sales tax $33,651.83 $33,651.83 sales tax calc per mfg quote and inv - 10-11-18- ACTUAL BILLED PER STATE TAX RATE 6.875 $33,651.83 N/A
FRIEGHT $6,811.29 $6,811.29 Freight from mfg to staging per Q-61103 - 10-11-18- ACTUAL INVOICED $6,811.29 N/A
Transmitter Site Preparation $5,000.00 $5,000.00 Site prep for installation of the interim and main transmitters and RF components not part of Installation SOW. $4,000.00 N/A
Primary Transmitter ULXTE-40 $1,384,504.33 $1,328,404.33 $908,224.40
Sales Tax $59,650.33 $59,650.33 Sales tax est on mfg invoice $54,447.16 N/A
Plumbing of the new transmitter cooling systems $22,570.00 $22,570.00 plumber required to install the new transmitter cooling systems per PO20217 $17,318.81 N/A
Site Survey - TX $25,000.00 $25,000.00 Site survey and report are required to be performed before the new transmitter and components installation plan can be finalized. $14,500.00 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $900,000.00 N/A $743,651.62 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $34,118.94 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A $8,546.24 N/A
2" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
25 Ton system $91,500.00 $87,000.00 N/A N/A N/A
FRIEGHT $5,900.00 $5,900.00 FREIGHT-PER INV US0314196 $5,641.63 N/A
Transmitter Training $3,300.00 $3,300.00 Transmitter training - offsite - 1 week in duration at mfg site. N/A N/A
Electrical systems installation for new transmitters $102,984.00 $102,984.00 Electrician required to provide and install the equipment in preparation of the new transmitters electrical requirements. per po20228 $0.00 N/A
Transmitter Site Preparation $7,000.00 $7,000.00 Site prep for installation of the interim and main transmitters and RF components not part of Gates SOW. $6,500.00 N/A
Disconnect existing Transmitter $25,000.00 $25,000.00 Disconnect transmitter and components from existing configuration and move within building to make way for new facilities. $23,500.00 N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
WXOW- CORY-MASK FILTER STAND-INV-18-451
Amount:
$2,150.00

Component Description:
2nd 1/3 payment FOR INTERIM TX PER VALIDATED 399-Quote-Q-61103 Lines-(A B and E) Total is $439,729.57. Which is below $470k allotment.
Amount:
$146,576.52

Component Description:
WXOW-GATES-TX-INV-US0314197- LINE A,B
Amount:
$135,028.97

Component Description:
1/3 DOWN FOR INTERIM TX PER VALIDATED 399-Quote-Q-61103 Lines-(A B and E) Total is $439,729.57. Which is below $470k allotment.
Amount:
$146,576.52

Component Description:
WXOW-GATES-INV US316088- LINE E INSTALL
Amount:
$11,547.56

Component Description:
WXOW-BORTON-CHILLER INV-4805 - REMOVE VARIANCE
Amount:
$19,659.00
Switchgear - industrial 800 amp

Component Description:
WXOW-GATES-INT- INV US0316088 LINE D ELEC
Amount:
$2,228.77

Component Description:
Gates-quote Q-61103-INT Electrical switching-LlNE D. 1/3 deposit per inv.
Amount:
$3,532.54

Component Description:
WXOW-GATES-INV-US0314197-LINE D
Amount:
$22.90

Component Description:
Gates-quote Q-61103-INT Electrical switching-LlNE D. 2nd 1/3 payment
Amount:
$3,532.54
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
15 Ton system Information not provided.
UHF inside RF system including switching

Component Description:
WXOW-RF Switching Gates Quote G-61103 LINE C. RF Accessories- 2nd inv 1/3
Amount:
$11,207.86

Component Description:
WXOW-RF Switching Gates Quote G-61103 LINE C. RF Accessories- dep inv 1/3
Amount:
$11,207.86

Component Description:
WXOW-GATES-INV-US0314197-LINE C
Amount:
$11,207.87
Sales tax

Component Description:
WXOW-GATES-TAX-INV-US0314197
Amount:
$19,785.63

Component Description:
WXOW- SALES tax - 33 percent payment per Q-61103. march 5th-Rounding error added 1 cent to request to match the INV request.
Amount:
$11,090.54

Component Description:
WXOW-GATES-INT INV US0316088 LINE TAX
Amount:
$22,561.29
FRIEGHT

Component Description:
WXOW-GATES-FREIGHT-INV-US314197
Amount:
$5,400.00

Component Description:
WXOW-GATES-INT INV US0316088 LINE FREIGHT
Amount:
$6,811.29
Transmitter Site Preparation

Component Description:
WXOW- QCOMM - SITE PREP-INV QC18-034 - INT
Amount:
$4,000.00
Sales Tax

Component Description:
WXOW-GATES-MAIN-INV-US0314196-TAX
Amount:
$34,563.72

Component Description:
WXOW-GATES_MAIN-TX SALES TAX see inv and Q-61102 3-30-added 1 cent to sales tax due to rounding error. Please delete the duplicate request. 4-2- please disregard or delete this submittal.
Amount:
N/A

Component Description:
WXOW-GATES_MAIN-TX SALES TAX see inv and Q-61102. -3-30- USE THIS submittal. FINAL ANSWER...3:41pm 4-2- - corrected inv $ amount Use this submittal and delete the other.
Amount:
$19,883.44
Plumbing of the new transmitter cooling systems

Component Description:
WXOW-BERNIE- PLUMBING FOR TX COOLERS- INV856698
Amount:
$17,318.81
Site Survey - TX

Component Description:
WXOW- QCOMM SURVEY INV- QC18-028
Amount:
$14,500.00
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
1/3 DEPOSIT REQUIRED -MAIN TX. QUOTE- Q-61102-LINES A,B and E is $269,305.46
Amount:
$269,305.46

Component Description:
WXOW -MAIN TX. 4-2- please use other submittal
Amount:
N/A

Component Description:
2nd Payment - WXOW -MAIN TX. QUOTE- Q-61102-LINES A,B and E is $269,305.46 4-3- please use this submittal
Amount:
$269,305.46

Component Description:
WXOW-GATES-MAIN-INV-US0314196-LINE A,B
Amount:
$205,040.70
Service entrance 3 phase/800 amp/208 volt Information not provided.
Switchgear - industrial 800 amp

Component Description:
GATES-MAIN TX RF Switching- quote Q-61102 - LINE is C or 2nd payment 4-3- Process this corrected submittal. UPLOADED QUOTE AND INV ZEROED BAD REQUEST
Amount:
$17,059.47

Component Description:
GATES-MAIN TX RF Switching- quote Q-61102 - LINE is C or 1/3 deposit required.
Amount:
$17,059.47

Component Description:
-4-2- please delete this request
Amount:
N/A
Transformer 3 phase/480v - 300 KVA

Component Description:
WXOW-GATES-MAIN-INV-US0314196-LINE D
Amount:
$2,848.75

Component Description:
2ND PAYMENT-GATES-MAIN TX-WXOW -See quote Q-61102 LINE D is ELECTRIC parts. 3-30-added 1 cent to sales tax due to rounding error. Please delete the duplicate request. 4-2 - zeroed out. please delete this request.
Amount:
N/A

Component Description:
GATES-MAIN TX-WXOW -See quote Q-61102 LINE D is ELECTRIC parts. 1/3 deposit required.
Amount:
$2,848.74

Component Description:
GATES-MAIN TX-WXOW -See quote Q-61102 LINE D is ELECTRIC parts. 4-3- Process this corrected submittal. UPLOADED QUOTE AND INV ZEROED BAD REQUEST
Amount:
$2,848.75
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
25 Ton system Information not provided.
FRIEGHT

Component Description:
WXOW-GATES-FREIGHT-INV-US314196
Amount:
$5,641.63
Transmitter Training Information not provided.
Electrical systems installation for new transmitters

Component Description:
WXOW- PAND T ELECTRIC - TX-INV 15885 - 10-11-18 MATRIX AND NAME
Amount:
$4,680.00

Component Description:
WXOW-P&T ELECTRICAL FOR TX - INV15770 - 10-11-18 - MATRIX AND NAME
Amount:
$77,618.00
Transmitter Site Preparation

Component Description:
WXOW-QCOMM- SITE PREP - INV QC18-034 MAIN
Amount:
$6,500.00
Disconnect existing Transmitter

Component Description:
WXOW- DECOM-TX-INV QC18-058
Amount:
$23,500.00

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 $609,970.00 $593,600.00 N/A $313,898.31 N/A
Total for all systems $3,865,023.45 $3,808,208.45 N/A $2,235,567.80 N/A
Interim Antenna TFU-8WB $322,290.00 $306,800.00 $78,453.80
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $120,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $10,400.00 N/A $8,329.50 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
FREIGHT $6,000.00 $6,000.00 FREIGHT FROM MFG TO STAGING OR STATION. MAY HAVE MULTIPLE SHIPPERS $5,645.30 N/A
UHF . Broadband Slot, Side Mount, 8 bay, 20 kW input, directional, horizontally polarized $60,000.00 $57,000.00 N/A $40,432.50 N/A
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 N/A $24,046.50 N/A
Primary Antenna TFU-18GTH $287,680.00 $286,800.00 $235,444.51
UHF - High Power Top Mount One Station antenna elliptically or circularly polarized $270,000.00 $270,000.00 Entered Catalog of Costs dollar amount. The Predetermined did not auto complete for the Primary antenna. To alleviate the situation add the CofC to the EST cost column. We do not have any upgrade costs at the time of the filing. $220,573.81 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,760.00 N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $10,400.00 N/A $9,110.70 N/A

Components

Actual Information Description File Name
Combiner output splitting/switching for dual feed lines, if applicable Information not provided.
Sweep test of existing antenna Information not provided.
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
DIELECTRIC-WXOW-INTERIM- ELBOW-BALANCE INV LINE 16- 3-28-UPLOADED - Order Conf 405002 - 10-11-18 UPLOADED NEW
Amount:
$925.50

Component Description:
WXOW-ELBOW-line18- 2nd 45 percent due-
Amount:
$4,164.75

Component Description:
WXOW-INTERIM ELBOW DEPOSIT LINE #18
Amount:
$4,164.75
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
FREIGHT

Component Description:
WXOW-DIELECTRIC-INTERIM -FREIGHT INV 93053 - 3-28-uploaded Order Confirmation-405002
Amount:
$4,455.00

Component Description:
WXOW-DIE-FREIGHT - INV 170007
Amount:
$1,190.30
UHF . Broadband Slot, Side Mount, 8 bay, 20 kW input, directional, horizontally polarized

Component Description:
WXOW-DIELECTRIC-INTERIM-INV-89002-LINE 17 ANTENNA-BALANCE -3-28-UPLOADED Order Conf- 405002 - 10-11-18-NEW UPLOAD
Amount:
$4,492.50

Component Description:
WXOW - INTERIM ANTENNA 45% DEPOSIT
Amount:
$20,216.25

Component Description:
WXOW-ANT-INTERIM-2nd 45 percent -INV MAN00115-line 20
Amount:
$20,216.25
New combiner, cost per channel (without antenna)

Component Description:
WXOW- DIE- COMBINER INV MAN00400
Amount:
$24,046.50
UHF - High Power Top Mount One Station antenna elliptically or circularly polarized

Component Description:
WXOW-MAIN ANTENNA 45 PERCENT INV LINES #1,3, AND 4. 4-5-UPLOADED UPGRADE AND PO 4-17-RFAS-uploaded Cover Letter and PO 19944 and 19952
Amount:
$111,552.53

Component Description:
WXOW-MAIN ANTENNA 10 DEPOSIT INV LINES #1,3, AND 4. LINE #2 IS NOT BILLED TO THE FCC FOR IT IS THE V-POL UPGRADE.
Amount:
$24,226.95

Component Description:
MAIN ANTENNA 35% DEPOSIT INV - LINES #1,3 AND 4.
Amount:
$84,794.33
Sweep test of existing antenna

Component Description:
SWEEP 35% DEPOSIT INV LINE#26
Amount:
$2,240.00

Component Description:
WXOW-SWEEP TEST 10% DEPOSIT INV LINE #26
Amount:
$640.00

Component Description:
WXOW-MAIN ANTENNA-SWEEP 45PERCENT INV LINES #26 4-5-UPLOADED UPGRADE AND PO
Amount:
$2,880.00
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
WXOW- ELBOW 10% DEPOSIT FOR LINES #5 AND 6
Amount:
$1,012.30

Component Description:
WXOW-DIELECTRIC-ELBOW - 45% INV LINES # 5 AND 6 4-5-UPLOADED UPGRADE AND PO
Amount:
$4,555.35

Component Description:
ELBOW - 35% DEPOSIT INV LINES # 5 AND 6 ONLY
Amount:
$3,543.05

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 $285,600.00 $273,000.00 N/A $194,631.18 N/A
Total for all systems $3,865,023.45 $3,808,208.45 N/A $2,235,567.80 N/A
Interim Transmission Line $127,800.00 $121,500.00 $90,057.94
Rigid Transmission Line - copper, 4 1/16" $127,800.00 $121,500.00 N/A $90,057.94 N/A
Primary Transmission Line $157,800.00 $151,500.00 $104,573.24
Disconnect existing Interior RF components $12,500.00 $12,500.00 Disconnect interior transmission line and filters from existing configuration and move within the building to make way for new facilities. $12,500.00 N/A
Securirty - Site $17,500.00 $17,500.00 This site requires security once the new transmission line and equipment arrive on site to be installed. Estimated length of 4-6 weeks. N/A N/A
Rigid Transmission Line - copper, 4 1/16" $127,800.00 $121,500.00 N/A $92,073.24 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 4 1/16"

Component Description:
WXOW-INTERIM TX LINE DEPOSIT 45% LINE #2
Amount:
$44,458.47

Component Description:
WXOW-INTERIM TX LINE- 2nd 45percent inv - LINE 2 and 21
Amount:
$44,458.47

Component Description:
DIELECTRIC-WXOW-DIGIT LINE-BALANCE INV - LINE 1 - 10-11-18 UPLOADED NEW
Amount:
$7,597.66

Component Description:
WXOW-DIE-LINE-SECTION REPLACEMENT-INV-162026
Amount:
$1,141.00
Disconnect existing Interior RF components

Component Description:
WXOW- DECOMM RF - INV QC18-058
Amount:
$12,500.00
Securirty - Site Information not provided.
Rigid Transmission Line - copper, 4 1/16"

Component Description:
TX LINE 35% DEPOSIT INV FOR LINE #7
Amount:
$35,806.26

Component Description:
WXOW-DIELECTRIC-TX LINE 45% INV FOR LINE #7 4-5-UPLOADED UPGRADE AND PO
Amount:
$46,036.62

Component Description:
WXOW- TX LINE 10% DEPOSIT LINE #26
Amount:
$10,230.36

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 $381,100.00 $464,090.00 N/A $200,460.00 N/A
Total for all systems $3,865,023.45 $3,808,208.45 N/A $2,235,567.80 N/A
Primary Tower TOWER $381,100.00 $464,090.00 $200,460.00
Tall Tower (greater than 500') $210,500.00 $302,090.00 Tool is not accounting for two separate antenna installations. One for the interim and One for the main. $200k each is the budget on a tall tower. $199,260.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $1,200.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
WXOW-PCI-TOWER DEP REIMBURSABLE NOW THAT CREW ON SITE-INV7240
Amount:
$50,000.00

Component Description:
WXOW-PCI-ARRIVAL INV 7330
Amount:
$99,630.00

Component Description:
WXOW-PCI- ON SITE INSTALLING ANT AND LINE - INV 7312
Amount:
$49,630.00
Structural engineering tower load study for well documented tower

Component Description:
WXOW-TOWER RIG ANALYSIS-FORD-INV205618
Amount:
$1,200.00
Minor tower reinforcement/modifications 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 $354,106.00 $336,836.00 N/A $209,221.62 N/A
Total for all systems $3,865,023.45 $3,808,208.45 N/A $2,235,567.80 N/A
Outside Professional Services $354,106.00 $336,836.00 $209,221.62
General Repack Attorney $10,000.00 $10,000.00 see uploaded memo from Brooks Pierce-QMI Repack Invoice Memo for Shared Legal Expenses (Matter 104411 00054) for Form 399 $8,548.70 N/A
PM Reimbursable expenses $13,408.00 $13,408.00 PM - infield travel and Per Diem reimbursable expenses $9,878.42 N/A
Quarterly reporting -Atty $4,500.00 $4,500.00 Preparation and submittal of the FCC required quarterly report 387 by the attorney. EST. 6qtrs@$750 N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 We need 1 STA for the initial request and we are budgeting 1 additional STA in case the project requires an addition STA for unforeseen issues during the construction period. N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 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 $4,162.00 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 We need 1 STA for the initial request and we are budgeting 1 additional STA in case the project requires an addition STA for unforeseen issues during the construction period. $1,100.00 N/A
Project management of the transition $205,558.00 $195,178.00 CO - DUE TO ADDITIONAL SERVICES FOR INTERIM ENGINEERING DESIGN AND AND PM AND LENGTH OF TIME REQUIRED BY TOWER CREW AND HVAC AND PLUMBING $180,562.50 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A 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
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $3,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,970.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A

Components

Actual Information Description File Name
General Repack Attorney

Component Description:
WXOW-BROOKS-JAN-18 INV-3949055
Amount:
$49.50

Component Description:
Brooks -WXOW- NOV17- atty - inv
Amount:
$221.57

Component Description:
WXOW-BROOKS - INV3952580- APRIL18
Amount:
$1,798.50

Component Description:
WXOW-LEGAL INV-3951197 FOR MAR18 WORK
Amount:
$792.00

Component Description:
WXOW-BROOKS-JUNE18-INV3954663
Amount:
$1,287.00

Component Description:
WXOW-BROOKS-OCT18- INV 3959630
Amount:
$363.00

Component Description:
WXOW-BROOKS-MAY18-INV3953760
Amount:
$2,788.50

Component Description:
WXOW- BROOKS JUL18-INV 3955733
Amount:
$1,072.50

Component Description:
WXOW-LEGAL INV 3950147 FEB 18 WORK
Amount:
$49.50

Component Description:
Brooks-WXOW-atty-July17 inv
Amount:
$275.00

Component Description:
Brooks-WXOW-ATTY fees- SEPT17-inv
Amount:
$80.57

Component Description:
Brooks-WXOW-atty -OCT17-inv
Amount:
$322.28

Component Description:
WXOW-Brooks-atty -May17
Amount:
$190.85

Component Description:
Brooks-WXOW-atty-June17 inv
Amount:
$266.44

Component Description:
WXOW-BROOKS AUG18 INV 3957120
Amount:
$49.50

Component Description:
Brooks-WXOW-AUG17-inv
Amount:
$117.85
PM Reimbursable expenses

Component Description:
WXOW- PM - AUG-NOV-18 TRAVEL- INV QC19-017
Amount:
$6,480.00

Component Description:
WXOW-PM TRAVELEP-1THRU3-18- INV QC18-049
Amount:
$2,378.42

Component Description:
WXOW-PM - travel reimbursements- INV QC17-145
Amount:
$1,020.00
Quarterly reporting -Atty Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization 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:
LEGAL WORK FOR WXOW SEPT 17
Amount:
$564.00

Component Description:
LEGAL WXOW JULY 2017 -399
Amount:
$1,846.00

Component Description:
LEGAL WXOW AUG 2017 - 399
Amount:
$423.00

Component Description:
LEGAL WXOW APRIL 2017 399
Amount:
$517.00

Component Description:
LEGAL WXOW 399 MAY 2017
Amount:
$453.00

Component Description:
LEGAL WXOW JUNE 2017 399
Amount:
$359.00
Prepare request for Special Temporary Authorization

Component Description:
WXOW-LOHNES-STA-INV201805-0275-08-64549
Amount:
$1,100.00
Project management of the transition

Component Description:
WXOW- PM AUG-NOV18- INV QC19-017
Amount:
$15,375.00

Component Description:
WXOW-PM-1THRU3-18 INVQC18-049
Amount:
$31,275.00

Component Description:
WXOW-PM 4THRU7 18 INV QC18-068
Amount:
$98,730.00

Component Description:
WXOW-PM-SEPT-DEC-17 - INV-QC18-020
Amount:
$18,045.00

Component Description:
WXOW-QCOMM-PM-INV QC17-145 - REPLACED PREVIOUS SUBMITAL- INV QC17-133 - PLEASE DELETE- THIS IS FOR LINE ITEM 4004
Amount:
$17,137.50

Component Description:
PM - WXOW - 50% DEPOSIT INV-see quote PM QCOMM QC17004 requiring deposit. INV QC17-133 is paid.
Amount:
$45,704.00
Prepare and or review reimbursement form Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
ENGR-WXOW- NEW CHANNEL STUDY - 399
Amount:
$3,000.00

Component Description:
WXOW-LOHNES-MAP- INV201803-0275-08-64549
Amount:
$700.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
ENGR-WXOW-CP APP- LOHNES
Amount:
$1,970.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application 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 $63,080.00 $62,515.00 N/A $6,450.00 N/A
Total for all systems $3,865,023.45 $3,808,208.45 N/A $2,235,567.80 N/A
Other Expenses $63,080.00 $62,515.00 $6,450.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 FCC required announcements. N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,950.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 Rent 40 yard dumpster with multiple pickups. Estimated 6- months on site. Potential hazardous waste management issues. $0.00 N/A
Equipment Delivery and Handling Charges $8,000.00 $8,000.00 Transport, forklift rental and handling fees from staging area to transmitter site. $3,000.00 N/A
Equipment Storage $13,000.00 $13,000.00 Expecting multiple staggered equipment deliveries from different vendors and need to store and stage new equipment prior to installation date. Anticipate from 6-24 months of storage time. $500.00 N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 Required FCC announcements and good will public relations must we upheld. The production airing and disseminating of these announcements are fundamental to our operations. N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
DTV Medical Facility Notification

Component Description:
WXOW- MED NOTICE- INV 1012
Amount:
$2,950.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges

Component Description:
WXOW-CASEYS DELIVERY OF EQ FROM STAGING TO STATION INV1011
Amount:
$3,000.00
Equipment Storage

Component Description:
WXOW-CASEYS-1ST QTR-STORAGE AND FORKLIFT - INV 1005
Amount:
$2,300.00

Component Description:
WXOW- CASEYS- FORKLIFT - INV 1010
Amount:
$500.00
Develop and air announcement of upcoming channel change Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,865,023.45 $3,808,208.45 $2,235,567.80

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. No
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. 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.

BRADY DREASLER

CORPORATE DIRECTOR OF ENGINEERING


08/12/2019

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

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

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

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

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

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

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

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

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

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

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

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

BRADY DREASLER

CORPORATE DIRECTOR OF ENGINEERING


08/12/2019

Attachments

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