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:
51517
Service:
DTV
Call Sign:
KTXA
Channel:
18 (UHF)
File Number:
0000027020
FRN:
0002057271
Date Submitted:
11/06/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TELEVISION STATION KTXA INC.

Doing Business As: TELEVISION STATION KTXA INC.

Daniel G. Ryson

1725 DeSales St. NW

Suite 501

Washington, DC 20036

United States

+1 (202) 457-4505 dryson@cbs.com Corporation

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

Daniel G. Ryson

Associate Director of Spectrum Management

CBS

Daniel G. Ryson

1725 DeSales Street NW

Suite 501

Washington, DC 20036

United States

+1 (202) 457-4074 dryson@cbs.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Facility has broadband antenna and combiner for KTVT (CH19) & KTXA (CH29). Tx line must be replaced to accomodate repack (CH18) & (CH19), so Interim site will be built for KTVT (CH19) and KTXA (CH29). Once done, KTVT will return to Main (CH19), KTXA wil

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 DCX
Year 1997
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 90 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-150
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 92.8 kW
Justification for New Transmitter Comark cannot retune existing transmitter (ATTACHMENT 1). A replacement IOT transmitter is more expensive (Attachment 11) than the proposed solid state replacement (ATTACHMENT 2), which qualifies as a one-step upgrade (See Statement and Attachment 14).

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 300.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Old transmitter removal

Remove old transmitter from main site. See ATTACHMENT 8

Transmitter Electrical

Transmitter Electrical

RF components for install

RF components and labor for main tx install. See ATTACHMENT 6

Sales tax

State Sales Tax

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-40
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25.3 kW
Justification for New Transmitter Change of KTXA to CH18 will require the replacement of MAIN facility transmission line. An interim facility for both KTXA and KTVT will be required in order to stay on air during this change out. see ATTACHMENT 4

Interim 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 500 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 600.0 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? Yes
Size 3300.0 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
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

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Other Transmitter Cost Not Listed

Name Description

Retune interim TX

Retune interim transmitter to new operating channel at Phase 3. See ATTACHMENT 7

HVAC Ice Shield

Ice Protection over new HVAC units, heat exchangers and repack broadcasters equipment to be installed. See Exhibit 6.

Sales Tax

Sales Tax

Studio Transmitter Link

Fiber optic Studio Transmitter Link decoder. Required to receive broadcast programming from KTXA studio. Includes hardware only. See Attachment 19 line items 1-8.

Install Interim RF System

Install Interim RF System. Please See Attachment 5

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Retune Existing
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 2
Number of Panels 56
Design power capacity in use 100.0 %
Lower Limit 500.00 MHz
Upper Limit 566.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer Dielectric
Model TUM30-04-14/56H-2-R-T
Year 2012

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
23422 KTVT

Primary Antenna

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Adjustment to Existing Antenna

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

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
19
18

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 Lease New
Ownership Leased
Owner American Tower
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 Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 8
Number of Panels/Bays 52
Lower Limit 494.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 90.0 %
Other Antenna Type N/A
ERP: 208.0 kW
Manufacturer
Model TUM-AP-C4-14/48H-2-B
Year 2018
Justification for New Antenna Change of KTXA to CH18 will require the replacement of MAIN facility transmission line. An interim facility for both KTXA and KTVT will be required in order to stay on air during this changeout.

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 4
Frequencies of channels supported Upper and lower frequency
Frequency 494.0 MHz - 608.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 7 3/16 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

RF system test

Test of RF system. ATC

Combiner Installation

Installation of combiner

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? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 2
Length 1800 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
23422 KTVT

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 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 2
Length 1800 feet per run
Justification for New Transmission Line Existing segments incorrect match for new channel due to "Flange Build-Up". See ATTACHMENT 10

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Remove and replace tx line

Remove existing line. install new line. See Attachment 9

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 Lease New
Type Rigid
Diameter 7 3/16 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 2
Length 1650 feet per run
Justification for New Transmission Line Required for new shared interim antenna

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Nitrogen Generator

Nitrogen Generator Upgrade

TX line bridge

Line support and ice bridge

TX Line to ATC Combiner

6 1/8-inch line to connect to ATC Combiner broadband port input.

Test Load

50 kW Interim site test load

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

Auxiliary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use Interim Site
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1055009
Coordinates (NAD83) Latitude (NAD83) 32° 35' 22.0" N-
Longitude (NAD83) 096° 58' 12.9" W-
Overall Structure Height 1550.83 feet
Support Structure Height 1453.07 feet
Ground Elevation Above Mean Sea Level (AMSL) 829.71 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Tower, LLC
Date Constructed 11/04/2008

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
23422 KTVT DTV

Auxiliary 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 tower with candelabra
Tower Reinforcements Please select whether tower reinforcements are needed: Serious Reinforcements needed

Auxiliary Tower

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Tower Rigging Costs

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

Auxiliary Tower

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Other Tower Expenses Not Listed

Name Description

Construction Proj Mgmt

Manage tower modification reinforcement and facilities upgrade.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1059733
Coordinates (NAD83) Latitude (NAD83) 32° 32' 36.0" N-
Longitude (NAD83) 096° 57' 33.0" W-
Overall Structure Height 1635.15 feet
Support Structure Height 1523.60 feet
Ground Elevation Above Mean Sea Level (AMSL) 813.97 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 06/18/2000

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
68834 KPXD-TV DTV
60534 KSTR-DT DTV
49326 KDTN DTV
22201 KDAF DTV
17037 KDFI DTV
67910 KDTX-TV DTV
42359 KTXD-TV DTV
23422 KTVT DTV
49324 KERA-TV DTV

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Project Management

KTXA pro rata share of American Tower Corporation tower management. See Attachment 12A.

Tower Structural Analysis

KTXA pro rata share of American Tower Corporation tower structural analysis. See Attachment 12A.

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 250
Explanation Company lacks internal resources.
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 No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare and file Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review Yes
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 No
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
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

Address Transition Timing

Address Transition Timing with other tower tenants. See Attachment 13 Item 1-A-1.

Installation of STL

Install fiber optic decoder required to receive KTXA studio programming at interim transmitter site. See Attachment 19 Line Item 10.

Project oversight on behalf of KTXA

Engineering oversight on behalf of KTXT

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 Yes
Non-zoning permits Yes
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)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? No
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Migratory Bird Assessment

Migratory Bird Assessment/Permit. See Attachment 13 Item 1-B-1.

Site Coordination Meeting

Site coordination meetings with all broadcasters, contractors and vendors involved with the site deliveries and construction. See Attachment 13 Item 1-B-1.

Site security at interim site

security to protect against theft and vandalism during const.

Tower rental at interim site

American tower charge for interim site during transition

Tree Clearing

This cost is for the removal of trees and vegetation to ensure the proper clearance of taglines and laydown areas, required for construction. See Attachment 13 Item 1-B-1.

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 $4,382,769.04 $3,700,941.56 N/A $3,240,556.45 N/A
Total for all systems $9,724,458.04 $5,942,708.56 N/A $4,595,821.38 N/A
Interim Transmitter ULXTE-40 $1,394,680.16 $1,176,715.46 $879,926.83
Install Interim RF System $16,217.00 $16,217.00 Install RF System for the interim site RF system installation. Please see Attachment 5. Note: Final cost was decreased $9,000 from the originally quoted 25,217. The credit is shown in Attachment 41. $3,608.50 N/A
Studio Transmitter Link $16,093.00 $16,093.00 Cost is for the fiber optic decoder required to receive KTXA programming at the interim transmitter site. An existing encoder will be utilized at the studio site. Please see Attachment 19. Remote commissioning cost is listed separately. N/A N/A
Sales Tax $65,384.16 $65,384.16 Please See March Invoices Statement, Invoice 2A, and 8.25% of total shown in Attachment 4A - Interim Transmitter Change Order. $60,713.33 N/A
HVAC Ice Shield $40,000.00 $40,000.00 Part of American Tower costs $30,000.00 N/A
Other -- Building Addition Size: 3300.0 $62,700.00 $62,700.00 Required for repack equipment. Includes ceiling joist reinforcement, material and installation of mezzanine level to support filters, switches, etc. See Exhibit 6. N/A N/A
25 Ton system $91,500.00 $34,800.00 Two 25 ton HVAC units to maintain operational temperatures for the new repack transmitters. There are no existing HVAC units in this space. See Exhibit 6. $26,100.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $31,200.00 $29,400.00 N/A N/A N/A
Retune interim TX $23,586.00 $23,586.00 See Attachment 7 $23,586.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $792,535.30 See Attachment 4 (Transmitter + Freight), Attachment 4A, and March 2018 Invoices Statement. Includes transmitter and freight but excludes state sales tax, which is shown separately. $735,919.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Transformer 3 phase/480v - 500 KVA $48,400.00 $46,000.00 N/A N/A N/A
Primary Transmitter ULXTE-150 $2,988,088.88 $2,524,226.10 $2,360,629.62
Sales tax $188,211.50 $188,211.50 Please see Invoice 1A. $170,117.00 N/A
RF components for install $31,937.00 $31,937.00 Misc. RF components for transmitter installation. See Attachment 6. $15,968.50 N/A
Transmitter Electrical $102,699.38 $102,699.38 Please see quote provided as Attachment 43 $102,699.38 N/A
Old transmitter removal $19,641.00 $19,641.00 See Exhibit 8 $9,820.50 N/A
3" Rigid Conduit and Wiring (Cost per foot) $15,600.00 $14,700.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW $2,630,000.00 $2,167,037.22 IOT transmitter cannot be re-tuned (Attachment 1). New solid state transmitter cost is less than IOT replacement. See Statement, March 2018 Invoices Statement. Cost is calculated from Attachment 2C as modified by Change Order Attachment 2B. $2,062,024.24 N/A

Components

Actual Information Description File Name
Install Interim RF System

Component Description:
RF System Installation at Interim Site. See quote Attachment 5. Cost discounted because some parts and work weren't needed.
Amount:
$3,608.50
Studio Transmitter Link Information not provided.
Sales Tax

Component Description:
Based on $60,713.33 (Attachment 18) Minus Transmitter Sales Tax Accounted for in Initial Down Payment and Second Payment.
Amount:
$14,101.43

Component Description:
Second Progress Payment Interim Transmitter Sales Tax.
Amount:
$23,305.95

Component Description:
State Sales Tax Down Payment Please See March Invoices Statement, Invoice 2A, and 8.25% of total shown in Attachment 4A - Interim Transmitter Change Order.
Amount:
$23,305.95
HVAC Ice Shield

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-C-6.
Amount:
$10,000.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-C-6.
Amount:
$20,000.00
Other -- Building Addition Size: 3300.0 Information not provided.
25 Ton system

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-C-2.
Amount:
$8,700.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-C-2.
Amount:
$17,400.00
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Retune interim TX

Component Description:
Retune Interim Transmitter to Channel 18 for post-transition operation at interim site. This is the final payment. See Attachment 7 for quote.
Amount:
$11,793.00

Component Description:
See quote provided as Attachment 7. This is a 50% down payment.
Amount:
$11,793.00
Service entrance 3 phase/800 amp/208 volt Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Second Interim Transmitter Progress Payment. Excludes 8.25% Sales Tax, Shown Separately.
Amount:
$258,734.70

Component Description:
Balance Due on Equipment Shipped. Excludes Sales Tax Shown Separately. Also Excludes Installation & Proof, which will be invoiced upon completion.
Amount:
$218,449.60

Component Description:
Transmitter Down Payment. Please see March 2018 Invoices Statement.
Amount:
$258,734.70
Switchgear - industrial 800 amp Information not provided.
Transformer 3 phase/480v - 500 KVA Information not provided.
Sales tax

Component Description:
Down Payment State Sales Tax. Please See March 2018 Invoices Statement.
Amount:
$66,539.41

Component Description:
Attachment 38 shows total tax amount of 170,117.00. A portion of Invoice 1A was already attributed to tax. This makes up the difference.
Amount:
$103,577.59
RF components for install

Component Description:
Install and provide components to connect to the combiner. This is a down payment. See quote provided as Attachment 6.
Amount:
$15,968.50
Transmitter Electrical

Component Description:
Please see Attachment 43 for quotation.
Amount:
$102,699.38
Old transmitter removal

Component Description:
50% Down Payment for Primary Transmitter Removal and Disposal. See quote in Attachment 8.
Amount:
$9,820.50
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW

Component Description:
Primary Transmitter Approximately 1/3 Progress Payment. See quote Attachment 2C and Change Order Attachment 2B.
Amount:
$715,122.26

Component Description:
Primary Transmitter Third Progress Payment. Excludes Sales Tax, listed separately.
Amount:
$586,451.45

Component Description:
Down Payment. Please see March 2018 Invoices Statement.
Amount:
$760,450.53

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 $322,560.00 $305,216.00 N/A $139,247.50 N/A
Total for all systems $9,724,458.04 $5,942,708.56 N/A $4,595,821.38 N/A
Interim Antenna TUM-AP-C4-14/48H-2-B $231,630.00 $218,816.00 $99,247.50
Combiner Installation $9,250.00 $9,250.00 See Attachment 13A. (Note: ATC design changes altered estimated cost.) $0.00 N/A
RF system test $10,000.00 $10,000.00 See Attachment 13A. (Note: ATC design changes altered estimated cost.) $7,500.00 N/A
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed) $16,850.00 $8,500.00 See Attachment 13A. (Note: ATC design changes altered estimated cost.) $6,375.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $78,616.00 See Attachment 36, first item. Note: ATC will no longer be providing this component, shown in Attachment 13A, line item 3-C-1. See Attachment 40. $0.00 N/A
Sweep test of existing antenna $6,730.00 $7,850.00 Sweep of line for pre-transition channel by ATC ($3750) and again for post-transition by Peter Eckmann (see Attachment 39). $6,922.50 N/A
UHF - High Power Top Mount Eight Station broadband panel antenna elliptically or circularly polarized $104,600.00 $104,600.00 American Tower to install to accommodate interim operation. See Attachment 13A. (Note: ATC design changes altered estimated cost.) $78,450.00 N/A
Primary Antenna TUM30-04-14/56H-2-R-T $90,930.00 $86,400.00 $40,000.00
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 Combiner and mask filter for KTXA. See Attachment 3. Includes KTXA combiner system, installation, and shipping. Excludes the KXTA mask filter, which is already shown in the GatesAir quote. Also excludes combiner components attributable to KTVT. $40,000.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
Combiner Installation

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. This work was not completed by ATC so we're claiming $0. See Attachment 35C Item 3-C-2.
Amount:
N/A

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. This work was not completed by ATC so we're claiming $0. See Attachment 34C Item 3-C-2.
Amount:
N/A
RF system test

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$2,500.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$5,000.00
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed)

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-C-2.
Amount:
$2,125.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-C-2.
Amount:
$4,250.00
New combiner, cost per channel (without antenna) Information not provided.
Sweep test of existing antenna

Component Description:
Sweep interim line to determine suitability of interim facility at post-transition channel 18.
Amount:
$4,110.00

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-C-2.
Amount:
$937.50

Component Description:
Invoice is 50% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 35C Item 3-C-2.
Amount:
$1,875.00
UHF - High Power Top Mount Eight Station broadband panel antenna elliptically or circularly polarized

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-B.
Amount:
$26,150.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-B.
Amount:
$52,300.00
New combiner, cost per channel (without antenna)

Component Description:
This invoice includes costs that aren't being purchased from this vendor or are attributable to another station. Therefore, CBS is not seeking 100% reimbursement. See Attachment 3 for quotation.
Amount:
$40,000.00
Sweep test of existing antenna Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $2,700,341.00 $1,238,847.00 N/A $798,357.90 N/A
Total for all systems $9,724,458.04 $5,942,708.56 N/A $4,595,821.38 N/A
Interim Transmission Line $1,181,141.00 $148,241.00 $59,812.50
Test Load $31,030.00 $31,030.00 50 kW test load plus 6 1/8-inch interconnect. Includes installation, shipping, and installation materials. See Attachment 36. N/A N/A
TX Line to ATC Combiner $37,461.00 $37,461.00 6 1/8-inch transmission line to connect transmitter output to ATC broadband combiner input port. See Attachment 36, item 3. Includes shipping, installation, and materials. N/A N/A
Nitrogen Generator $3,750.00 $3,750.00 KXTA's pro rata share for Nitrogen Generator Upgrade. See Attachment 13A. (Note: ATC design changes added this new cost.) $2,812.50 N/A
TX line bridge $10,000.00 $10,000.00 ATC. See Attachment 13 $7,500.00 N/A
Rigid Transmission Line - copper, 7 3/16" broadband $1,098,900.00 $66,000.00 See Attachment 13A for KTXA's pro rata share. (Note: ATC design changes altered estimated cost.) $49,500.00 N/A
Primary Transmission Line $1,519,200.00 $1,090,606.00 $738,545.40
Remove and replace tx line $270,000.00 $270,000.00 Rigging and main transmission line replacement. See Attachment 9 N/A N/A
Rigid Transmission Line - copper, 8 3/16" $1,249,200.00 $820,606.00 Transmission line, elbow complex, and RF sweep. See Attachment 10 $738,545.40 N/A

Components

Actual Information Description File Name
Test Load Information not provided.
TX Line to ATC Combiner Information not provided.
Nitrogen Generator

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$937.50

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$1,875.00
TX line bridge

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-B.
Amount:
$2,500.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-B.
Amount:
$5,000.00
Rigid Transmission Line - copper, 7 3/16" broadband

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-A.
Amount:
$16,500.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-A.
Amount:
$33,000.00
Remove and replace tx line Information not provided.
Rigid Transmission Line - copper, 8 3/16"

Component Description:
45% down payment for dual transmission line, elbow complexes, and sweep test. Please see quote provided as Attachment 10.
Amount:
$369,272.70

Component Description:
45% progress payment for dual transmission line, elbow complexes, and sweep test. Please see quote provided as Attachment 10.
Amount:
$369,272.70

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 $2,114,783.00 $523,039.00 N/A $320,889.53 N/A
Total for all systems $9,724,458.04 $5,942,708.56 N/A $4,595,821.38 N/A
Primary Tower GTOWER $614,283.00 $273,809.00 $133,967.03
Minor tower reinforcement/modifications $158,000.00 $256,559.00 See Attachments 12A & 45. Tower Reinforcement (3-A-2), Address Transition Timing (1-A-1), & Site coordination (Item 1-B-1). Attachment 45 provides the cost for removal and replacement of transmission line, including credit for old line. $118,704.53 N/A
Tower Project Management $2,650.00 $2,650.00 KTXA pro rata share of American Tower Corporation tower project management. Please see Attachment 12A (Item 3-D-1). $662.50 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $0.00 Included in transmission line installation N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $8,267.00 Please see Attachment 12A. KTXA pro rata share of American Tower Corporation tower mapping. $8,267.00 N/A
Tower Structural Analysis $6,333.00 $6,333.00 Please see Attachment 12A. KTXA pro rata share of American Tower Corporation tower structural analysis. $6,333.00 N/A
Auxiliary Tower GTOWER $1,500,500.00 $249,230.00 $186,922.50
Serious tower reinforcement/modifications $1,052,000.00 $177,929.00 KXTA's pro rata share for tower reinforcement. See Attachment 13A. (Note: ATC design changes altered estimated cost.) $133,446.75 N/A
Construction Proj Mgmt $7,500.00 $7,500.00 American tower mgmt. See Attachment 13 $5,625.00 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $8,760.00 See Attachment 13A. (Note: ATC design changes altered estimated cost.) This is the total of $4,960 for mapping and $3,800 for structural engineering. $6,570.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $55,041.00 KXTA's pro rata share for tower rigging. See Attachment 13A. (Note: ATC design changes altered estimated cost.) $41,280.75 N/A

Components

Actual Information Description File Name
Minor tower reinforcement/modifications

Component Description:
Please see quote provided as Attachment 45. Note: Cost includes credit for old line.
Amount:
$109,129.53

Component Description:
Interim Site Capital Contribution Milestone 1 (25%). Includes pro rata costs for tower reinforcement, Address transition timing, and site coordination meeting. See Attachment 12A.
Amount:
$9,575.00
Tower Project Management

Component Description:
Pro rata cost of primary tower construction project management. See Attachment 12A.
Amount:
$662.50
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Primary Tower mapping - pro rata share. See quote Attachment 12A.
Amount:
$8,267.00
Tower Structural Analysis

Component Description:
Cost represents pro rata cost of primary tower structural engineering study. See quote Attachment 12A.
Amount:
$6,333.00
Serious tower reinforcement/modifications

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-A-2.
Amount:
$44,482.25

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-A-2.
Amount:
$88,964.50
Construction Proj Mgmt

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-D-1.
Amount:
$1,875.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-D-1.
Amount:
$3,750.00
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C two items in 3-A-1.
Amount:
$2,190.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C two Items in 3-A-1.
Amount:
$4,380.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 3-C-1.
Amount:
$13,760.25

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 3-C-1.
Amount:
$27,520.50

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 $87,625.00 $65,580.00 N/A $21,995.00 N/A
Total for all systems $9,724,458.04 $5,942,708.56 N/A $4,595,821.38 N/A
Outside Professional Services $87,625.00 $65,580.00 $21,995.00
Project oversight on behalf of KTXA $6,000.00 $6,000.00 Internal project management. N/A N/A
Installation of STL $1,750.00 $1,750.00 Cost is for remote commissioning of the fiber optic decoder required to receive KTXA programming at the interim transmitter site. An existing encoder will be utilized at the studio site. Please see Attachment 19. Hardware is listed separately. N/A N/A
Address Transition Timing $2,500.00 $2,500.00 Address transition timing with other tower tenants. See Attachment 13 Item 1-A-1. $1,875.00 N/A
RF Exposure Measurements $21,050.00 $3,000.00 See Attachment 13 Item 1-A-4. $2,250.00 N/A
NEPA Section 106 environmental review, if needed $6,310.00 $1,080.00 See Attachment 13 Item 1-A-3. $810.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,700.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $10,750.00 See American Tower Quote Attachment 13 $8,250.00 N/A
Project management of the transition $39,500.00 $37,500.00 Company lacks internal resources. This cost item accidentally omitted from original Form 399 filing. Added April, 2018. $7,110.00 N/A

Components

Actual Information Description File Name
Project oversight on behalf of KTXA Information not provided.
Installation of STL Information not provided.
Address Transition Timing

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-A-1.
Amount:
$625.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-A-1.
Amount:
$1,250.00
RF Exposure Measurements

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-A-4.
Amount:
$750.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-A-4.
Amount:
$1,500.00
NEPA Section 106 environmental review, if needed

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-A-3.
Amount:
$270.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-A-3.
Amount:
$540.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare FCC Application for Construction Permit - Engineering Section.
Amount:
$1,700.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-A-2.
Amount:
$2,500.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-A-2.
Amount:
$5,000.00

Component Description:
Engineering Study for New Channel Assignment.
Amount:
$750.00
Project management of the transition

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-A-1.
Amount:
$2,370.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-A-1.
Amount:
$4,740.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $116,380.00 $109,085.00 N/A $74,775.00 N/A
Total for all systems $9,724,458.04 $5,942,708.56 N/A $4,595,821.38 N/A
Other Expenses $116,380.00 $109,085.00 $74,775.00
Tree Clearing $1,600.00 $1,600.00 This cost is for the removal of trees and vegetation to ensure the proper clearance of taglines and laydown areas, required for construction. See Attachment 13 Item 1-B-1. $1,200.00 N/A
Tower rental at interim site $57,600.00 $57,600.00 interim tower rental. American Tower. See Attachment 13 $43,200.00 N/A
Site security at interim site $8,550.00 $8,550.00 security during construction for theft prevention and vandalism. See Attachment 13 $6,412.50 N/A
Site Coordination Meeting $2,500.00 $2,500.00 Site coordination meetings with all broadcasters, contractors and vendors involved with the site deliveries and construction. See Attachment 13 Item 1-B-1. $1,875.00 N/A
Migratory Bird Assessment $350.00 $350.00 See Attachment 13 Item 1-B-1. $262.50 N/A
MVPD Notification of Channel Change $0.00 $0.00 N/A N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 American tower interim site equipment. See attachment 13 $3,750.00 N/A
Non-zoning permits $24,000.00 $24,000.00 American Tower interim site. See Attachment 13 $18,075.00 N/A
Local Zoning $4,700.00 $4,700.00 American Tower costs. See Attachment 13 $0.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $200.00 FCC Filing Fee (Rates have increased.) N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 FCC Filing Fee (Rates have increased.) N/A N/A
DTV Medical Facility Notification $11,550.00 $4,250.00 N/A N/A N/A

Components

Actual Information Description File Name
Tree Clearing

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$400.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$800.00
Tower rental at interim site

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$14,400.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$28,800.00
Site security at interim site

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$2,137.50

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$4,275.00
Site Coordination Meeting

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$625.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$1,250.00
Migratory Bird Assessment

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$87.50

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$175.00
MVPD Notification of Channel Change Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-A-4.
Amount:
$1,250.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-A-4.
Amount:
$2,500.00
Non-zoning permits

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C two $4,700 Items in 3-D-1.
Amount:
$2,350.00

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-B-1.
Amount:
$2,500.00

Component Description:
Invoice is 25% Down Payment for ATC Milestone One with costs divided among multiple categories. See Attachment 34C Item 1-A-3.
Amount:
$1,175.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-A-3.
Amount:
$2,350.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C Item 1-B-1.
Amount:
$5,000.00

Component Description:
Invoice is 50% Down Payment for ATC Milestone Two with costs divided among multiple categories. See Attachment 35C two $4,700 Items in 3-D-1.
Amount:
$4,700.00
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $9,724,458.04 $5,942,708.56 $4,595,821.38

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.

Andrew J Siegel

Assistant Secretary


11/06/2019

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.

Andrew J Siegel

Assistant Secretary


11/06/2019

Attachments

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