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:
57840
Service:
DTV
Call Sign:
WSLS-TV
Channel:
34 (UHF)
File Number:
0000027856
FRN:
0025636598
Date Submitted:
07/19/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRAHAM MEDIA GROUP, VIRGINIA, LLC

Doing Business As: d/b/a WSLS-TV

Ricky Williams

401 Third Street SW

Roanoke, VA 24011

United States

+1 (540) 512-1542 rwilliams@wsls.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

William T Godfrey , Jr. .

Consulting Engineers

Kessler and Gehman Associates, Inc.

William T. Godfrey, Jr.

Kessler and Gehman Associates, Inc.

507-D NW 60th Street

Gainesville, FL 32607

United States

+1 (352) 332-3157 jeff@kesslerandgehman.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 Replace main and aux transmitters. Replace old analog antenna system with new antenna system designed for assigned channel. Operate existing main through assigned phase. Replace aux antenna and line. Map and analyze tower; design and modify if needed.

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 Auxiliary
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 Diamond
Year 2007
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.8 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 TMU9
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.8 kW
Justification for New Transmitter The manufacturer of the existing transmitter advises that the transmitter cannot be re-tuned to the assigned channel. See attachment.

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) Yes
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

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 Sigma
Year 2007
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 30 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 THU9EVO-24
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 37 kW
Justification for New Transmitter The manufacturer of the existing IOT transmitter advises that the transmitter cannot be re-tuned to the assigned channel. Therefore, a new Rohde & Schwarz THU9EVO-24 is being purchased.

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) Yes
Power 150 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Additional electrical service needed for the new transmitter and RF plumbing installation.
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? Yes
Size 700.0 square feet
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

Additional Interior RF System

Interior RF System Existing Transmitter to Interim Transmission line

Transmitter Remote Control

Modification of the transmitter Remote Control system is required for it to interface with the new transmitters.

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 Auxiliary
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 65.0 kW
Manufacturer
Model TLP-24H
Year 2001

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use 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? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 65.0 kW
Manufacturer
Model TBD
Year 2018
Justification for New Antenna The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel.

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? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-30DSC-R-C170
Year 2006

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? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 930.0 kW
Manufacturer
Model TFU-30DSC/VP-R C170
Year 2018
Justification for New Antenna The existing primary antenna is a single channel slot which cannot accommodate the assigned channel. The proposed antenna is e-pol which is considered an upgrade with a 15% delta in costs according to manufacturer. However, the 399 is budgeted for h-pol.

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 4 1/16 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

Mounting Support Pole

Required for top mounting main antenna (first priority station)

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 Utilize Existing
Use Auxiliary (Backup)
Description of Use 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 ERI
Type Flexible Air
Diameter Other
Other Diameter 2 1/4 inches
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 200 feet per run

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep Tests

Sweep test to verify performance on assigned channel.

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 225 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 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 270 feet per run
Justification for New Transmission Line New longer line for top mount antenna must be larger diameter to achieve assigned ERP. This must be done to recover lost coverage area since the station will receive in excess of 1% interference.

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 Owned
Is this tower consider Complex? Terrain Constrained
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? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1024381
Coordinates (NAD83) Latitude (NAD83) 37° 12' 03.3" N-
Longitude (NAD83) 080° 08' 52.8" W-
Overall Structure Height 242.78 feet
Support Structure Height 170.93 feet
Ground Elevation Above Mean Sea Level (AMSL) 3720.10 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Graham Media Group, Virginia, LLC
Date Constructed 01/01/1980


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: Serious Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Transmission Line Layout

Transmission Line Layout Prior to Mobilization

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 500
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects.
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 Yes
For Main Facility Yes
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 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 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 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 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 Yes
Number of Days 45
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Architectural and Engineering

Architectural and Engineering for New Transmission Facility. See Quote attached to Osborn inv 29014

Other Engineering Services

Fewer Project Management "PM" tasks are required & Other Engineering Services "OES" are required, therefore the PMthe PM total has been reduced to 600 hrs ($90,000 at $150/hr), & a new OES category has been created & funded with the money removed from PM.

Other Legal Services

Other Legal Services related to the DTV Repack

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 Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
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

Name Description

Heavy equipment rentals

Required for Decom

Tax

Tax

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 $2,945,259.25 $1,404,674.26 N/A $1,213,234.26 N/A
Total for all systems $6,003,607.45 $3,207,009.37 N/A $2,208,819.36 N/A
Primary Transmitter THU9EVO-24 $2,781,059.25 $1,287,809.25 $1,123,729.25
Transmitter Remote Control $19,950.00 $19,950.00 N/A $19,950.00 N/A
Additional Interior RF System $140,000.00 $140,000.00 N/A $38,435.00 N/A
Other -- Building Addition Size: 700.0 $68,559.25 $68,559.25 Need concrete pad for new heat exchangers which also require cable trays, conduit and an ice shield due to extreme weather conditions atop the mountain. $68,559.25 See attached Osborn Engineering Quote and summary page for additional details.
Other Electrical Service: Additional electrical service needed for the new transmitter and RF plumbing installation. $100,000.00 $100,000.00 N/A $57,665.00 See attached Osborn Engineering Quote and summary page for additional details.
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $701,250.00 $701,250 is the difference between $233,750 invoice 9500076219 (which was Forwarded For Payment) for the originally specified IOT transmitter and the remaining balance due for the new THU9EVO-24 transmitter. $701,250.00 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A $4,120.00 N/A
Two IOT system (50 kW) $954,000.00 $233,750.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***This is the cost for a new 2-tube, DCX Paragon-2 MSDC-IOT digital UHF transmitter from the most recent Comark price list. $233,750.00 N/A
Auxiliary Transmitter TMU9 $164,200.00 $116,865.01 $89,505.01
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $8,940.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $80,565.01 N/A $80,565.01 N/A

Components

Actual Information Description File Name
Transmitter Remote Control

Component Description:
Bohn inv #200249 Remote Control UL20190118jgv1
Amount:
$19,950.00
Additional Interior RF System

Component Description:
R&S inv #9500092053 Ext Heat Exchanger on Station Load UL20190418jgv1
Amount:
$10,050.00

Component Description:
R&S 9500102206 v190625jgv1
Amount:
$11,560.00

Component Description:
R&S inv #9500092053 CH 30 Main TX to Magic T input UL20190418jgv1
Amount:
$4,775.00

Component Description:
R&S 9500086411 v190528jgv1
Amount:
$11,300.00

Component Description:
Developed a Solution for Transmitter & Mask Filter on New Channel - Also See attached "KGA Quote"
Amount:
$750.00
Other -- Building Addition Size: 700.0

Component Description:
Osborn inv #25404R Facility Building Survey and Condition Assessment UL20190205jgv4
Amount:
$5,375.00

Component Description:
Lionberger 1333-01 v190628jgv1
Amount:
$44,801.00

Component Description:
Osborn inv #28226 Prof Srvs 1-27-18 to 2-23-18 UL20181101jgv1
Amount:
$11,191.82

Component Description:
Inv 1034840 WSLS Professional Services UL20180511jgv1
Amount:
$494.50

Component Description:
Osborn inv #29392 In house printing UL20181101jgv1
Amount:
$246.00

Component Description:
Osborn inv #25404R Facility Elec Survey and Condition Assessment UL20190411jgv6
Amount:
$11,825.93
Other Electrical Service: Additional electrical service needed for the new transmitter and RF plumbing installation.

Component Description:
Developed a Solution for Electrical and HVAC on New Channel - Also See attached "KGA Quote"
Amount:
$500.00

Component Description:
R&S 9500084015 v190528jgv1
Amount:
$57,165.00

Component Description:
Osborn inv #25404 Facility Elec Survey and Condition Assessment UL20181203jgOsborn inv #25404R Facility Elec Survey and Condition Assessment UL20190205jgv4
Amount:
$6,450.93

Component Description:
WSLS Osborn inv #29669 Prof Srvs through 7-29-18 UL20180726jgv1
Amount:
$60,252.10
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
R&S inv #9500092024 THU9EVO-24 transmitter 50 pct pmt 2 UL20190111jgv1 ... applied to correct THU9EVO-24 component on 190124
Amount:
$467,500.00

Component Description:
R&S inv #9500092026 THU9EVO-24 transmitter 25 pct final pmt UL20190111jgv1 ... applied to correct THU9EVO-24 component on 190124
Amount:
$233,750.00
Transformer 3 phase/480v - 150 KVA

Component Description:
R&S 9500085911 v190528jgv1
Amount:
$4,120.00
Two IOT system (50 kW)

Component Description:
R&S inv #9500092026 THU9EVO-24 transmitter 25 pct final pmt UL20190111jgv1
Amount:
$233,750.00

Component Description:
Inv: WSLS THU9EVO-24 transmitter 25% down pmt UL20180312
Amount:
$233,750.00

Component Description:
R&S inv #9500092024 THU9EVO-24 transmitter 50 pct pmt 2 UL20190111jgv1
Amount:
$467,500.00
Switchgear - industrial 800 amp

Component Description:
R&S inv #9500092053 WSLS Aux TX UL20190418jgv1
Amount:
$8,940.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
R&S inv #9500092027 TMU9-3 Aux TX 50 pct DP upon delivery UL20190117jgv1
Amount:
$40,282.51

Component Description:
R&S inv #9500092025 TMU9-3 Aux TX 25 pct final pmt UL20190117jgv1
Amount:
$20,141.25

Component Description:
Inv: WSLS TMU9-3 aux transmitter 25% down pmt UL20180313
Amount:
$20,141.25

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 $705,906.00 $587,637.70 N/A $404,208.30 N/A
Total for all systems $6,003,607.45 $3,207,009.37 N/A $2,208,819.36 N/A
Primary Antenna TFU-30DSC/VP-R C170 $491,966.00 $440,421.70 $361,239.30
Mounting Support Pole $163,016.00 $163,016.00 Required for top mount support (refer to attached quote). The site's access road cannot accommodate the 70' top mount pole, which required cutting it in half; see attached Change Order included with Dielectric inv MAN00606 $99,914.40 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $21,750.00 N/A $9,787.50 N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $12,383.00 Elbow complex is actually 6-1/8". See attached Dielectric quote. $11,144.70 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $236,872.70 Recognizing that e-pol is an upgrade, the station is budgeting for "h-pol only" which Dielectric said is a 15% delta. Therefore, the estimated cost for an h-pol antenna is only $240,000 instead of the estimated cost of $275,000 for an e-pol antenna (15%). $236,872.70 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $3,520.00 N/A
Auxiliary Antenna TBD $213,940.00 $147,216.00 $42,969.00
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 $2,700.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $5,107.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $85,000.00 N/A $6,346.00 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $28,816.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $28,816.00 N/A

Components

Actual Information Description File Name
Mounting Support Pole

Component Description:
Inv MAN00430 WSLS Support pole 45 perc pmt 2 UL20180713jgv1
Amount:
$46,800.00

Component Description:
WSLS Die inv #MAN00606 Mt pole mod 45 pct pmt 1 UL20181105jgv2
Amount:
$26,557.20

Component Description:
WSLS Die inv #MAN00607 Mt pole mod 45 pct pmt 2 UL20181105jgv2
Amount:
$26,557.20
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Inv MAN00430 WSLS Side mt brckts 45 perc pmt 2 UL20180713jgv1
Amount:
$9,787.50
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
Inv MAN00325 WSLS Elbow Complex UL20180423jg
Amount:
$5,572.35

Component Description:
Inv MAN00430 WSLS Elbox comp 45 perc pmt 2 UL20180713jgv1
Amount:
$5,572.35
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Inv MAN00430 WSLS Main ant 45 perc pmt 2 UL20180713jgv1
Amount:
$80,562.60

Component Description:
R&S inv #9500092053 Main ant to RF Switch connection comps UL20190418jgv1
Amount:
$16,280.00

Component Description:
Inv MAN00325 WSLS TFU-30DSC VP-R C170 etc Main Antenna UL20180423jg
Amount:
$140,030.10
Sweep test of existing antenna

Component Description:
Die 354022 v190719pmv1
Amount:
$640.00

Component Description:
Inv MAN00430 WSLS Sweep tests 45 perc pmt 2 UL20180713jgv1
Amount:
$2,880.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
Die inv #274004 TLP-24 aux ant scatter analysis pmt 2 UL20190125jgv1
Amount:
$2,700.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Die inv #274004 TLP-24 aux ant brackets pmt 2 UL20190125jgv1
Amount:
$5,107.00
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
Die inv #274004 TLP-24 aux ant pmt 2 UL20190125jgv1
Amount:
$5,558.00

Component Description:
Die inv #274004 TLP-24 aux ant test transition pmt 2 UL20190125jgv1
Amount:
$788.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
Inv: WSLS TLP-24H(C)VP aux antenna 50 percent down pmt UL20180316
Amount:
$28,816.00

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 $60,940.00 $58,240.00 N/A $49,459.50 N/A
Total for all systems $6,003,607.45 $3,207,009.37 N/A $2,208,819.36 N/A
Primary Transmission Line $54,540.00 $51,840.00 $49,459.50
Rigid Transmission Line - copper, 6 1/8" $54,540.00 $51,840.00 N/A $49,459.50 N/A
Auxiliary Transmission Line $6,400.00 $6,400.00 $0.00
Sweep Tests $6,400.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Inv MAN00325 WSLS Transmission Line UL20180423jg
Amount:
$20,643.53

Component Description:
Die inv #202001 Nitrogen generator UL20181102jgv1
Amount:
$8,172.44

Component Description:
Inv MAN00430 WSLS Trans line 45 perc pmt 2 UL20180713jgv1
Amount:
$20,643.53
Sweep Tests 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 $1,492,100.00 $392,916.81 N/A $233,905.56 N/A
Total for all systems $6,003,607.45 $3,207,009.37 N/A $2,208,819.36 N/A
Primary Tower TOWER $1,492,100.00 $392,916.81 $233,905.56
Serious tower reinforcement/modifications $1,052,000.00 $154,969.81 N/A $100,247.06 N/A
Transmission Line Layout $6,500.00 $6,500.00 N/A N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $203,477.00 N/A $105,688.50 N/A
Structural engineering tower load study for well documented tower $12,600.00 $27,970.00 The tower studies and modifications have turned out to be more complicated than originally anticipated (20180815jgv1) $27,970.00 The initial tower study was performed, and a potential issue with the top plate on the tower was discovered which required additional analysis.

Components

Actual Information Description File Name
Serious tower reinforcement/modifications

Component Description:
WSLS ERI inv #WSLS-002 Tower work 50 perc dp UL20180731jgv2
Amount:
$22,664.56

Component Description:
ERI inv #WSLS-001 Tower work 50 perc pmt 1 UL20181101jgv1
Amount:
$20,642.50

Component Description:
Site Res 249553 v190711jgv1
Amount:
$2,580.00

Component Description:
ERI inv #WSLS-TV-003 Tower mods 50 pct pay 1 UL20181102jgv1
Amount:
$54,360.00
Transmission Line Layout Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
ERI inv #WSLS-001-1 Ant and line install 50 pct pmt 1 UL20181127jgv2
Amount:
$105,688.50
Structural engineering tower load study for well documented tower

Component Description:
WSLS Malouf inv #1805084V4 Structural Analysis UL20180816jg v1
Amount:
$7,000.00

Component Description:
Inv: WSLS Tower Data Collection UL20180402
Amount:
$2,720.00

Component Description:
Inv 1805084V1 WSLS Mod Design and Structural Analysis UL20180424jg v1
Amount:
$7,500.00

Component Description:
WSLS Malouf inv #1805084V3 Structural Analysis UL20180815jg v1
Amount:
$3,500.00

Component Description:
Coordinate Tower Modifications - Also See Attached "KGA Quote"
Amount:
$1,250.00

Component Description:
Develop an Upgrade or Replacement solution for Tower - Also See Attached "KGA Quote"
Amount:
$750.00

Component Description:
Inv: WSLS Structural Analysis UL20180305
Amount:
$4,500.00

Component Description:
Coordinate Tower mapping & analyses - Also See Attached "KGA Quote"
Amount:
$750.00

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 $518,595.00 $483,338.40 N/A $210,709.54 N/A
Total for all systems $6,003,607.45 $3,207,009.37 N/A $2,208,819.36 N/A
Outside Professional Services $518,595.00 $483,338.40 $210,709.54
Other Engineering Services $147,500.00 $147,500.00 Fewer Project Management "PM" tasks are required & Other Engineering Services "OES" are required, therefore the PM total has been reduced to 200 hrs ($30,000 at $150/hr), & the OES category has been funded with the money removed from PM. $116,085.00 N/A
Architectural and Engineering $68,350.00 $68,350.00 Architectural and Engineering for New Transmission Facility. See Quote attached to Osborn inv 29014 $8,967.04 N/A
Additional Field Engineering Service, 45 Days $90,000.00 $90,000.00 N/A $23,600.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $0.00 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 $550.00 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 $7,000.00 N/A 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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 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 N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $6,000.00 $3,000 for the 1% expansion initial 90-day CP application and $3,000 for expansion facilities in the 1st priority filing window pursuant to DA 17-106 where costs reasonably incurred in the 1st priority window for expanded facilities will be reimbursed. $6,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $14,000.00 $7,000 for the 1% expansion initial 90-day CP application and $7,000 for expansion facilities in the 1st priority filing window pursuant to DA 17-106 where costs reasonably incurred in the 1st priority window for expanded facilities will be reimbursed. $14,000.00 N/A
Other Legal Services $1,000.00 $1,000.00 Other Legal Services related to the DTV Repack $419.85 N/A
Project management of the transition $79,000.00 $30,000.00 The majority of the PM hours and $ has been moved to OES and the "Prepare and or review reimbursement form" components. $27,349.25 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 $13,738.40 The station continues to need assistance preparing and submitting its Actual Cost invoices, and the Estimated Cost reflects that. $13,738.40 Legal assistance beyond that originally anticipated has been required.

Components

Actual Information Description File Name
Other Engineering Services

Component Description:
KGA inv #947-135 Actual Cost invoices Oct 18 UL20190212jgv1
Amount:
$100.00

Component Description:
Inv 947-88 WSLS OES Jan18 - Jun18 UL20180720jgv1
Amount:
$44,325.00

Component Description:
KGA inv #947-117 2018 Q4 387 UL20190212jgv1
Amount:
$300.00

Component Description:
KGA 947-185 v190704jgv1
Amount:
$3,135.00

Component Description:
KGA 947-186 v190704jgv1
Amount:
$2,152.50

Component Description:
KGA inv #947-104 Actual Cost invs 180607 - 180905 UL20180720jgv1
Amount:
$2,227.50

Component Description:
KGA 947-186 v190614pmv1
Amount:
$2,152.50

Component Description:
KGA inv #947-151 OES by WTG Jan 2019 UL20190308jgv1
Amount:
$2,725.00

Component Description:
KGA 947-187 v190614pmv1
Amount:
$4,155.00

Component Description:
KGA inv #947-136 Actual Cost invoices Nov 18 UL20190212jgv1
Amount:
$2,775.00

Component Description:
KGA 947-187 v190704jgv1
Amount:
$4,155.00

Component Description:
KGA inv #947-150 OES by WTG Dec 2018 UL20190308jgv1
Amount:
$5,225.00

Component Description:
KGA 947-188 v190704jgv1
Amount:
$6,427.50

Component Description:
KGA inv #947-113 OES Jul18 - Oct18 UL20180720jgv1
Amount:
$27,400.00

Component Description:
KGA inv #947-148 OES by WTG 181022-181031 UL20190308jgv1
Amount:
$1,600.00

Component Description:
KGA inv #947-116 Site Visit Dec 2018 UL20190212jgv1
Amount:
$5,400.00

Component Description:
KGA inv #947-149 OES by WTG Nov 2018 UL20190308jgv1
Amount:
$5,350.00

Component Description:
KGA 947-188 v190614pmv1
Amount:
$6,427.50

Component Description:
Inv 947-75 WSLS Actual Cost UL20180705jgv1
Amount:
$1,687.50

Component Description:
KGA inv #947-134 Actual Cost invoices Sept 18 UL20190212jgv1
Amount:
$125.00

Component Description:
KGA 947-185 v190614pmv1
Amount:
$3,135.00

Component Description:
KGA inv #947-137 Actual Cost invoices Dec 18 UL20190212jgv1
Amount:
$975.00
Architectural and Engineering

Component Description:
Osborn inv #29014 Prof Srvs thru 4-27-18 UL20181105jgv1
Amount:
$8,967.04
Additional Field Engineering Service, 45 Days

Component Description:
KGA inv #947-38 GatesAir manufacturer visit UL20181211jgv2
Amount:
$1,800.00

Component Description:
KGA inv #167-60 Site visit UL20190308jgv1
Amount:
$5,400.00

Component Description:
KGA inv #947-69 Field Eng Services UL20190212jgv1
Amount:
$3,800.00

Component Description:
KGA inv #947-49 Site visit UL20181204jgv2
Amount:
$5,400.00

Component Description:
Inv: WSLS R&S manufacturer visit UL20180316
Amount:
$1,800.00

Component Description:
Additional Field Engineering Services (On Site Equipment inventory & facilities survey) - Also see Attached "KGA Quote"
Amount:
$5,400.00
Comprehensive coverage verification via field study, if needed

Component Description:
Partial Completion of Comprehensive coverage verification via field study - see "KGA Quote" for fixed price fee.
Amount:
$38,200.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase

Component Description:
Inv 947-71 WSLS FAA 7460 UL20180531jgv1
Amount:
$550.00
ASR modification (prepare FCC Form 854) 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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering Portion of 1% Expansion CP application for Initial 90-Day Filing Window - Also see "KGA Quote".
Amount:
$3,000.00

Component Description:
Expanded Facilities - Prepare engineering section of Form 301 FCC First Priority Filing Window CP Application to compensate for IX in excess of 1%. Reimbursable pursuant to DA 17-106.
Amount:
$3,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Expanded Facilities - Performed engineering studies for increased coverage and antenna development in 1st Priority Filing Window to compensate for IX in excess of 1%. Reimbursable pursuant to DA 17-106.
Amount:
$7,000.00

Component Description:
1% Expansion Engineering Studies and Coordination for Initial 90-CP application - Also see "KGA Quote".
Amount:
$7,000.00
Other Legal Services

Component Description:
C&B 60847118 v190610pmv1
Amount:
$71.10

Component Description:
C&B inv #60836450 Various legal UL20190405jgv1
Amount:
$106.65

Component Description:
WSLS Covington inv #60812707 Review and file 2018 Q2 Progress Report UL20181019jgv1
Amount:
$68.40

Component Description:
C&B 60842539 v190704jgv1
Amount:
$71.10

Component Description:
Covington inv #60836450 Legal services thru 190131 UL20190308jgv1
Amount:
$106.65

Component Description:
Covington inv #60827770 Legal services thru 181130 UL20190308jgv1
Amount:
$102.60
Project management of the transition

Component Description:
Project Management - Also see attached "KGA Quote" Hours: 23-1/3 Rate: $150/hr Time Period: 8/1/17 - 8/31/17
Amount:
$3,500.00

Component Description:
Inv 947-57 WSLS 2018Q1 387 UL20180622jgv1
Amount:
$300.00

Component Description:
Inv 947-81 WSLS 2018Q2 387 UL20180713jgv1
Amount:
$300.00

Component Description:
KGA inv #947-81 Form 387 2018 Q2 UL20180720jgv1
Amount:
$300.00

Component Description:
Inv 947-65 WSLS Proj Mgt 2017 Aug - Dec UL20180625jgv2
Amount:
$20,190.00

Component Description:
Inv: WSLS 2017Q4 387 UL20180302
Amount:
$300.00

Component Description:
Inv: WSLS 2017Q3 387 UL20180302
Amount:
$300.00

Component Description:
KGA inv #947-109 Form 387 2018 Q3 UL20180720jgv1
Amount:
$300.00

Component Description:
KGA 947-163 v190704jgv1
Amount:
$300.00

Component Description:
KGA 947-193 v190718jgv1
Amount:
$300.00

Component Description:
Inv 60768465 WSLS Various legal UL20180514 jgv1
Amount:
$1,559.25
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Inv: WSLS Reimburse review etc UL20180305
Amount:
$513.00

Component Description:
KGA inv #947-138 Actual Cost prep & submit by JG Jan 2019 UL20190308jgv1
Amount:
$3,325.00

Component Description:
Covington inv #60781604 Various legal UL20181127jgv2
Amount:
$1,070.00

Component Description:
KGA 947-176 v190704jgv1
Amount:
$1,475.00

Component Description:
KGA 947-172 v190704jgv1
Amount:
$1,620.00

Component Description:
Covington inv #60775905 Various legal UL20181120jgv3
Amount:
$1,197.90

Component Description:
KGA 947-167 v190704jgv1
Amount:
$1,412.50

Component Description:
KGA inv #947-158 Actual Cost prep & submit by JG Feb 2019 UL20190308jgv1
Amount:
$625.00

Component Description:
Prepared FCC 399 reimbursement form (Initial Filing) - Also see attached "KGA Quote"
Amount:
$2,500.00

Component Description:
Inv: WSLS Various legal UL20180329 rev'd 20180329jg
Amount:
$1,197.90

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 $280,807.20 $280,202.20 N/A $97,302.20 N/A
Total for all systems $6,003,607.45 $3,207,009.37 N/A $2,208,819.36 N/A
Other Expenses $280,807.20 $280,202.20 $97,302.20
Tax $2,777.20 $2,777.20 Tax $2,777.20 N/A
Equipment Storage $10,000.00 $10,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $50,000.00 $50,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $87,400.00 $87,400.00 See attached Rohde Schwarz USA Quote & Invoice 9500092053 plus Rohde and Schwarz Quote No. 188820.0 ($52,000 + 6,810 + $7,270 + $21,320) $87,400.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 An STA will be required for interim operation while the main facility is being built-out. N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 A license application may be required after structural analysis results are received which would require a CP mod application and then the license application. N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 A minor change of CP application may be required after structural analysis results are received. N/A N/A
Heavy equipment rentals $5,440.00 $5,440.00 N/A $5,440.00 N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A $1,685.00 N/A
Develop and air announcement of upcoming channel change $100,000.00 $100,000.00 It is expected that the station will spend at least $100,000 developing and airing the required announcements. N/A N/A
Non-zoning permits $10,000.00 $10,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tax

Component Description:
R&S 9500102206 v190625jgv1
Amount:
$2,777.20
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
R&S 9500102206 v190625jgv1
Amount:
$7,270.00

Component Description:
R&S 9500102206 v190625jgv1
Amount:
$21,320.00

Component Description:
R&S inv #9500092053 Decommissioning Sigma UL20190418jgv1
Amount:
$52,000.00

Component Description:
R&S 9500102206 v190625jgv1
Amount:
$6,810.00
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Heavy equipment rentals

Component Description:
R&S 9500102206 v190625jgv1
Amount:
$5,440.00
MVPD Notification of Channel Change

Component Description:
KGA 947-168 v190704jgv1
Amount:
$1,685.00
Develop and air announcement of upcoming channel change Information not provided.
Non-zoning permits Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $6,003,607.45 $3,207,009.37 $2,208,819.36

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
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.

Jeffrey C Gehman

Engineering Associate


07/19/2019

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.

Jeffrey C Gehman

Engineering Associate


07/19/2019

Attachments

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