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:
11113
Service:
DTV
Call Sign:
WLGA
Channel:
17 (UHF)
File Number:
0000028669
FRN:
0001751940
Date Submitted:
12/19/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CNZ COMMUNICATIONS SE, LLC

Randy E. Nonberg

15200 Sunset Blvd

Suite 202

PACIFIC PALISADES, CA 90272

United States

+1 (310) 573-1600 randynonberg@cnzcommunications.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

Thomas Edmund Long , Jr .

Director of Engineering

CNZ Communications SE LLC

Thomas Long Jr

526 Main Avenue SE

Hickory, NC 28602

United States

+1 (828) 324-5265 tlongjr@whky.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 Current transmission system consists of a single transmitter feeding a rigid transmission line which connects to an antenna on the tower. Work includes tower study/rehabilitation to support new antenna, R&R antenna, line and transmitter.

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 Alternate
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 Quantum
Year 2006
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 55 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 THU9-36 Evo
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 55 kW
Justification for New Transmitter Existing transmitter is no longer supported. This new transmitter is the alternate xmtr of a main-alternate system that is the direct replacement of the existing transmitter.

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) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 125.0 feet
Other Electrical Service Yes
Description Wiring and support for cooling system and control.
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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Add 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? No
Existing Transmitter Manufacturer and Type Manufacturer
Model N/A
Year 2000
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 20 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-16
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 20 kW
Justification for New Transmitter This transmitter provides the RF signal for site #2 of the WLGA DTS. The present licensed facility does not include a DTS site #2 xmtr.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 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

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 Quantum
Year 2006
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 55 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 THU9-36 Evo
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 55 kW
Justification for New Transmitter Existing 110kw main-alternate TX is no longer supported by the manufacturer. This new transmitter is the main transmitter for WLGA. Another transmitter is listed as the replacement alternate transmitter.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 125.0 feet
Other Electrical Service Yes
Description Support of Cooling systems, and control
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

Information not provided.

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 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: 500.0 kW
Manufacturer
Model ATW24G475-HSS-30
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? 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: 500.0 kW
Manufacturer
Model TBD
Year 2017
Justification for New Antenna Existing antenna is not designed to operate on the repack channel

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 7 3/16 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? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Primary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this antenna directional? No
Is antenna in operating condition? No
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 8
Design power capacity in use 50.0 %
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Other Antenna Type N/A
ERP: 32.0 kW
Manufacturer
Model MODEL ABC
Year 2000

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 12
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 25.0 %
Other Antenna Type N/A
ERP: 32.0 kW
Manufacturer
Model ETU6U4-ESP2C-17
Year 2019
Justification for New Antenna This antenna radiates the signal from Site #2 of the WLGA DTS. This is a new site and a new antenna.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
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? No
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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type 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: 350.0 kW
Manufacturer
Model TFU16WB
Year 2017
Justification for New Antenna Need lower side mount antenna to remain on air during replacement of main antenna

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? S
Feed Line Size 3 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

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 7 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1765 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 7 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1765 feet per run
Justification for New Transmission Line According to manufactures freq chart the existing line lengths will not support the repacked channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Primary Transmission Line

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Add 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 this transmission currently shared with any other stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1 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 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 950 feet per run
Justification for New Transmission Line This is new transmission line for the WLGA DTS site #2 which provides the RF signal to the site #2 antenna.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 4 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 200 feet per run
Justification for New Transmission Line Need to move line to install new main antenna. Need 200 feet of line to reach from current combiner to base of tower

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? 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? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 36° 36' 36.0" N-
Longitude (NAD83) 084° 36' 36.0" W-
Overall Structure Height 1.00 feet
Support Structure Height 1.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 100.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Unknown
Date Constructed 06/13/2019


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: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1243417
Coordinates (NAD83) Latitude (NAD83) 32° 19' 16.4" N-
Longitude (NAD83) 084° 47' 28.2" W-
Overall Structure Height 1765.73 feet
Support Structure Height 1642.70 feet
Ground Elevation Above Mean Sea Level (AMSL) 482.93 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Tower, LLC
Date Constructed 10/06/2005

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
39457 WVRK FM
3359 WRBL DTV
595 WTVM 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 N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Crew Rain Delay

Tower Crew was delayed for two days due to heavy rain.

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 300
Explanation Applicant has no internal resources capable of overseeing, identifying, purchasing, installing and commissioning this repack project. It will rely solely on outside services to manage all work required.
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 No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

PMO and FS SURVEY

Project management service for DTS Site #2 and field strength survey for DTS Site #2.

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 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

Antenna and line ship tax

Shipping and tax for ERI Master order WLGA DTS2

Antenna and Line Ship Tax

Shipping and tax for ERI Master order WLGA DTS1

FS Survey

Field strength survey for DTS Site #2.

PMO DTS 2

Project management for WLGA DTS Site #2.

Miscellaneous expenses for DTS Site 2.

Med notifications, disposal, storage, etc, costs for WLGA DTS site 2.

Local Zoning permits

Permits for construction and related matters for WLGA DTS Site 2.

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 $4,498,050.00 $3,832,125.00 N/A $1,981,514.70 N/A
Total for all systems $8,250,389.91 $7,640,959.91 N/A $3,750,777.35 N/A
Primary Transmitter THU9EVO-16 $741,800.00 $656,200.00 $0.00
Service entrance 3 phase/800 amp/208 volt $14,400.00 $14,050.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $37,150.00 N/A N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $600,000.00 N/A $0.00 N/A
Primary Transmitter THU9-36 Evo $1,878,125.00 $1,585,800.00 $990,757.35
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,500,000.00 N/A $990,757.35 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A N/A N/A
4" Rigid Conduit and Wiring (Cost per foot) $12,625.00 $12,000.00 N/A N/A N/A
Other Electrical Service: Support of Cooling systems, and control $2,500.00 $2,500.00 Provide support for cooling system on liquid cooled transmitter N/A N/A
Auxiliary Transmitter THU9-36 Evo $1,878,125.00 $1,590,125.00 $990,757.35
Other Electrical Service: Wiring and support for cooling system and control. $2,500.00 $2,500.00 N/A N/A N/A
4" Rigid Conduit and Wiring (Cost per foot) $12,625.00 $12,625.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $36,800.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $38,200.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,500,000.00 N/A $990,757.35 N/A

Components

Actual Information Description File Name
Service entrance 3 phase/800 amp/208 volt Information not provided.
Switchgear - industrial 800 amp Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW Information not provided.
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
The amount of 50% is requested because it is for the main transmitter of the main & alternate pair of transmitters. This includes 50% of the RF system cost.
Amount:
$330,252.45

Component Description:
The amount of 50% is requested because it is for the main transmitter of the main & alternate pair of transmitters. This includes 50% of the RF system cost.
Amount:
$660,504.90
Switchgear - industrial 800 amp Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other Electrical Service: Support of Cooling systems, and control Information not provided.
Other Electrical Service: Wiring and support for cooling system and control. Information not provided.
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
The amount of 50% is requested because it is for the alternate transmitter of the main & alternate pair of transmitters. This includes 50% of the RF system cost.
Amount:
$660,504.90

Component Description:
The amount of 50% is requested because it is for the alternate transmitter of the main & alternate pair of transmitters. This includes 50% of the RF system cost.
Amount:
$330,252.45

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 $653,270.00 $639,250.00 N/A $208,035.40 N/A
Total for all systems $8,250,389.91 $7,640,959.91 N/A $3,750,777.35 N/A
Interim Antenna TFU16WB $232,240.00 $220,800.00 $33,620.40
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $180,000.00 N/A $33,620.40 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $0.00 N/A
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) $7,600.00 $7,400.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A $0.00 N/A
Primary Antenna TBD $229,040.00 $226,600.00 $174,415.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,250.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 500 kW input, directional,, horizontally polarized $180,000.00 $180,000.00 From the catalog - One station –200-500 kW, horizontally polarized $125,000 - $180,000 $155,740.00 N/A
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed) $13,900.00 $13,200.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $9,800.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A $2,625.00 N/A
Primary Antenna ETU6U4-ESP2C-17 $191,990.00 $191,850.00 $0.00
Sweep test of existing antenna $6,730.00 $6,730.00 N/A N/A N/A
UHF - High Power, Side Mount, broadband panel, 12 bay,, 32 kW input, directional,, elliptically or circularly polarized $180,000.00 $180,000.00 N/A N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,120.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
Temp install for WLGA. Tower crew cost for that operation.
Amount:
$33,620.40

Component Description:
Transmission Line and parts for temp antenna to remove main and replace with new antenna
Amount:
$25,260.70
Sweep test of existing antenna Information not provided.
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna

Component Description:
Sweep Test part of master invoice quote. Item 32 of quote.
Amount:
$3,125.00

Component Description:
2nd 1/2 Sweep Test part of master invoice quote. Item 32 of quote.
Amount:
$3,125.00
UHF - High Power, Side Mount, basic slot antenna, 500 kW input, directional,, horizontally polarized

Component Description:
Main Antenna and Scatter Study part of master invoice quote. Item 1 and 4 of quote.
Amount:
$77,870.00

Component Description:
2nd 1/2 Main Antenna and Scatter Study part of master invoice quote. Item 1 and 4 of quote.
Amount:
$77,870.00
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Side Mount Brackets part of master invoice quote. Item 3 of quote.
Amount:
$4,900.00

Component Description:
2nd 1/2 Side Mount Brackets part of master invoice quote. Item 3 of quote.
Amount:
$4,900.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
Engineering services: analysis and determination of cells recovered with DTS32 KW ERP vs proposed 150 kW ERP; review of scattering analysis and coordination of antenna separation distance from tower.
Amount:
$2,625.00
Sweep test of existing antenna Information not provided.
UHF - High Power, Side Mount, broadband panel, 12 bay,, 32 kW input, directional,, elliptically or circularly polarized Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) 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 $718,550.00 $699,550.00 N/A $470,260.34 N/A
Total for all systems $8,250,389.91 $7,640,959.91 N/A $3,750,777.35 N/A
Interim Transmission Line $14,800.00 $25,260.00 $25,260.70
Flexible Air Transmission Line - dielectric, 4" $14,800.00 $25,260.00 This cost included connectors, reducers, and matching transformers. $25,260.70 This estimated cost included line, connectors, reducers, and matching transformers.
Primary Transmission Line $511,850.00 $487,140.00 $444,999.64
Rigid Transmission Line - copper, 7 3/16" $511,850.00 $487,140.00 N/A $444,999.64 N/A
Primary Transmission Line $191,900.00 $187,150.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $191,900.00 $187,150.00 N/A N/A N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 4"

Component Description:
Cost of Temp line, connectors, Reducers, and matching transformers
Amount:
$25,260.70
Rigid Transmission Line - copper, 7 3/16"

Component Description:
Rain delay tower days due to bad weather tower crew could not work.
Amount:
$5,000.00

Component Description:
Sweep Test part of master invoice quote. Quote items 5-24 and 26 to 31.
Amount:
$222,499.82

Component Description:
2nd 1/2 trans line part of master invoice quote. Quote items 5-24 and 26 to 31.
Amount:
$222,499.82
Rigid Transmission Line - copper, 6 1/8" 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 $917,600.00 $1,017,615.00 N/A $914,381.50 N/A
Total for all systems $8,250,389.91 $7,640,959.91 N/A $3,750,777.35 N/A
Primary Tower GTOWER $399,800.00 $380,000.00 $373,266.50
Tower Crew Rain Delay $5,000.00 $5,000.00 N/A $5,000.00 N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $197,737.50 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $147,684.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A $22,845.00 N/A
Primary Tower TOWER $517,800.00 $637,615.00 $541,115.00
Short Tower (less than 500') $84,200.00 $84,200.00 N/A N/A N/A
Major tower reinforcement/modifications $421,000.00 $541,115.00 See attached quote for DTS Site #2 tower. WLGA agrees to this portion per agreement with tower owner. $541,115.00 Estimated cost of the tower modification is $1,082,230. 50% is the share of WLGA of the total cost.
Structural engineering tower load study for well documented tower $12,600.00 $12,300.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower Crew Rain Delay

Component Description:
Tower Crew Rain Delay
Amount:
$5,000.00
Tall Tower (greater than 500')

Component Description:
Invoice for broadcast structural including proposal/purchase order accepted/approved and signed and dated.
Amount:
$10,475.00

Component Description:
American Tower services: address transition timing and coordination issues; management of the timeliness and schedules. Site coordination meeting.
Amount:
$5,000.00

Component Description:
Install part of master invoice quote. Item 33 partial.
Amount:
$90,000.00

Component Description:
Tower engineering study of modification/changes of the structural drawings.
Amount:
$2,000.00

Component Description:
2nd 1/2 Install part of master invoice quote. Item 33 partial.
Amount:
$90,000.00

Component Description:
Repack engineering services: investigation of tower costs attributable to WLGA for purpose of determining reimbursement for form 399.
Amount:
$262.50
Minor tower reinforcement/modifications

Component Description:
2nd 1/2 Install part of master invoice quote. Item 33 partial
Amount:
$73,842.00

Component Description:
Install part of master invoice quote. Item 33 partial.
Amount:
$73,842.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
2nd 1/2 Tower Map part of master invoice quote. Item 25 of quote.
Amount:
$3,250.00

Component Description:
Tower Map part of master invoice quote. Item 25 of quote.
Amount:
$3,250.00

Component Description:
Invoice for broadcast tower mapping including proposal/purchase order approved/accepted signed and dated.
Amount:
$16,345.00
Short Tower (less than 500') Information not provided.
Major tower reinforcement/modifications

Component Description:
Cost of the tower modification cost as explained in the cover letter submitted.
Amount:
$541,115.00
Structural engineering tower load study for well documented tower Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $710,145.00 $700,250.00 N/A $82,550.50 N/A
Total for all systems $8,250,389.91 $7,640,959.91 N/A $3,750,777.35 N/A
Outside Professional Services $710,145.00 $700,250.00 $82,550.50
PMO and FS SURVEY $530,000.00 $530,000.00 The estimate includes 300 hours of engineering time plus $80000 for time to execute the field strength study. N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $57,696.50 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A $4,123.50 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $0.00 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 $1,120.00 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 $700.00 N/A
Project management of the transition $47,400.00 $45,000.00 N/A $11,980.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,030.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $0.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $4,900.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 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), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A

Components

Actual Information Description File Name
PMO and FS SURVEY Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Engineering services: DTS, DTS-2, preparation of exhibits and information for conference with FCC Eval team regarding 399.
Amount:
$10,850.00

Component Description:
Engineering repack services: coverage map for union of DTS sites; discussed additional structural costs for addition of WLGA DTS Site 2.
Amount:
$437.50

Component Description:
Engineering services: "well served" analysis, options for DTS primary site, FCC meeting in Washington DC.
Amount:
$12,896.50

Component Description:
Engineering services: site parameters and antenna studies; review with ERI for Site 2; Site 2 budget and transmission system study, including 399 concerns.
Amount:
$6,475.00

Component Description:
Engineering repack services: pattern review for antennas, DTS-2 transmission system configuration, coordination with outside consultant for transmitter power requirements.
Amount:
$4,375.00

Component Description:
Repack engineering services: recreation of 399 form for site #2, and review transmitter and antenna combo justification.
Amount:
$1,137.50

Component Description:
Engineering repack services; creation of CP extension and revised antenna specifications.
Amount:
$1,050.00

Component Description:
Engineering repack services for November 2018.
Amount:
$1,662.50

Component Description:
Research of channel options for CP. Dev of Ch 3 transmission system and creation of CP application. Ch 17 engineering analysis to recapture population lost due to repack. DTS engineering analysis and exhibit preparation.
Amount:
$7,875.00

Component Description:
Engineering repack services: investigation of tower cost for 399 reimbursement and update of form 399.
Amount:
$1,225.00

Component Description:
Engineering Services: WLGA re-engineer WLGA DTS site #1 and site #2; adjustment of ERP and antenna patterns ; interference analysis and generation of maps for FCC review.
Amount:
$6,037.50

Component Description:
Engineering Services: Revise coverage and interference analysis for site #1 and site #2; adjustment of ERP and antenna patterns; interference analysis and generation of maps for FCC review.
Amount:
$3,675.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Attorney fees for extension of STA, tolling of CP, draft exhibits for STA extension, finalize and file tolling and extension of STA.
Amount:
$2,980.00

Component Description:
Attorney consultation with WLGA officer and project engineer regarding WLGA repack reimbursement issues.
Amount:
$278.00

Component Description:
Invoice billing drafting request for withdrawal of major change application and discussion regarding application dismissal.
Amount:
$466.50

Component Description:
Billing filing of request to withdraw major change application, application for WLGA DTS .
Amount:
$399.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Invoice billing discussion regarding potential move scenario.
Amount:
$211.50
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

Component Description:
Consultation regarding follow-up with FCC; FCC reimbursement; transition report, MVPD and consumer notification requirements.
Amount:
$1,120.00
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

Component Description:
Channel repack plan and preparation of construction permit exhibits.
Amount:
$700.00
Project management of the transition

Component Description:
Engineering repack services: project management activities and investigate/resolve and update 399 regarding transmitter reimbursement.
Amount:
$1,000.00

Component Description:
Project management of the transition, pre-construction services.
Amount:
$9,480.00

Component Description:
WLGA repack project management services. Research and coordination with engineering attorney, vendors and site owner.
Amount:
$1,500.00

Component Description:
Project management of WLGA project in field and in office.
Amount:
$43,125.00
Prepare and or review reimbursement form

Component Description:
Invoice billing WLGA repack to finalize and file 399 and CP.
Amount:
$500.00

Component Description:
Attorney fees to review FCC response to request for reimbursement and prepare cover letter for reimbursement request.
Amount:
$903.50

Component Description:
Prepare and review form 399
Amount:
$1,350.00

Component Description:
Invoice billing reveiw of WLGA DTS and repack application status.
Amount:
$627.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Address transition and coordination issues with other stations.
Amount:
$2,500.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering Services: WLGA service loss recovery analysis; analysis to identify alternate antenna patterns and ERP to cover entire authorized coverage area.
Amount:
$3,062.50

Component Description:
WLGA repack: prepare CP and assist with 399 preparation and review for repacked channel.
Amount:
$525.00

Component Description:
Service through 10/30/17 repack engineering services; quarterly progress report; final engineering and creation of application for DTS.
Amount:
$1,312.50

Component Description:
WLGA channel repack plan and preparation of construction permit exhibits; evaluate move to Atlanta.
Amount:
$700.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit 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), License to Cover Application Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $752,774.91 $752,169.91 N/A $94,034.91 N/A
Total for all systems $8,250,389.91 $7,640,959.91 N/A $3,750,777.35 N/A
Other Expenses $752,774.91 $752,169.91 $94,034.91
Antenna and line ship tax $75,000.00 $75,000.00 N/A N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 N/A $0.00 N/A
Equipment Storage $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,950.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A $0.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Local Zoning $2,000.00 $2,000.00 N/A N/A N/A
Non-zoning permits $2,000.00 $2,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A N/A N/A
Local Zoning permits $5,000.00 $5,000.00 N/A N/A N/A
Miscellaneous expenses for DTS Site 2. $15,000.00 $15,000.00 N/A $0.00 N/A
PMO DTS 2 $450,000.00 $450,000.00 N/A N/A N/A
FS Survey $80,000.00 $80,000.00 N/A N/A N/A
Antenna and Line Ship Tax $91,084.91 $91,084.91 N/A $91,084.91 N/A

Components

Actual Information Description File Name
Antenna and line ship tax Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
DTV Medical Facility Notification

Component Description:
WLGA medical notifications completed for the FCC repack.
Amount:
$2,950.00
FCC Filing Fees - Form 2100 minor change CP application

Component Description:
FCC Fees: Modification of a construction permit to convert from DTV to DTS application.
Amount:
$1,070.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Local Zoning Information not provided.
Non-zoning permits Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Local Zoning permits Information not provided.
Miscellaneous expenses for DTS Site 2. Information not provided.
PMO DTS 2 Information not provided.
FS Survey Information not provided.
Antenna and Line Ship Tax

Component Description:
Sales Tax and Shipping for ERI master order for Antenna and TX Line
Amount:
$91,084.91

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $8,250,389.91 $7,640,959.91 $3,750,777.35

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.

David Nonberg

Vice President


12/19/2019

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.

David Nonberg

Vice President


12/19/2019

Attachments

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